Original Practice Questions — NRNP 6540
(Advanced Practice Care of Older Adults)
1. An 82-year-old woman is disoriented and acutely confused for 48 hours after hip surgery.
Her vitals are stable. Which is the best first step?
A. Start low-dose haloperidol immediately
B. Evaluate for reversible causes (meds, infection, electrolytes) ← Correct
C. Diagnose Alzheimer disease
D. Start SSRI for depression
Rationale: Delirium is often multifactorial; first identify and treat underlying causes
(infections, meds, metabolic, hypoxia). Antipsychotics may be used for severe agitation
after addressing causes.
2. Which change in pharmacokinetics is most typical of older adults and increases
sensitivity to benzodiazepines?
A. Increased hepatic metabolic clearance
B. Increased total body water
C. Decreased hepatic first-pass metabolism and decreased hepatic blood flow ←
Correct
D. Increased renal clearance
Rationale: Aging ↓ hepatic blood flow and metabolism for many drugs; total body water
decreases (not increases), and renal clearance often decreases — increasing drug
sensitivity.
3. A frail 85-year-old with creatinine 1.2 mg/dL has a serum creatinine that may
underestimate renal impairment because:
A. Muscle mass is often reduced in older adults ← Correct
B. Creatinine is more actively secreted in elderly
C. Older adults have increased GFR
D. They drink more fluids
Rationale: Low muscle mass lowers serum creatinine; estimated GFR (using
appropriate formula) must consider muscle mass to avoid overestimating kidney
, function.
4. An 80-year-old with chronic atrial fibrillation is started on warfarin. Which drug interaction
requires close monitoring?
A. Acetaminophen
B. Trimethoprim-sulfamethoxazole ← Correct
C. Calcium carbonate
D. Docusate
Rationale: TMP-SMX can potentiate warfarin (increases INR) via CYP interactions and
displacement; acetaminophen in high doses can also affect INR but TMP-SMX is higher
risk.
5. Which statement about blood pressure targets in older adults is supported by evidence
for primary prevention in many patients?
A. Treat to SBP <120 mmHg for all adults >75
B. No treatment is beneficial in over 80s
C. Individualize target; commonly aim for SBP <130–140 mmHg in healthy older adults
← Correct
D. SBP goal should always be >150 mmHg
Rationale: Goals should be individualized based on frailty/comorbidities; many
guideline statements recommend SBP targets ~130–140 for fit older adults, but more
conservative targets for frail patients.
6. A resident asks you why delirium and dementia are often confused. Which explanation is
best?
A. Dementia always causes fluctuating consciousness
B. Delirium is acute and fluctuating, dementia is chronic and progressive ← Correct
C. They are the same condition
D. Dementia resolves with treating infection
Rationale: Key difference: delirium onset is acute with fluctuating attention and
consciousness; dementia is chronic progressive cognitive decline.
7. Which vaccine is specifically recommended for adults aged ≥65 to reduce invasive
pneumococcal disease?
A. Live attenuated influenza vaccine
B. PCV13 (or PCV15/PCV20 depending on guidelines) ± PPSV23 per current
recommendations ← Correct
C. HPV vaccine
D. MMR vaccine
Rationale: Pneumococcal conjugate vaccines and PPSV23 are recommended in older
adults per current immunization schedules (regimens depend on local/national
guidance).
(Advanced Practice Care of Older Adults)
1. An 82-year-old woman is disoriented and acutely confused for 48 hours after hip surgery.
Her vitals are stable. Which is the best first step?
A. Start low-dose haloperidol immediately
B. Evaluate for reversible causes (meds, infection, electrolytes) ← Correct
C. Diagnose Alzheimer disease
D. Start SSRI for depression
Rationale: Delirium is often multifactorial; first identify and treat underlying causes
(infections, meds, metabolic, hypoxia). Antipsychotics may be used for severe agitation
after addressing causes.
2. Which change in pharmacokinetics is most typical of older adults and increases
sensitivity to benzodiazepines?
A. Increased hepatic metabolic clearance
B. Increased total body water
C. Decreased hepatic first-pass metabolism and decreased hepatic blood flow ←
Correct
D. Increased renal clearance
Rationale: Aging ↓ hepatic blood flow and metabolism for many drugs; total body water
decreases (not increases), and renal clearance often decreases — increasing drug
sensitivity.
3. A frail 85-year-old with creatinine 1.2 mg/dL has a serum creatinine that may
underestimate renal impairment because:
A. Muscle mass is often reduced in older adults ← Correct
B. Creatinine is more actively secreted in elderly
C. Older adults have increased GFR
D. They drink more fluids
Rationale: Low muscle mass lowers serum creatinine; estimated GFR (using
appropriate formula) must consider muscle mass to avoid overestimating kidney
, function.
4. An 80-year-old with chronic atrial fibrillation is started on warfarin. Which drug interaction
requires close monitoring?
A. Acetaminophen
B. Trimethoprim-sulfamethoxazole ← Correct
C. Calcium carbonate
D. Docusate
Rationale: TMP-SMX can potentiate warfarin (increases INR) via CYP interactions and
displacement; acetaminophen in high doses can also affect INR but TMP-SMX is higher
risk.
5. Which statement about blood pressure targets in older adults is supported by evidence
for primary prevention in many patients?
A. Treat to SBP <120 mmHg for all adults >75
B. No treatment is beneficial in over 80s
C. Individualize target; commonly aim for SBP <130–140 mmHg in healthy older adults
← Correct
D. SBP goal should always be >150 mmHg
Rationale: Goals should be individualized based on frailty/comorbidities; many
guideline statements recommend SBP targets ~130–140 for fit older adults, but more
conservative targets for frail patients.
6. A resident asks you why delirium and dementia are often confused. Which explanation is
best?
A. Dementia always causes fluctuating consciousness
B. Delirium is acute and fluctuating, dementia is chronic and progressive ← Correct
C. They are the same condition
D. Dementia resolves with treating infection
Rationale: Key difference: delirium onset is acute with fluctuating attention and
consciousness; dementia is chronic progressive cognitive decline.
7. Which vaccine is specifically recommended for adults aged ≥65 to reduce invasive
pneumococcal disease?
A. Live attenuated influenza vaccine
B. PCV13 (or PCV15/PCV20 depending on guidelines) ± PPSV23 per current
recommendations ← Correct
C. HPV vaccine
D. MMR vaccine
Rationale: Pneumococcal conjugate vaccines and PPSV23 are recommended in older
adults per current immunization schedules (regimens depend on local/national
guidance).
