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

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Geriatric Syndrome Questions with

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80-year-old Jane is living by herself and has had a rough go of things lately. Her primary care provider determines that her self- neglect is resulting from an existing vulnerability or a combination of several existing vulnerabilities. These vulnerabilities function as both etiology and outcome of the process of self-neglect in a process known as what? Correct Answers Negative feedback loop 80-year-old Jane is seen in your office today, you know that which of the following is indicative of abuse? Correct Answers

• Fractures
• Malnutrition
• Dehydration
• None of these alone are indicative of abuse and must be assessed with history and laboratory findings A 66-year-old patient was seen in your clinic 2 weeks ago and started on Zoloft 50mg daily. He calls you today and says he doesn't feel any better. How should you, the nurse practitioner, respond to this patient? Correct Answers "Zoloft may take 4- weeks to achieve its full effect." A 70-year-old patient is in your clinic today to discuss starting medication for depression. After reviewing her history, you note no known allergies, and all previous labs are within normal limits. Which type of medication is best to prescribe this patient? Correct Answers SSRI

A 79-year-old patient comes to your clinic with feelings of depression. She completes the Geriatric Depression Scale (GDS) and you note her score to be 15. What is the next best plan of action for this patient? Correct Answers Refer to Psychiatry A patient arrives to your clinic after working outside all day in summer. He complains of nausea, fatigue, and dizziness. He has no known sick contacts. His vital signs are rectal temperature of 100.2ºF, HR 86, BP 118/65, RR 18, and he's 97% on room air. He takes no medications and has no pertinent medical history. His most likely diagnosis is: Correct Answers Heat exhaustion A patient has been taking Lexapro 10 mg daily for eight weeks. The patient initially reported feeling sad and irritable. The patient's sleep, appetite, energy, and appearance have now begun to improve and she denies thoughts of suicide. Which statement applies to this patient? Correct Answers The Lexapro dose should NOT be changed A patient is in your office with complaints of fatigue, constipation, cold intolerance, and depressed mood. Along with depression, what other differential diagnosis should be considered for this patient? Correct Answers Hypothyroidism A spiritual assessment can be conducted when? Correct Answers Anytime According to the Virginia Department of Health, in 2014, which of the following statements are true? (Select all that apply)

Correct Answers - Women were more likely than men to experience abuse

• Adults were more frequently abused, neglected, or exploited in their own homes. According to the Virginia Department of Health, in 2014, which of the following types of elder abuse was more prevalent? Correct Answers Self-neglect Age related changes include all of the following EXCEPT? Correct Answers Decreased sweat gland quantity Alcohol is the most abused substance among older adults. Which is the second most abused substance among older adults? Correct Answers Opioids An elderly patient presents to your clinic complaining they don't feel like they are sleeping well, they wake up feeling irritable. They ask you how many hours of sleep should they be getting each night, your best response is: Correct Answers The amount of sleep an older adult needs each night is 7-9 hours of quality sleep An elderly patient presents to your clinic with a chief complaint of lack of energy, little enjoyment in social activities, and trouble sleeping. Her husband states that she hasn't gone to her bridge club meetings and stays in bed frequently throughout the day. What should the nurse practitioner recommend for this patient? SELECT ALL THAT APPLY. Correct Answers - Sertraline (Zoloft)
• Cognitive Behavioral Therapy

An elderly patient presents to your clinic with complaints of excessive daytime sleepiness, what questions are important to ask the patient (select all that apply)? Correct Answers - What time do you go to bed?

• How long does it take to fall asleep?
• Do you wake at night? If so, how many times? An older adult presents to your clinic stating they recently have found they are waking up still feeling tired, and are irritable throughout the day, what are some sleep hygiene measures you can recommend to them? (select all that apply) Correct Answers
• Follow a regular schedule, go to bed and wake up at the same time even on weekends and traveling
• Avoid late day caffeine intake
• Avoid large meals within 2-3 hours of bedtime, decrease late day fluid intake. Approximately how many kcal does an older adult need? Correct Answers 30 kcal/kg of body weight As an individual ages their beliefs: Correct Answers Strengthen At what GFR should a patient be referred to nephrology for management? Correct Answers <30 ml/min Barriers to healthcare for the elderly related to technology include: (Select all that apply) Correct Answers - Lack of funds/resources
• Lack of knowledge
• Lack of educational support

Chronic pain definition Correct Answers Pain lasting > months, with or without cause Classic symptoms for heat stroke include: Correct Answers Temperature < 104ºF Dietary management for failure to thrive can include all of the following except: Correct Answers Offering low-fiber foods to increase time for nutrient absorption Differentials that are associated with disrupted sleep are? (select all that apply) Correct Answers - Insomnia

• Anemia
• Anxiety Erectile dysfunction can be treated with: (select all that apply): Correct Answers - Sex therapy
• PDE5 inhibitors (sildenafil, tadalafil)
• Vacuum constriction devices Failure to thrive is a syndrome that involves physical frailty, disability, and impaired neuropsychiatric function. Which of the following is not an indicator of physical frailty? Correct Answers Weight loss of 1% body weight in past year For patients with undernutrition, what should treatment focus on? Correct Answers The underlying cause and dietary modification

Healthcare providers should: (select all that apply) Correct Answers - Have patience with the elderly when navigating electronic medical records

• Explain the benefits of electronic health records to older adults and encourage the use of them
• Answer questions related to finding credible health resources online Herb induced alteration in the metabolism of which of the following enzymes is commonly associated with drug-herb interactions? Correct Answers P450 enzymes High sleep efficiency is found to be associated with: Correct Answers Decreased episodes of depression How long does evidence of kidney dysfunction need to be present for it to be considered chronic kidney disease? Correct Answers 3 months How many different religions are commonly practiced in the United States? Correct Answers 7 How much sodium should a patient with chronic kidney disease be limited to daily? Correct Answers 2 grams If a patient is experiencing heat stroke, what is NOT an effective way to lower core body temperature Correct Answers Tylenol If a patient is experiencing symptoms and needs diagnostic testing, which diagnostics could be ordered? Select all that apply. Correct Answers - Echocardiogram

• Electrocardiogram
• Cardiac exercise testing If a patient misses an appointment to a specialist that you referred them to, you should: Correct Answers Reach the patient in their preferred communication manner and remind them of appointment dates and times If a patient presents with Serotonin syndrome, which herbal supplement should we ask if they take? Correct Answers St. John's Wort If you have a patient that you suspect is having difficulty accessing her electronic health record, you should: Correct Answers Call and speak with her about her lab results and follow up directions Key characteristics of an aging adult are: Correct Answers Muscle weakness and atrophy Labs that would indicate complications from hyperthermia include? Correct Answers ↑ bicarbonate Megestrol can be used to stimulate appetite in patients with failure to thrive. What class of medications can also be used to stimulate appetite in patients with failure to thrive? Correct Answers SSRIs Mrs. Smith, an 81-year-old female, comes to the office for her annual well visit. As they are doing the medication reconciliation, the provider knows that which medications can

play a factor in the safety of the older adult driver. Select All that Apply: Correct Answers - Benzodiazepines

• Tricyclic antidepressants
• Opioids Patients undergoing testosterone therapy should be monitored every 6-12 months because of risk of: Correct Answers Erythrocytosis Pharmacologic therapy for elderly patients diagnosed with insomnia that need a sleep aid include Correct Answers Trazodone in low doses Prevalence of chronic pain in the elderly Correct Answers

50% Prevention includes all of the following EXCEPT? Correct Answers Stop drinking water if you don't feel thirsty Researchers found that older adults find religion to be a source of what? Correct Answers Comfort and hope Results of telephone-based behavioral activation with mental imagery in people with depression showed: Correct Answers 2 out of 16 participants in the treatment condition met diagnostic criteria for depression Risk factors for heat-related illnesses include all of the following EXCEPT Correct Answers Smoking

Select all that apply. Which of the following would be appropriate differential diagnoses when thinking about a patient that abuses alcohol? Correct Answers - Dementia

• Delirium
• Urinary tract infection
• Cerebrovascular accident Sleep related changes as you age include: Correct Answers Decreased REM sleep The provider is aware of cognitive abilities playing a factor and makes sure to do a careful assessment for which disorder? Correct Answers Age-associated dementia The provider knows that the acceptable requirement for visual field testing for an older adult driver is: Correct Answers 20/ The tools used for a spiritual assessment are called what: Correct Answers FICA and HOPE Treatment includes all of the following EXCEPT? Correct Answers Continue cooling until body temperature returns to 98.6ºF True or False: Medications typically used for weight loss such as appetite suppressants may be contraindicated in the older population. Correct Answers True Video calls such as Facetime can decrease feelings of ________ in the elderly. Correct Answers Social isolation

What aerobic exercise is best for patients who have osteoarthritis? Correct Answers Stationary bicycle What are key factors when assessing a patient's herbal supplement usage? (Select all that apply). Correct Answers - Using a nonjudgmental tone

• Asking about their reasoning for use of each supplement
• Ask about herbal use at every appointment What are physical signs of chronic kidney disease in the elderly? (Select all that apply) Correct Answers - Leg swelling
• Shortness of breath
• Difficulty urinating What are some considerations when prescribing pain medication to geriatric patients? (select all that apply) Correct Answers - Patients' risk/history of falls
• Polypharmacy
• Kidney function What are some factors that increase older adults risk of interactions with herbal supplement use? (Select all that apply) Correct Answers - Polypharmacy
• Decreased hepatic function
• Decreased renal function What are some negative consequences to an older adult losing weight? Correct Answers - Fractures
• Bone density loss
• Muscle mass loss

What are some recommendations for practitioners to utilize to prevent falls in the elderly (select all that apply)? Correct Answers - Improve strength and balance

• Optimize medications
• Modify environmental factors
• Laboratory tests What are the two first line antihypertensive medications for chronic kidney disease? (Select all that apply) Correct Answers
• Ace inhibitors
• Angiotensin receptor blockers What are two major risk factors related with poor physical and mental health status? Correct Answers Loneliness and social isolation What are two modifiable risk factors that can be eliminated to decrease an elderly patient's chance of developing chronic kidney disease? (Select all that apply) Correct Answers - Smoking
• Nephrotoxic drugs What class of medications should be started to reduce water retention due to chronic kidney disease? Correct Answers Diuretics What components are important in the physical exam when it comes to fall prevention (select all that apply)? Correct Answers - Neuro exam
• Blood pressure
• Muscle strength

What entity verifies that the herbal supplements have labels that accurately identify the contents of the product? Correct Answers - Food & Drug Administration

• The Drug Enforcement Administration
• United States Department of Health
• None of the above What is a positive affect from physical activity in geriatric populations? Correct Answers It helps prevent and manage chronic illness What is obesity? Correct Answers A multifactorial disease caused by the acquisition of enough body fat that causes a negative impact on health, by increasing the risk of developing other chronic diseases and is associated with premature death What is sarcopenic obesity? Correct Answers High risk geriatric syndrome that is caused by the combination of the loss of muscle strength and function along with being obese What is the number one cause of chronic kidney disease? Correct Answers Diabetes mellitus What lab value are the stages of chronic kidney classified? Correct Answers GFR What labs are important to consider in fall prevention in the elderly (select all that apply)? Correct Answers - CBC
• Vitamin D
• CMP

• Not hA1C What labs would the provider order to rule in/out coexisting problems when working with a patient experiencing caregiver burden (as exemplified by decreased mood, decreased appetite, insomnia, weight gain, fatigue, and worthlessness) (Select all that apply) Correct Answers - CBC
• CMP
• TSH What physical intervention to assist with self-care would be most helpful for someone struggling with caregiver burden? Correct Answers Exercise (not spending time with friends or laughter) What risk factors put an elderly patient at an increased risk of falling (select all that apply)? Correct Answers - History of falling
• Medication history (4 or more)
• Fear of falling
• Medical history
• Poor nutrition What screening tool may assist the provider with gathering information about how the caregiver is coping with their caregiving duties? Correct Answers Zarit Burden Screening What symptoms would indicate need for further diagnostic evaluation prior to initiating an exercise regimen? Select all that apply. Correct Answers - Chest pain
• Shortness of breath at rest or exertion

• Difficulty breathing at night
• Palpitations When a male patient comes in complaining of erectile dysfunction, they should be evaluated for all except: Correct Answers Benign prostatic hyperplasia When a patient becomes too hot, what mechanisms encourage heat loss? Correct Answers Vasodilation and increased sweating When assessing a patient for failure to thrive, which of these tests would be most appropriate? Correct Answers "Get up and go test" When assessing a patient for failure to thrive, who should you obtain the history from? Correct Answers The patient and caregivers When assessing mobility in the elderly patient, which of the following is included in your assessment? (Select all that apply) Correct Answers - Muscle strength
• Gait speed
• Symmetry
• Balance When checking lab work on Jane, an 80-year-old female, you find that her cholesterol level is low. What could this be indicative of? Correct Answers Malnutrition

When conducting a telehealth visit for an elderly patient the provider should: Correct Answers Ask the patient if they prefer a telephone only or video call platform When do elderly Asian-Americans NOT have better health and report being happier? Correct Answers When they can be fully immersed in western culture and adopt new values quickly When does muscle mass begin to decline? Correct Answers After the 4th decade of life When it comes to her supplements, the FDA is responsible for which of the following: Correct Answers - Verifying the contents of a supplement

• Verifying the efficacy of a supplement
• Verifying that the ingredient on the label is what is contained in the product
• None of the above When recommending stretches to treat plantar fasciitis, it is best to provide your elder patient with: Correct Answers A handout with detailed exercises and stretches, as well as supplemental online resources that are optional Which diagnostic test is least helpful when assessing chronic pain? Correct Answers Ultrasound Which entity requires medical providers to record patient's use of herbal supplements as part of their medical record? Correct Answers Joint Comission

Which individual was among one of the most vulnerable during COVID? Correct Answers 75-year-old Which is NOT a normal part of female sexual function with aging? Correct Answers Inability to achieve orgasm Which medication has NOT been implicated in heat-related illnesses? Correct Answers Tylenol Which of the below are risk factors associated with alcohol or substance abuse in older adults? Select all that apply. Correct Answers - Chronic pain

• Loss of loved ones
• Transition in living or care situations
• Physical disability or reduced mobility Which of the below is a screening tool that is specifically for geriatric alcoholism screening? Correct Answers G-MAST Which of the below populations is most affected by alcohol use disorder? Correct Answers Native Americans and Alaskan natives Which of the following are CDC recommendations for adults 65 or older? Select all that apply. Correct Answers - At least 150 minutes per week of moderate intensity activity
• 2 days a week of muscle strengthening activities
• Balance training at least 3 days a week.

Which of the following are treatment options for female pathophysiologic changes with aging? (select all that apply) Correct Answers - Water based lubricants

• Low dose vaginal estrogen
• Pelvic floor therapy Which of the following are true regarding elder abuse and the use of technology? Correct Answers Elder financial fraud and scams affects approximately 1 of every 18 cognitively intact, community-dwelling older adults each year Which of the following assessment tools includes counting backwards from 100 by 7s? Correct Answers Mini mental status exam Which of the following can be an early sign of CVD? Correct Answers Erectile dysfunction Which of the following can be an indicator of dehydration in an elderly patient? Correct Answers Hypernatremia Which of the following drugs have known interactions with Ginkgo? (Select all that apply) Correct Answers - Aspirin
• Anticonvulsants
• Antidepressants
• Diuretics Which of the following drugs have known interactions with St. John's Wort? (Select all that apply) Correct Answers - Digoxin
• Benzodiazepines
• Warfarin

Which of the following has shown effectiveness in reversing failure to thrive? Correct Answers Short-term aggressive caloric replacement Which of the following herbal is known for increasing the effects of anticoagulants therefore leading to abnormal bleeding or hemorrhage? Correct Answers Ginkgo Which of the following is a Geriatric Depression Scale score diagnostic for severe depression? Correct Answers 12 Which of the following is a risk factor for falls in the elderly? Correct Answers Visual impairment Which of the following is not a benefit of spirituality? Correct Answers Culinary benefits Which of the following is the primary care provider responsible for in terms of management of elder abuse? (Select all that apply) Correct Answers - Reporting

• Documentation of findings
• Interacting with law enforcement and the courts
• Determining decisional and executive capacity Which of the following medical conditions could make smart phone use difficult for a patient? (Select all that apply) Correct Answers - Diabetic retinopathy
• Rheumatoid arthritis

Which of the following should be included in a physical assessment of an obese adult? Correct Answers - Waist circumference

• Skin assessment
• Check muscle for tone and strength Which of the following statements is true? Correct Answers All elderly people have different levels of technology literacy Which of the following was NOT a finding of a two-year prospective cohort study regarding social interaction in the elderly? Correct Answers Social activity increased after COVID, especially in older women Which one of the following is NOT one of the three components that contribute to failure to thrive? Correct Answers Increased age Which pain scale is the best to use for most geriatric patients with chronic pain? Correct Answers Brief Pain Inventory Which patient needs to be medically cleared before starting an exercise regimen? Select all that apply. Correct Answers - Someone who has hyperlipidemia and is asymptomatic but has been getting short of breath while watching TV
• Someone who is inactive, asymptomatic with diabetes mellitus Which should be included in taking a history from an elderly patient? (Select all that apply) Correct Answers - Meal preparation
• Living conditions

• Exercise
• Family relationships
• History of falls Which statement is true about sleep and the aging adult? Correct Answers Older adults need 7-9 hours of quality sleep a night Who needs diagnostics testing like ECG and/or cardiac exercise test prior to initiating exercise regimen? Correct Answers Patients who experience chest pain or shortness of breath You have a patient that screened positive for alcohol use disorder. No hepatomegaly is present on exam. Which labs should you order? Select all that apply Correct Answers - CMP
• CBC
• PT/INR
• PTT -- NOT CT You have just diagnosed your 76-year-old Caucasian male patient with alcohol use disorder. He does not seek medical care often. He came with his daughter to this appointment. She reports that he has drank "all her life." Which of the below medications should you prescribe him? Correct Answers - Folic acid
• Thiamine Your 68-year-old patient tells you that she read about weight loss pills online and she was thinking about ordering them. You advise her: Correct Answers To be cautious of things she reads

online, and to consult with you before ordering or starting any new medications or supplements Your patient is a 70-year-old man who does not seek consistent medical care. He shows up in your office today to establish care. Which of the following physical assessment findings should cause the nurse practitioner to utilize the G-MAST screening tool? Correct Answers Tachycardia, peripheral neuropathy, hepatosplenomegaly, tremulousness