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

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NRP 5 55

Adult & Geriatric

Management I

MIDTERM EXAM REVIEW

1. Which of the following is considered a primary prevention strategy in geriatric care?
   • A) Administering vaccinations
   • B) Providing physical therapy for a fall patient
   • C) Performing a cardiac catheterization
   • D) Initiating palliative care
   • Correct Answer: A Rationale: Vaccinations prevent disease before it occurs, which is a key aspect of primary prevention.
2. What is the most common cause of delirium in older adults?
   • A) Dehydration
   • B) Dementia
   • C) Stroke
   • D) Sleep deprivation
   • Correct Answer: A Rationale: Dehydration is frequently overlooked in older adults and can lead to confusion and delirium.
3. Which of the following tools is commonly used for assessing risk of falls in elderly patients?

• A) Geriatric Depression Scale (GDS)
• B) Mini-Mental State Examination (MMSE)
• C) Timed Up and Go (TUG) test
• D) Nutritional Risk Screening (NRS)
• Correct Answer: C Rationale: The TUG test is specifically designed to assess mobility and fall risk.

4. The BEERS Criteria are used to:

• A) Identify safe medications for older adults
• B) Recommend medications to avoid in older adults
• C) Assess the risk of delirium
• D) Provide guidelines for physical activity
• Correct Answer: B Rationale: The BEERS Criteria highlights potentially inappropriate medications for older adults.

5. Which of the following conditions can contribute to polypharmacy in older adults?

• A) Chronic illnesses
• B) Social isolation
• C) Inadequate health literacy
• D) All of the above

• Correct Answer: D Rationale: Multiple factors, including those listed, contribute to polypharmacy.

Fill-in-the-Blank Questions

6. The acronym ADLs stands for _________. Correct Answer: Activities of Daily Living Rationale: ADLs refer to basic self-care tasks that individuals carry out daily.
7. _________ is a type of healthcare that focuses on relieving symptoms of serious illness rather than curing the illness itself. Correct Answer: Palliative care Rationale: Palliative care is about improving quality of life for patients with serious illnesses.
8. The primary screening tool for cognitive dysfunction in older adults is the _________. Correct Answer: Mini-Mental State Examination (MMSE) Rationale: The MMSE is widely used to assess cognitive function in older adults.

9. In nursing care, the term 'sundowning' refers to increased confusion and agitation that occurs during _________. Correct Answer: Evening hours Rationale: Sundowning often manifests in dementia patients as evening approaches.
10. A common complication of immobility in older adults is _________. Correct Answer: Deep vein thrombosis (DVT) Rationale: Immobility can lead to decreased circulation, increasing the risk of DVT.

True/False Questions

11. True or False: All older adults will experience some decline in cognitive functioning. Correct Answer: False Rationale: Cognitive decline is not uniform, and many older adults retain high levels of cognitive function throughout their lives.
12. True or False: The Geriatric Syndrome encompasses conditions like frailty, falls, incontinence, and pressure ulcers. Correct Answer: True Rationale: The term Geriatric Syndrome refers to a multifactorial health condition commonly seen in older adults.

13. True or False: Elderly patients metabolize drugs faster than younger adults. Correct Answer: False Rationale: Older adults generally metabolize drugs more slowly due to diminished liver function.
14. True or False: Social disengagement theory suggests that older adults choose to withdraw from social interactions. Correct Answer: True Rationale: Disengagement theory posits that withdrawal is a natural part of aging for many individuals.
15. True or False: Dementia is a normal part of aging. Correct Answer: False Rationale: While cognitive changes can occur, dementia is not considered normal aging.

Multiple Response Questions

16. Which of the following factors can contribute to depression in older adults? (Select all that apply)
    • A) Loss of a spouse
    • B) Chronic pain

• C) Increased cognitive function
• D) Social isolation
• Correct Answers: A, B, D Rationale: Loss, pain, and isolation are known risk factors for depression in older populations.

17. Common geriatric syndromes include: (Select all that apply)

• A) Falls
• B) Polypharmacy
• C) Heart failure
• D) Delirium
• Correct Answers: A, B, D Rationale: Falls, polypharmacy, and delirium are categorized as geriatric syndromes; heart failure is a disease.

18. Which of the following are signs of dehydration in older adults? (Select all that apply)

• A) Dry mouth
• B) Confusion
• C) Increased urination
• D) Dizziness
• Correct Answers: A, B, D

Rationale: Dry mouth, confusion, and dizziness can indicate dehydration, whereas increased urination often suggests hydration.

19. Risk factors for developing pressure ulcers include: (Select all that apply)
    • A) Immobility
    • B) Inadequate nutrition
    • C) High blood pressure
    • D) Advanced age
    • Correct Answers: A, B, D Rationale: Immobility, poor nutrition, and advanced age significantly increase the risk of pressure ulcers.
20. Common interventions for managing chronic pain in older adults include: (Select all that apply)
    • A) Non-pharmacological treatments
    • B) High doses of narcotics
    • C) Physical therapy
    • D) Stress management techniques
    • Correct Answers: A, C, D Rationale: Non-pharmacological treatments, physical therapy, and stress management are effective pain interventions, whereas high doses of narcotics may not always be appropriate.

Additional Questions

21. Which of the following is true about elder abuse?
    • A) It only occurs in nursing homes
    • B) It encompasses physical, emotional, financial, and sexual abuse
    • C) Elder abuse is often reported by family members
    • D) It is rare in older adults living independently
    • Correct Answer: B Rationale: Elder abuse includes multiple forms of abuse, not limited to any specific setting.
22. Advanced Care Planning includes the following components, except:
    • A) Completing a living will
    • B) Appointing a healthcare proxy
    • C) Making funeral arrangements
    • D) Discussing treatment preferences with family
    • Correct Answer: C Rationale: While important, funeral arrangements are not part of Advanced Care Planning's focus on healthcare decisions.
23. Which of the following assessments is important for evaluating the needs of older adult patients with cognitive impairment?
    • A) Pain assessment scale

• B) Fall risk assessment
• C) Functional status assessment
• D) Nutritional assessment
• Correct Answer: C Rationale: A functional status assessment helps gauge cognitive function and its impact on daily living.

24. The most effective approach in geriatric care for patients with behavioral concerns is medication management.

• A) True
• B) False
• Correct Answer: B Rationale: Medication management should be complemented by non- pharmacological approaches for behavioral concerns.

25. The term 'informed consent' relates to:

• A) Providing legal representation for a patient
• B) Ensuring patients understand the risks and benefits of treatments
• C) Filing hospital paperwork
• D) Conducting patient education solely by nurses
• Correct Answer: B Rationale: Informed consent refers to ensuring patients are well- informed about their treatment options.

26. Which of the following conditions is NOT typically associated with frailty?
    • A) Reduced strength
    • B) Increased endurance
    • C) Vulnerability to stressors
    • D) Weight loss
    • Correct Answer: B Rationale: Increased endurance is contrary to the definition of frailty, which typically involves decreased strength.
27. Which of the following factors can impact medication adherence in older adults? (Select all that apply)
    • A) Complexity of medication regimen
    • B) Memory loss
    • C) Living independently
    • D) Support from family members
    • Correct Answers: A, B Rationale: A complex regimen and memory loss are significant barriers, whereas living independently and familial support can enhance adherence.
28. True or False: It is common for older adults to experience a decrease in basal metabolic rate (BMR).

Correct Answer: True Rationale: As people age, changes in body composition often lower BMR leading to a decreased caloric need.

29. Which of the following is part of the recommended approach for managing elder financial exploitation? (Select all that apply)
    • A) Reporting suspicious activities to authorities
    • B) Instructing older adults to manage their finances entirely alone
    • C) Enhancing financial literacy among seniors
    • D) Discussing concerns with family members
    • Correct Answers: A, C, D Rationale: Reporting, education, and communication with family are key preventive measures against exploitation. Multiple Choice: Which of the following is a common risk factor for falls in elderly patients? A) Regular exercise B) Visual impairment C) High protein diet D) Hydration Correct Answer: B) Visual impairment Rationale: Visual impairment can lead to decreased spatial awareness and increased risk of falls among elderly patients.

Fill-in-the-Blank: The __ is a common assessment tool used to evaluate the functional status of older adults. Correct Answer: Katz Index of Independence in Activities of Daily Living Rationale: This index helps to assess an individual's ability to perform daily living activities independently. True/False: Polypharmacy is defined as the concurrent use of five or more medications. Correct Answer: True Rationale: Polypharmacy increases the risk of adverse drug interactions and complicates treatment regimens in older adults. Multiple Response: Which of the following are signs of depression in geriatric patients? (Select all that apply) A) Social withdrawal B) Increased appetite C) Fatigue D) Loss of interest in previously enjoyed activities Correct Answers: A) Social withdrawal, C) Fatigue, D) Loss of interest in previously enjoyed activities Rationale: These symptoms are commonly associated with depression in older adults.

Multiple Choice: What is the primary goal of palliative care for geriatric patients? A) To cure the disease B) To achieve the best quality of life C) To prolong life at all costs D) To ensure hospitalization Correct Answer: B) To achieve the best quality of life Rationale: Palliative care focuses on comfort and quality of life, rather than curative treatment. Fill-in-the-Blank: The __ scale is utilized to assess the risk of pressure ulcers in hospitalized patients. Correct Answer: Braden scale Rationale: The Braden scale evaluates sensory perception, moisture, activity, mobility, nutrition, and friction to determine pressure ulcer risk. True/False: Dementia and delirium are the same condition. Correct Answer: False Rationale: Dementia is a chronic, progressive condition, while delirium is an acute, often reversible state of confusion. Multiple Response: Which of the following interventions can be effective in managing chronic pain in older adults? (Select all that apply) A) Non-pharmacological therapies

B) Opioid medications C) Regular exercise D) Ignoring the pain Correct Answers: A) Non-pharmacological therapies, B) Opioid medications, C) Regular exercise Rationale: A multidisciplinary approach often yields the best results in managing chronic pain. Multiple Choice: In geriatric assessment, which aspect is considered critical for understanding an older adult’s living situation? A) Family history B) Social support network C) Employment status D) Hobbies Correct Answer: B) Social support network Rationale: The social support network plays a significant role in the health and well-being of older adults. Fill-in-the-Blank: Elderly patients often experience __, which can contribute to malnutrition. Correct Answer: Dysphagia Rationale: Dysphagia, or difficulty swallowing, can lead to inadequate nutrient intake and malnutrition.

True/False: It is appropriate to use physical restraints on elderly patients to prevent falls. Correct Answer: False Rationale: The use of physical restraints can lead to physical and psychological harm and should be avoided when possible. Multiple Choice: Which of the following is a common cognitive assessment tool used for older adults? A) Mini-Mental State Examination (MMSE) B) Glasgow Coma Scale C) Barthel Index D) Geriatric Depression Scale Correct Answer: A) Mini-Mental State Examination (MMSE) Rationale: The MMSE is widely used to assess cognitive function and screen for cognitive impairment. Multiple Response: Which of the following factors can contribute to elder abuse? (Select all that apply) A) Caregiver stress B) Social isolation C) Mental health issues of the caregiver D) Financial stability Correct Answers: A) Caregiver stress, B) Social isolation, C) Mental health issues of the caregiver

Rationale: These factors can increase the risk of abuse and neglect in vulnerable older adults. Multiple Choice: Which type of incontinence is characterized by a sudden, intense urge to urinate followed by involuntary leakage? A) Stress incontinence B) Functional incontinence C) Urge incontinence D) Overflow incontinence Correct Answer: C) Urge incontinence Rationale: Urge incontinence involves a strong desire to urinate, leading to involuntary loss of urine. Fill-in-the-Blank: The __ approach is crucial in managing chronic diseases in older adults by involving interdisciplinary collaboration. Correct Answer: Holistic Rationale: A holistic approach considers all aspects of a patient’s life, leading to better health outcomes. True/False: Older adults are less likely to experience anxiety compared to younger adults. Correct Answer: False Rationale: Anxiety can be prevalent in older adults, often exacerbated by health concerns and loss of independence.

Multiple Choice: Which medication class is commonly prescribed to manage hypertension in older adults? A) Beta-blockers B) Antibiotics C) Antidepressants D) Antihistamines Correct Answer: A) Beta-blockers Rationale: Beta-blockers are frequently used to manage hypertension due to their efficacy and safety profile in older patients. Multiple Response: Which are common side effects of polypharmacy in older adults? (Select all that apply) A) Confusion B) Dizziness C) Improved cognitive function D) Increased fall risk Correct Answers: A) Confusion, B) Dizziness, D) Increased fall risk Rationale: These side effects can result from the interactions of multiple medications in older patients. Multiple Choice: Which of the following is an effective strategy for managing sleep disturbances in older adults? A) Increased caffeine intake

B) Establishing a regular sleep schedule C) Napping throughout the day D) Reducing nighttime fluid intake Correct Answer: B) Establishing a regular sleep schedule Rationale: A consistent sleep schedule can improve sleep quality and duration in older adults. Fill-in-the-Blank: The __ model emphasizes the importance of understanding the biological, psychological, and social factors in geriatric care. Correct Answer: Biopsychosocial Rationale: This model fosters a comprehensive understanding of the complexities of aging and health management.

1. Multiple Choice: Which medication is considered first-line treatment for managing chronic heart failure in geriatric patients? a) Captopril b) Furosemide c) Metoprolol d) Digoxin Answer: c) Metoprolol - Beta-blockers like metoprolol are recommended for chronic heart failure as they have been shown to decrease mortality and hospitalization rates.

2. Fill-in-the-Blank: ________ is the recommended initial imaging study for an elderly patient suspected of having a hip fracture. Answer: X-ray - An X-ray is typically the first imaging technique used to evaluate a suspected hip fracture due to its availability and ability to provide clear images of bone structure.
3. True/False: Polypharmacy is an expected standard in the treatment of complex geriatric syndromes. Answer: False - Polypharmacy can lead to increased risks of adverse drug reactions and interactions, and should be managed carefully with the aim of minimizing the number of medications.
4. Multiple Response: Select all that apply. Which of the following are common risk factors for falls in the elderly? a) Visual impairment b) Cognitive decline c) Polypharmacy d) Increased physical activity Answers: a) Visual impairment, b) Cognitive decline, c) Polypharmacy - These are all recognized risk factors for falls, whereas increased physical activity, when safe and appropriate, can actually help reduce the risk of falls by improving strength and balance.
5. Multiple Choice: What is the most appropriate initial approach to managing urinary incontinence in the elderly? a) Scheduled toileting

b) Indwelling catheterization c) Surgical intervention d) Pharmacological treatment Answer: a) Scheduled toileting - Behavioral interventions like scheduled toileting are first-line approaches as they are non-invasive and can be effective in managing incontinence.

6. Fill-in-the-Blank: The term ________ refers to the decline in cognitive function due to the aging process, distinct from neurodegenerative diseases. Answer: Age-associated memory impairment - This term describes normal changes in memory and cognitive function that occur with aging.
7. True/False: Delirium and dementia can be easily distinguished based on patient history and clinical presentation. Answer: False - Delirium and dementia have overlapping symptoms and can be challenging to differentiate without thorough assessment including cognitive testing and sometimes imaging.
8. Multiple Response: Which of the following symptoms are indicative of depression in geriatric patients? Select all that apply. a) Persistent sadness b) Weight loss c) Memory loss d) Irritability

Answers: a) Persistent sadness, b) Weight loss, d) Irritability - These symptoms can be indicative of depression, while memory loss is more commonly associated with dementia.

9. Multiple Choice: A geriatric patient with a history of hypertension and diabetes should be regularly monitored for which of the following complications? a) Osteoarthritis b) Cognitive decline c) Urinary tract infections d) Skin integrity issues Answer: b) Cognitive decline - Patients with hypertension and diabetes have an increased risk of cognitive decline due to potential vascular damage.
10. Fill-in-the-Blank: The Beers Criteria is a guideline used to identify ________ in the elderly. Answer: Potentially inappropriate medications - The Beers Criteria helps healthcare providers identify medications that may be harmful or less effective in older adults.
11. True/False: The Mini-Mental State Examination (MMSE) is a comprehensive test used to diagnose dementia. Answer: False - The MMSE is a screening tool for cognitive impairment, not a diagnostic test for dementia.

12. Multiple Response: Select all that apply. In managing diabetes in geriatric patients, which factors must be considered? a) Simplifying the medication regimen b) Tight glycemic control c) Patient's life expectancy d) Patient's functional status Answers: a) Simplifying the medication regimen, c) Patient's life expectancy, d) Patient's functional status - These factors are important to consider for individualizing diabetes management in the elderly, while tight glycemic control may not be appropriate due to the risks of hypoglycemia.
13. Multiple Choice: Which of the following is a common cause of anemia in the elderly? a) Vitamin B12 deficiency b) Excessive iron intake c) Dehydration d) Increased erythropoietin production Answer: a) Vitamin B12 deficiency - Anemia in the elderly is often caused by nutritional deficiencies, including vitamin B12 deficiency.
14. Fill-in-the-Blank: ________ is a non-pharmacological intervention that can improve sleep quality in elderly patients with insomnia. Answer: Cognitive-behavioral therapy for insomnia (CBT-I) - CBT-I is an effective non-pharmacological treatment that can improve sleep quality without the risks associated with medication.

15. True/False: All elderly patients with hypertension should be treated with medication to achieve a blood pressure target of less than 130/80 mmHg. Answer: False - Blood pressure targets in the elderly should be individualized based on overall health, comorbid conditions, and potential risks of treatment.
16. Multiple Response: Which of the following are components of a comprehensive geriatric assessment? Select all that apply. a) Functional status b) Nutritional status c) Advanced directives d) Family history Answers: a) Functional status, b) Nutritional status, c) Advanced directives - These are all key components of a comprehensive geriatric assessment, which is a multidimensional process designed to evaluate an older adult's functional ability, physical health, cognition, and mental health, and socio-environmental circumstances.
17. Multiple Choice: What is the primary goal of palliative care in geriatric patients? a) Cure the underlying disease b) Prolong life at all costs c) Improve quality of life d) Conduct research for geriatric syndromes

Answer: c) Improve quality of life - The primary goal of palliative care is to improve the quality of life for patients and their families facing the problems associated with life-threatening illness.

18. Fill-in-the-Blank: ________ is the most common type of urinary incontinence in elderly women. Answer: Stress urinary incontinence - This type of incontinence is caused by weakened pelvic floor muscles and is common in elderly women.
19. True/False: It is safe to assume that cognitive decline is an inevitable part of aging and requires no further investigation. Answer: False - While some cognitive decline can be expected with aging, significant changes warrant further investigation to rule out treatable conditions.