NR-580 Adult-
Gerontology Primary
Care Capstone &
Intensive:
Comprehensive
Practice Examination
### Question 1
,An 82-year-old male with a history of heart failure presents with increased shortness of breath and a
new S3 gallop. Which of the following is the most likely pathophysiological explanation for the S3 heart
sound in this patient?
A. Stiffening of the ventricular wall during atrial contraction
B. Rapid ventricular filling into a dilated, non-compliant chamber
C. Turbulent blood flow across a calcified aortic valve
D. Delayed closure of the pulmonic valve during inspiration
💫RATIONALE✔️✔️: The S3 gallop occurs during the early diastolic phase of ventricular filling. It is
often a sign of volume overload and is characteristic of systolic heart failure where blood enters a
compliant but overly full ventricle. This sound is common in older adults with dilated cardiomyopathy
and indicates the need for aggressive fluid management .
💫ANSWER✔️✔️: B. Rapid ventricular filling into a dilated, non-compliant chamber
---
### Question 2
A 72-year-old female with Type 2 Diabetes and moderate frailty has a current HbA1c of 8.2%. According
to the American Diabetes Association (ADA) guidelines for older adults, what is the most appropriate
action?
A. Maintain current therapy as her target HbA1c should be < 8.5%
B. Intensify therapy with a GLP-1 receptor agonist to reach a target of < 7.0%
C. Switch to intensive insulin therapy to prevent microvascular complications
D. De-prescribe all oral hypoglycemics as she is at high risk for hypoglycemia
,💫RATIONALE✔️✔️: The ADA recommends less stringent glycemic targets for older adults with
complex health needs or frailty. For this patient, a target HbA1c of less than 8.0-8.5% is acceptable to
avoid the risks of hypoglycemia. Over-treating diabetes in the elderly can lead to falls, fractures, and
cognitive impairment .
💫ANSWER✔️✔️: A. Maintain current therapy as her target HbA1c should be < 8.5%
---
### Question 3
Which of the following characteristics is most suggestive of delirium rather than dementia?
A. Gradual onset of memory loss
B. Acute onset and fluctuating course
C. Irreversible cognitive decline
D. Stable level of consciousness
💫RATIONALE✔️✔️: Delirium is characterized by a rapid, acute onset and a course that fluctuates
throughout the day. Dementia is typically a slow, progressive, and irreversible decline in cognitive
function over years. Distinguishing between these two is vital because delirium often indicates an
underlying medical emergency like infection or drug toxicity .
💫ANSWER✔️✔️: B. Acute onset and fluctuating course
---
, ### Question 4
What is the standard definition of polypharmacy in the geriatric population?
A. The use of 2 or more medications
B. The use of 5 or more medications
C. The use of 10 or more medications
D. The concurrent use of medications without appropriate indications
💫RATIONALE✔️✔️: Polypharmacy is most commonly defined as the concurrent use of 5 or more
medications. This is a significant concern in the geriatric population as it increases the risk of adverse
drug events, drug interactions, and medication non-adherence .
💫ANSWER✔️✔️: B. The use of 5 or more medications
---
### Question 5
Which of the following medications is the preferred choice for preventing herpes zoster (shingles) in
older adults?
A. Zostavax
B. Shingrix
C. Valtrex (valacyclovir)
D. Acyclovir
Gerontology Primary
Care Capstone &
Intensive:
Comprehensive
Practice Examination
### Question 1
,An 82-year-old male with a history of heart failure presents with increased shortness of breath and a
new S3 gallop. Which of the following is the most likely pathophysiological explanation for the S3 heart
sound in this patient?
A. Stiffening of the ventricular wall during atrial contraction
B. Rapid ventricular filling into a dilated, non-compliant chamber
C. Turbulent blood flow across a calcified aortic valve
D. Delayed closure of the pulmonic valve during inspiration
💫RATIONALE✔️✔️: The S3 gallop occurs during the early diastolic phase of ventricular filling. It is
often a sign of volume overload and is characteristic of systolic heart failure where blood enters a
compliant but overly full ventricle. This sound is common in older adults with dilated cardiomyopathy
and indicates the need for aggressive fluid management .
💫ANSWER✔️✔️: B. Rapid ventricular filling into a dilated, non-compliant chamber
---
### Question 2
A 72-year-old female with Type 2 Diabetes and moderate frailty has a current HbA1c of 8.2%. According
to the American Diabetes Association (ADA) guidelines for older adults, what is the most appropriate
action?
A. Maintain current therapy as her target HbA1c should be < 8.5%
B. Intensify therapy with a GLP-1 receptor agonist to reach a target of < 7.0%
C. Switch to intensive insulin therapy to prevent microvascular complications
D. De-prescribe all oral hypoglycemics as she is at high risk for hypoglycemia
,💫RATIONALE✔️✔️: The ADA recommends less stringent glycemic targets for older adults with
complex health needs or frailty. For this patient, a target HbA1c of less than 8.0-8.5% is acceptable to
avoid the risks of hypoglycemia. Over-treating diabetes in the elderly can lead to falls, fractures, and
cognitive impairment .
💫ANSWER✔️✔️: A. Maintain current therapy as her target HbA1c should be < 8.5%
---
### Question 3
Which of the following characteristics is most suggestive of delirium rather than dementia?
A. Gradual onset of memory loss
B. Acute onset and fluctuating course
C. Irreversible cognitive decline
D. Stable level of consciousness
💫RATIONALE✔️✔️: Delirium is characterized by a rapid, acute onset and a course that fluctuates
throughout the day. Dementia is typically a slow, progressive, and irreversible decline in cognitive
function over years. Distinguishing between these two is vital because delirium often indicates an
underlying medical emergency like infection or drug toxicity .
💫ANSWER✔️✔️: B. Acute onset and fluctuating course
---
, ### Question 4
What is the standard definition of polypharmacy in the geriatric population?
A. The use of 2 or more medications
B. The use of 5 or more medications
C. The use of 10 or more medications
D. The concurrent use of medications without appropriate indications
💫RATIONALE✔️✔️: Polypharmacy is most commonly defined as the concurrent use of 5 or more
medications. This is a significant concern in the geriatric population as it increases the risk of adverse
drug events, drug interactions, and medication non-adherence .
💫ANSWER✔️✔️: B. The use of 5 or more medications
---
### Question 5
Which of the following medications is the preferred choice for preventing herpes zoster (shingles) in
older adults?
A. Zostavax
B. Shingrix
C. Valtrex (valacyclovir)
D. Acyclovir
