NU 627
Geriatric Healthcare
Proctored Midterm Exam
2026
(With Solutions)
1. An 82-year-old with a history of COPD and CHF presents with acute confusion
and lethargy. His oxygen saturation is 90% on room air, HR 110, BP 90/60
mmHg. Which is the priority initial intervention? A) Administer IV antibiotics B)
Start supplemental oxygen and monitor ABG C) Administer IV fluids cautiously D)
Start diuretics to reduce pulmonary edema Answer: C) Administer IV fluids
cautiously Rationale: Hypotension and lethargy suggest possible dehydration or
sepsis. Fluids are first to improve perfusion, but cautiously due to CHF risk. Oxygen
helps, but perfusion must be corrected to prevent hypoxia-related delirium.
2. Which of the following medications is most likely to increase the risk of falls in
geriatric patients? A) Metformin B) Benzodiazepines C) Acetaminophen D) Statins
Answer: B) Benzodiazepines Rationale: They cause sedation, impaired balance,
and cognitive slowing, increasing fall risk, particularly dangerous in elderly.
3. In managing chronic pain in a 75-year-old with osteoarthritis, which non-
pharmacological intervention has the strongest evidence for improving
function? A) Heat therapy B) Tai Chi exercises C) TENS therapy D) Acupuncture
Answer: B) Tai Chi exercises Rationale: Tai Chi improves balance, strength, and
function, also reducing pain. Other modalities have less consistent evidence.
4. A 79-year-old female has stage 3 CKD with eGFR 45. Which class of
antihypertensive drugs is preferred for nephroprotection? A) Beta blockers B)
ACE inhibitors C) Calcium channel blockers D) Diuretics Answer: B) ACE inhibitors
Rationale: ACE inhibitors reduce proteinuria and slow CKD progression but require
monitoring of potassium and renal function.
5. Which cognitive test is most sensitive for early detection of Alzheimer's
dementia? A) MMSE B) MOCA C) Clock Drawing Test D) Geriatric Depression
Scale Answer: B) MOCA Rationale: MOCA is more sensitive than MMSE in
detecting mild cognitive impairment and early dementia.
True/False
6. Polypharmacy is defined as taking five or more medications simultaneously.
Answer: True Rationale: This is a common clinical definition linked to increased
, adverse events in elderly.
7. Incontinence in older adults is always caused by a reversible condition.
Answer: False Rationale: While often caused by urinary tract infection or
medication, many cases are due to irreversible age-related changes.
8. Elderly patients may present atypically with infections, such as absence of
fever. Answer: True Rationale: Immune senescence leads to blunted febrile
response, complicating diagnosis.
9. Advanced directives are legally binding in all US states. Answer: False
Rationale: Laws vary state-by-state, making it essential to know local legislation.
10. Dementia patients benefit from routine physical exercise tailored to their
ability. Answer: True Rationale: Exercise improves function, mood, and slows
cognitive decline.
Short Answer
11. Explain why geriatric patients are more prone to adverse drug reactions.
Answer: Due to altered pharmacokinetics including decreased renal/hepatic
clearance, changes in body fat and water, and polypharmacy increasing interactions.
Rationale: Real-world practice shows adjusting dose and careful reconciliation
reduces morbidity.
12. List three common atypical presentations of infection in elderly patients.
Answer: Confusion/delirium, falls, functional decline without fever. Rationale:
Recognizing atypical symptoms prevents delays in treatment.
13. What is the preferred approach to assess pain in nonverbal elderly patients
with dementia? Answer: Use behavioral pain scales like PAINAD. Rationale: They
rely on observation of facial expressions, vocalizations rather than self-report.
14. Name two geriatric syndromes that frequently coexist and complicate clinical
management. Answer: Frailty and delirium. Rationale: Both increase vulnerability
and challenge recovery; often intertwined.
15. Why is vitamin D supplementation often recommended in elderly? Answer: To
improve bone health and reduce risk of fractures/falls due to common deficiency.
Rationale: Common in elderly due to reduced sunlight exposure, absorption.
Matching (Match the term to definition or example)
16-20
Term Definition/Example
A) Progressive loss of muscle
16) Sarcopenia
mass/function
17) Presbycusis B) Age-related hearing loss
18) Orthostatic C) Drop in BP upon standing
hypotension leading to dizziness
D) Acute fluctuating cognitive
19) Delirium
impairment
E) Use of multiple drugs
20) Polypharmacy
increasing risk of ADRs
Answers: 16-A, 17-B, 18-C, 19-D, 20-E Rationale: These are fundamental geriatric
concepts students must master.
, Fill in the Blank
21. The common tool used to assess fall risk in elderly is the ___________ test.
Answer: Timed Up and Go (TUG) Rationale: Quick, validated tool used in clinic to
stratify risk.
22. __________ is the preferred medication class for treating behavioral
symptoms in dementia due to the risk of stroke with antipsychotics. Answer:
Non-pharmacological interventions Rationale: Pharmacologic treatments have
serious side effects; behavioral therapy first line.
23. Elderly patients often require ________ doses of benzodiazepines to reduce
adverse effects. Answer: lower Rationale: Due to slower metabolism and
increased sensitivity.
24. Pain in the elderly may be underreported due to fear of ___________. Answer:
addiction or side effects Rationale: Patient beliefs impact reporting and treatment
adherence.
25. The Beers Criteria is used to identify potentially inappropriate ______________
in elderly patients. Answer: medications Rationale: Helps reduce polypharmacy
risks.
Multiple Choice
26. Which of the following is NOT a common cause of delirium in elderly
hospitalized patients? A) Medication side effects B) Urinary obstruction C)
Hypertension D) Electrolyte imbalances Answer: C) Hypertension Rationale:
Hypertension rarely causes delirium acutely, unlike other causes.
27. A 77-year-old with Parkinson’s disease is experiencing frequent freezing
episodes. Which medication adjustment would likely improve mobility? A)
Increase levodopa dose B) Start beta blockers C) Add benzodiazepines D) Stop
anticholinergics Answer: A) Increase levodopa dose Rationale: Levodopa improves
dopaminergic function and reduces freezing.
28. Which vaccine is especially recommended annually in elderly patients to
prevent complications? A) HPV vaccine B) Influenza vaccine C) Varicella vaccine
D) MMR vaccine Answer: B) Influenza vaccine Rationale: Elderly have higher
morbidity/mortality from flu.
29. Which cardiovascular condition is most likely to present with atypical
symptoms in elderly? A) Myocardial infarction B) Hypertension C) Atrial fibrillation
D) Peripheral artery disease Answer: A) Myocardial infarction Rationale: They may
present without chest pain, instead fatigue or confusion.
30. Which screening test is recommended annually in elderly to prevent aspiration
pneumonia? A) Swallowing evaluation B) Colonoscopy C) Bone density scan D)
Hearing test Answer: A) Swallowing evaluation Rationale: Dysphagia is common
and can cause silent aspiration.
True/False
31. A comprehensive geriatric assessment (CGA) improves functional outcomes
and reduces hospital readmissions. Answer: True Rationale: CGA addresses
multidimensional needs.
32. Elderly patients often require more aggressive resuscitation than younger
adults. Answer: False Rationale: Often require cautious approach due to fragility
and comorbidities.
33. Depression can mimic dementia in elderly patients. Answer: True Rationale:
Geriatric Healthcare
Proctored Midterm Exam
2026
(With Solutions)
1. An 82-year-old with a history of COPD and CHF presents with acute confusion
and lethargy. His oxygen saturation is 90% on room air, HR 110, BP 90/60
mmHg. Which is the priority initial intervention? A) Administer IV antibiotics B)
Start supplemental oxygen and monitor ABG C) Administer IV fluids cautiously D)
Start diuretics to reduce pulmonary edema Answer: C) Administer IV fluids
cautiously Rationale: Hypotension and lethargy suggest possible dehydration or
sepsis. Fluids are first to improve perfusion, but cautiously due to CHF risk. Oxygen
helps, but perfusion must be corrected to prevent hypoxia-related delirium.
2. Which of the following medications is most likely to increase the risk of falls in
geriatric patients? A) Metformin B) Benzodiazepines C) Acetaminophen D) Statins
Answer: B) Benzodiazepines Rationale: They cause sedation, impaired balance,
and cognitive slowing, increasing fall risk, particularly dangerous in elderly.
3. In managing chronic pain in a 75-year-old with osteoarthritis, which non-
pharmacological intervention has the strongest evidence for improving
function? A) Heat therapy B) Tai Chi exercises C) TENS therapy D) Acupuncture
Answer: B) Tai Chi exercises Rationale: Tai Chi improves balance, strength, and
function, also reducing pain. Other modalities have less consistent evidence.
4. A 79-year-old female has stage 3 CKD with eGFR 45. Which class of
antihypertensive drugs is preferred for nephroprotection? A) Beta blockers B)
ACE inhibitors C) Calcium channel blockers D) Diuretics Answer: B) ACE inhibitors
Rationale: ACE inhibitors reduce proteinuria and slow CKD progression but require
monitoring of potassium and renal function.
5. Which cognitive test is most sensitive for early detection of Alzheimer's
dementia? A) MMSE B) MOCA C) Clock Drawing Test D) Geriatric Depression
Scale Answer: B) MOCA Rationale: MOCA is more sensitive than MMSE in
detecting mild cognitive impairment and early dementia.
True/False
6. Polypharmacy is defined as taking five or more medications simultaneously.
Answer: True Rationale: This is a common clinical definition linked to increased
, adverse events in elderly.
7. Incontinence in older adults is always caused by a reversible condition.
Answer: False Rationale: While often caused by urinary tract infection or
medication, many cases are due to irreversible age-related changes.
8. Elderly patients may present atypically with infections, such as absence of
fever. Answer: True Rationale: Immune senescence leads to blunted febrile
response, complicating diagnosis.
9. Advanced directives are legally binding in all US states. Answer: False
Rationale: Laws vary state-by-state, making it essential to know local legislation.
10. Dementia patients benefit from routine physical exercise tailored to their
ability. Answer: True Rationale: Exercise improves function, mood, and slows
cognitive decline.
Short Answer
11. Explain why geriatric patients are more prone to adverse drug reactions.
Answer: Due to altered pharmacokinetics including decreased renal/hepatic
clearance, changes in body fat and water, and polypharmacy increasing interactions.
Rationale: Real-world practice shows adjusting dose and careful reconciliation
reduces morbidity.
12. List three common atypical presentations of infection in elderly patients.
Answer: Confusion/delirium, falls, functional decline without fever. Rationale:
Recognizing atypical symptoms prevents delays in treatment.
13. What is the preferred approach to assess pain in nonverbal elderly patients
with dementia? Answer: Use behavioral pain scales like PAINAD. Rationale: They
rely on observation of facial expressions, vocalizations rather than self-report.
14. Name two geriatric syndromes that frequently coexist and complicate clinical
management. Answer: Frailty and delirium. Rationale: Both increase vulnerability
and challenge recovery; often intertwined.
15. Why is vitamin D supplementation often recommended in elderly? Answer: To
improve bone health and reduce risk of fractures/falls due to common deficiency.
Rationale: Common in elderly due to reduced sunlight exposure, absorption.
Matching (Match the term to definition or example)
16-20
Term Definition/Example
A) Progressive loss of muscle
16) Sarcopenia
mass/function
17) Presbycusis B) Age-related hearing loss
18) Orthostatic C) Drop in BP upon standing
hypotension leading to dizziness
D) Acute fluctuating cognitive
19) Delirium
impairment
E) Use of multiple drugs
20) Polypharmacy
increasing risk of ADRs
Answers: 16-A, 17-B, 18-C, 19-D, 20-E Rationale: These are fundamental geriatric
concepts students must master.
, Fill in the Blank
21. The common tool used to assess fall risk in elderly is the ___________ test.
Answer: Timed Up and Go (TUG) Rationale: Quick, validated tool used in clinic to
stratify risk.
22. __________ is the preferred medication class for treating behavioral
symptoms in dementia due to the risk of stroke with antipsychotics. Answer:
Non-pharmacological interventions Rationale: Pharmacologic treatments have
serious side effects; behavioral therapy first line.
23. Elderly patients often require ________ doses of benzodiazepines to reduce
adverse effects. Answer: lower Rationale: Due to slower metabolism and
increased sensitivity.
24. Pain in the elderly may be underreported due to fear of ___________. Answer:
addiction or side effects Rationale: Patient beliefs impact reporting and treatment
adherence.
25. The Beers Criteria is used to identify potentially inappropriate ______________
in elderly patients. Answer: medications Rationale: Helps reduce polypharmacy
risks.
Multiple Choice
26. Which of the following is NOT a common cause of delirium in elderly
hospitalized patients? A) Medication side effects B) Urinary obstruction C)
Hypertension D) Electrolyte imbalances Answer: C) Hypertension Rationale:
Hypertension rarely causes delirium acutely, unlike other causes.
27. A 77-year-old with Parkinson’s disease is experiencing frequent freezing
episodes. Which medication adjustment would likely improve mobility? A)
Increase levodopa dose B) Start beta blockers C) Add benzodiazepines D) Stop
anticholinergics Answer: A) Increase levodopa dose Rationale: Levodopa improves
dopaminergic function and reduces freezing.
28. Which vaccine is especially recommended annually in elderly patients to
prevent complications? A) HPV vaccine B) Influenza vaccine C) Varicella vaccine
D) MMR vaccine Answer: B) Influenza vaccine Rationale: Elderly have higher
morbidity/mortality from flu.
29. Which cardiovascular condition is most likely to present with atypical
symptoms in elderly? A) Myocardial infarction B) Hypertension C) Atrial fibrillation
D) Peripheral artery disease Answer: A) Myocardial infarction Rationale: They may
present without chest pain, instead fatigue or confusion.
30. Which screening test is recommended annually in elderly to prevent aspiration
pneumonia? A) Swallowing evaluation B) Colonoscopy C) Bone density scan D)
Hearing test Answer: A) Swallowing evaluation Rationale: Dysphagia is common
and can cause silent aspiration.
True/False
31. A comprehensive geriatric assessment (CGA) improves functional outcomes
and reduces hospital readmissions. Answer: True Rationale: CGA addresses
multidimensional needs.
32. Elderly patients often require more aggressive resuscitation than younger
adults. Answer: False Rationale: Often require cautious approach due to fragility
and comorbidities.
33. Depression can mimic dementia in elderly patients. Answer: True Rationale:
