⭐NRNP 6540 – Advanced Practice Care
of Older Adults (GERONTOLOGY)
B(Gerontology | Primary Care | Chronic Disease | Geriatric Syndromes | Diagnostics |
Pharmacology)
1. An older adult presents with new-onset confusion,
agitation, and hallucinations beginning within hours.
What is the most likely diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Mild cognitive impairment
Correct Answer: B. Delirium
Rationale: Delirium is acute, fluctuating, and includes hallucinations and inattention. Dementia
is chronic and progressive.
2. Which medication is most strongly associated with
causing delirium in the elderly?
A. Lisinopril
B. Diphenhydramine
C. Amlodipine
D. Metformin
Correct Answer: B. Diphenhydramine
Rationale: Anticholinergics worsen cognition and increase delirium risk in older adults.
,3. A 78-year-old with heart failure presents with weight
gain and bilateral leg edema. Which medication
adjustment is most appropriate?
A. Discontinue ACE inhibitor
B. Increase loop diuretic
C. Add beta-blocker
D. Add digoxin
Correct Answer: B. Increase loop diuretic
Rationale: Edema and fluid overload indicate need for furosemide titration.
4. A 70-year-old female reports difficulty rising from a
chair, slow gait, and unintentional weight loss. What is
the most likely condition?
A. Dementia
B. Frailty syndrome
C. Osteoarthritis
D. Sarcopenia
Correct Answer: B. Frailty syndrome
Rationale: Frailty includes weakness, slow gait, low activity, fatigue, and weight loss.
5. Which vaccine is recommended for all adults ≥65
regardless of prior immunization?
A. Shingles vaccine (zoster)
B. Polio booster
C. HPV vaccine
D. MMR booster
Correct Answer: A. Shingles vaccine
Rationale: Adults ≥50–65 should receive recombinant zoster vaccine (RZV).
, 6. What is the preferred first-line treatment for new-onset
hypertension in older adults?
A. Beta-blocker
B. ACE inhibitor or thiazide diuretic
C. Calcium supplement
D. Clonidine
Correct Answer: B. ACE inhibitor or thiazide
Rationale: Evidence-based first-line agents per hypertension guidelines.
7. A 77-year-old with COPD has worsening dyspnea and
wheezing. What is the next step?
A. Start inhaled corticosteroid alone
B. Begin short-acting bronchodilator
C. Order CT angiography
D. Give IV fluids
Correct Answer: B. Begin SABA
Rationale: Acute exacerbation requires SABAs for bronchodilation.
8. Which sign suggests Alzheimer-type dementia over
vascular dementia?
A. Stepwise decline
B. Early gait impairment
C. Gradual progressive memory loss
D. Sudden worsening after stroke
Correct Answer: C. Gradual progressive memory loss
Rationale: Alzheimer’s is slow and progressive; vascular dementia is stepwise.
9. An elderly patient reports nocturia ×4 nightly. Which
benign cause is most likely?
of Older Adults (GERONTOLOGY)
B(Gerontology | Primary Care | Chronic Disease | Geriatric Syndromes | Diagnostics |
Pharmacology)
1. An older adult presents with new-onset confusion,
agitation, and hallucinations beginning within hours.
What is the most likely diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Mild cognitive impairment
Correct Answer: B. Delirium
Rationale: Delirium is acute, fluctuating, and includes hallucinations and inattention. Dementia
is chronic and progressive.
2. Which medication is most strongly associated with
causing delirium in the elderly?
A. Lisinopril
B. Diphenhydramine
C. Amlodipine
D. Metformin
Correct Answer: B. Diphenhydramine
Rationale: Anticholinergics worsen cognition and increase delirium risk in older adults.
,3. A 78-year-old with heart failure presents with weight
gain and bilateral leg edema. Which medication
adjustment is most appropriate?
A. Discontinue ACE inhibitor
B. Increase loop diuretic
C. Add beta-blocker
D. Add digoxin
Correct Answer: B. Increase loop diuretic
Rationale: Edema and fluid overload indicate need for furosemide titration.
4. A 70-year-old female reports difficulty rising from a
chair, slow gait, and unintentional weight loss. What is
the most likely condition?
A. Dementia
B. Frailty syndrome
C. Osteoarthritis
D. Sarcopenia
Correct Answer: B. Frailty syndrome
Rationale: Frailty includes weakness, slow gait, low activity, fatigue, and weight loss.
5. Which vaccine is recommended for all adults ≥65
regardless of prior immunization?
A. Shingles vaccine (zoster)
B. Polio booster
C. HPV vaccine
D. MMR booster
Correct Answer: A. Shingles vaccine
Rationale: Adults ≥50–65 should receive recombinant zoster vaccine (RZV).
, 6. What is the preferred first-line treatment for new-onset
hypertension in older adults?
A. Beta-blocker
B. ACE inhibitor or thiazide diuretic
C. Calcium supplement
D. Clonidine
Correct Answer: B. ACE inhibitor or thiazide
Rationale: Evidence-based first-line agents per hypertension guidelines.
7. A 77-year-old with COPD has worsening dyspnea and
wheezing. What is the next step?
A. Start inhaled corticosteroid alone
B. Begin short-acting bronchodilator
C. Order CT angiography
D. Give IV fluids
Correct Answer: B. Begin SABA
Rationale: Acute exacerbation requires SABAs for bronchodilation.
8. Which sign suggests Alzheimer-type dementia over
vascular dementia?
A. Stepwise decline
B. Early gait impairment
C. Gradual progressive memory loss
D. Sudden worsening after stroke
Correct Answer: C. Gradual progressive memory loss
Rationale: Alzheimer’s is slow and progressive; vascular dementia is stepwise.
9. An elderly patient reports nocturia ×4 nightly. Which
benign cause is most likely?
