Geriatric Care: Addressing the Unique Needs of Older Adults, Exams of Geriatrics

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NRP 5 56

Adult & Geriatric

Management II

MIDTERM EXAM REVIEW

1. Multiple Choice: What is the first-line pharmacological treatment for a 78 - year-old patient with newly diagnosed hypertension? a) Beta-blockers b) Calcium channel blockers c) ACE inhibitors d) Diuretics Correct Answer: c) ACE inhibitors Rationale: ACE inhibitors are often recommended as first-line treatment for hypertension in the elderly due to their protective effects on the kidneys and heart, and lower risk of side effects.
2. Fill-in-the-Blank: The most common cause of community-acquired pneumonia in geriatric patients is __________. Correct Answer: Streptococcus pneumoniae Rationale: Streptococcus pneumoniae is the leading cause of bacterial pneumonia in adults, especially in the geriatric population, due to decreased immunity and increased exposure in community settings.
3. True/False: Polypharmacy is defined as the use of five or more medications regularly. Correct Answer: True

Rationale: Polypharmacy is typically defined as the concurrent use of five or more medications, which can increase the risk of adverse drug reactions and interactions, particularly in older adults.

4. Multiple Response: Which of the following are recognized risk factors for falls in the elderly? (Select all that apply) a) Visual impairment b) Cognitive decline c) Urinary incontinence d) Use of sedatives Correct Answers: a) Visual impairment, b) Cognitive decline, c) Urinary incontinence, d) Use of sedatives Rationale: All listed options are established risk factors for falls, which are a major concern in geriatric care due to the potential for serious injury.
5. Multiple Choice: A 65 - year-old patient with type 2 diabetes should be screened for which of the following complications annually? a) Neuropathy b) Retinopathy c) Nephropathy d) All of the above Correct Answer: d) All of the above Rationale: Annual screening for neuropathy, retinopathy, and nephropathy is recommended for patients with type 2 diabetes to prevent complications and manage the disease effectively.

Multiple Choice: Which of the following is a common side effect of polypharmacy in elderly patients? A) Increased mobility B) Enhanced cognitive function C) Falls D) Improved sleep quality Correct Answer: C) Falls Rationale: Polypharmacy increases the risk of adverse drug reactions, which can lead to falls. Fill-in-the-Blank: The primary goal of geriatric assessment is to identify the patient's __ and develop a comprehensive care plan. Correct Answer: needs Rationale: Understanding the patient's needs is essential for tailoring an effective care plan. True/False: Delirium is often reversible if the underlying cause is addressed in a timely manner. Correct Answer: True Rationale: Delirium can be reversed with appropriate interventions targeting the underlying cause.

Multiple Response: Which of the following conditions are commonly assessed during a comprehensive geriatric assessment? (Select all that apply.) A) Cognitive function B) Nutritional status C) Financial status D) Social support Correct Answers: A) Cognitive function, B) Nutritional status, D) Social support Rationale: Cognitive function, nutritional status, and social support are critical components of geriatric assessment. Multiple Choice: Which medication is considered first-line treatment for hypertension in older adults? A) Beta-blockers B) ACE inhibitors C) Calcium channel blockers D) Diuretics Correct Answer: B) ACE inhibitors Rationale: ACE inhibitors are often preferred due to their favorable effects on renal function and cardiovascular outcomes. Fill-in-the-Blank: The acronym ADLs stands for _, _, and __. Correct Answer: Activities of Daily Living

Rationale: ADLs refer to the essential tasks required for daily self-care. True/False: A patient with chronic obstructive pulmonary disease (COPD) should be encouraged to perform regular aerobic exercises. Correct Answer: True Rationale: Regular aerobic exercise can improve respiratory function and overall quality of life in COPD patients. Multiple Response: Which of the following are signs of elder abuse? (Select all that apply.) A) Unexplained injuries B) Sudden changes in behavior C) Inconsistent medical history D) Excessive financial transactions Correct Answers: A) Unexplained injuries, B) Sudden changes in behavior, C) Inconsistent medical history Rationale: These signs may indicate potential elder abuse or neglect. Multiple Choice: What is the most common cause of heart failure in elderly patients? A) Myocardial infarction B) Hypertension C) Valvular heart disease D) Cardiomyopathy

Correct Answer: B) Hypertension Rationale: Hypertension is a leading risk factor for the development of heart failure in older adults. Fill-in-the-Blank: The process of evaluating a patient’s ability to manage their medications is known as __ assessment. Correct Answer: medication Rationale: Medication assessment is crucial for ensuring patient safety and adherence to treatment regimens. True/False: Cognitive decline is a normal part of aging and does not require intervention. Correct Answer: False Rationale: While some cognitive decline may occur with aging, significant changes may require evaluation and intervention. Multiple Response: Which of the following are potential complications of immobility in older adults? (Select all that apply.) A) Pressure ulcers B) Deep vein thrombosis C) Muscle atrophy D) Improved mental health Correct Answers: A) Pressure ulcers, B) Deep vein thrombosis, C) Muscle atrophy

Rationale: Immobility can lead to various complications, while improved mental health is not typically a consequence. Multiple Choice: What is the most effective first-line treatment for managing type 2 diabetes in older adults? A) Insulin therapy B) Metformin C) Sulfonylureas D) Thiazolidinediones Correct Answer: B) Metformin Rationale: Metformin is generally considered the first-line agent due to its efficacy and safety profile. Fill-in-the-Blank: The process of adjusting the care plan based on patient feedback is known as __ management. Correct Answer: collaborative Rationale: Collaborative management emphasizes the importance of patient involvement in their care. True/False: Pain management in older adults should be approached with caution due to the risk of opioid dependence. Correct Answer: True Rationale: Caution is necessary when prescribing opioids to older adults due to the risk of dependence and side effects.

Multiple Response: Which of the following are considered risk factors for falls in older adults? (Select all that apply.) A) Poor vision B) History of falls C) Use of assistive devices D) Polypharmacy Correct Answers: A) Poor vision, B) History of falls, D) Polypharmacy Rationale: These factors significantly increase the risk of falls in the elderly population. Multiple Choice: Which screening tool is most commonly used to assess depression in older adults? A) Geriatric Depression Scale B) Beck Depression Inventory C) Patient Health Questionnaire D) Hamilton Depression Rating Scale Correct Answer: A) Geriatric Depression Scale Rationale: The Geriatric Depression Scale is specifically designed for use in elderly populations. Fill-in-the-Blank: The term __ refers to a loss of independence in performing daily activities among older adults. Correct Answer: functional decline

Rationale: Functional decline is a significant concern that impacts the quality of life for older individuals. True/False: Advance directives are legally binding documents that express a person's healthcare preferences. Correct Answer: True Rationale: Advance directives outline a person's wishes regarding medical treatment and are legally recognized. Multiple Response: Which of the following strategies are effective for promoting social engagement among older adults? (Select all that apply.) A) Participation in community activities B) Regular phone calls with family C) Isolation in a quiet environment D) Joining clubs or groups of interest Correct Answers: A) Participation in community activities, B) Regular phone calls with family, D) Joining clubs or groups of interest Rationale: These strategies help combat loneliness and promote mental well-being through social engagement. Which of the following medications is most appropriate for managing chronic pain in an older adult with a history of opioid use disorder? A) Oxycodone

B) Acetaminophen C) Morphine D) Methadone Correct Answer: B) Acetaminophen Rationale: Acetaminophen is a safer alternative for pain management in patients with a history of opioid use disorder due to its lower potential for abuse.

2. What is a common side effect of anti-hypertensive medications in geriatric patients? A) Hyperkalemia B) Orthostatic hypotension C) Increased appetite D) Decreased urine output Correct Answer: B) Orthostatic hypotension Rationale: Older adults are particularly susceptible to orthostatic hypotension due to polypharmacy and age-related physiological changes.
3. The Mini-Mental State Examination (MMSE) is primarily used to assess: A) Physical mobility B) Nutritional status C) Cognitive function D) Pain levels

Correct Answer: C) Cognitive function Rationale: The MMSE is a widely used tool for screening cognitive impairment and assessing memory and orientation. Fill-in-the-Blank Questions

4. One of the leading causes of hospitalization among older adults is __________, which often leads to further complications. Correct Answer: falls Rationale: Falls are prevalent in elderly populations and can lead to significant morbidity and mortality.
5. The principle of __________ refers to the adjustment of drug dosages based on the renal function in older adults. Correct Answer: renal dosing Rationale: Renal dosing is critical in older adults due to changes in kidney function affecting drug metabolism and clearance.
6. In managing dementia, __________ therapy is often encouraged to enhance cognitive function and social interaction. Correct Answer: reminiscence Rationale: Reminiscence therapy involves discussing past experiences and can help engage older adults with dementia.

True/False Questions

7. True or False: The highest prevalence of depression often occurs in patients with chronic illness among the elderly. Correct Answer: True Rationale: Chronic illness can greatly impact the mental health of older adults, often leading to depression.
8. True or False: Advanced directives are legally binding documents that can guide healthcare decisions when a patient is unable to do so. Correct Answer: True Rationale: Advanced directives provide guidance on a patient’s healthcare preferences when they cannot communicate.
9. True or False: Older adults typically require higher doses of medications than younger adults due to increased metabolism. Correct Answer: False Rationale: Older adults often require lower doses due to decreased metabolism and excretion capacity. Multiple Response Questions
10. Which of the following conditions are commonly encountered in geriatric patients? (Select all that apply)

A) Osteoporosis B) Diabetes Mellitus C) Rheumatoid Arthritis D) Cystic Fibrosis Correct Answer: A) Osteoporosis, B) Diabetes Mellitus, C) Rheumatoid Arthritis Rationale: Osteoporosis, diabetes, and rheumatoid arthritis are prevalent in older adults; cystic fibrosis is generally diagnosed in childhood.

11. Which of the following interventions can help prevent delirium in older hospitalized patients? (Select all that apply) A) Ensuring adequate hydration B) Frequent orientation to time and place C) Restricting fluids D) Implementation of a sleep protocol Correct Answer: A) Ensuring adequate hydration, B) Frequent orientation to time and place, D) Implementation of a sleep protocol Rationale: Hydration, orientation, and promoting good sleep are critical in preventing delirium in older adults.
12. Identify the risk factors for polypharmacy among elderly patients. (Select all that apply) A) Presence of multiple chronic conditions B) Limited social support

C) High educational background D) Frequent healthcare provider visits Correct Answer: A) Presence of multiple chronic conditions, B) Limited social support, D) Frequent healthcare provider visits Rationale: Multiple chronic conditions and a lack of social support increase the likelihood of polypharmacy; education level does not directly correlate with polypharmacy risk. Additional Questions

13. Factors affecting medication adherence in geriatric patients may include: A) Cognitive decline B) Complex dosing schedules C) Financial constraints D) All of the above Correct Answer: D) All of the above Rationale: Cognitive decline, complex schedules, and financial issues all contribute significantly to medication non-adherence in older patients.
14. Which of the following assessments is essential for evaluating an older adult's risk for malnutrition? A) BMI and weight loss history B) Laboratory values alone

C) Family history of malnutrition D) Medication list Correct Answer: A) BMI and weight loss history Rationale: BMI and weight history are direct indicators of nutritional status in older adults.