Geriatric Care: Comprehensive Approach to Managing Older Adults, Exams of Nursing

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NU 611

Clinical Decision

Making

UPDATED FINAL EXAM GUIDE

1. A 68-year-old patient with a history of COPD presents with increased dyspnea and a productive cough. The nurse notes wheezing on auscultation. Which is the most appropriate next step in clinical decision- making? a) Initiate antibiotic therapy immediately. b) Increase the dose of the patient's inhaled corticosteroids. c) Order a chest X-ray and obtain sputum cultures. (Correct Answer: c) Rationale: Ordering diagnostic tests helps to confirm the cause of symptoms before initiating specific treatments.
2. A 72-year-old woman with type 2 diabetes presents with a non-healing ulcer on her foot. Which dressing type would be most appropriate for this wound? a) Dry gauze b) Hydrocolloid dressing c) Transparent film (Correct Answer: b) Rationale: Hydrocolloid dressings promote a moist environment conducive to wound healing, better suited for diabetic foot ulcers.
3. Which tool would be most appropriate for assessing the risk of falls in an elderly patient? a) Mini-Mental State Examination (MMSE) b) Morse Fall Scale

c) Braden Scale (Correct Answer: b) Rationale: The Morse Fall Scale specifically assesses the risk of falls.

4. What is the most important factor when deciding to initiate a statin therapy in a 65-year-old patient with no cardiovascular disease but with diabetes? a) LDL cholesterol level b) Blood pressure c) Age of the patient (Correct Answer: a) Rationale: LDL levels guide the initiation of statin therapy, especially in diabetic patients.
5. A 70-year-old male presents with urinary incontinence. Which diagnostic test should be ordered first? a) Cystoscopy b) Urinalysis c) Uroflowmetry (Correct Answer: b) Rationale: A urinalysis is a non-invasive, simple test to rule out urinary tract infection and other causes of incontinence.

Fill-in-the-Blank

6. For patients with chronic kidney disease (CKD), dietary intake of __________ should be carefully monitored to avoid exacerbation of their condition. (Correct Answer: phosphorus) Rationale: Excessive phosphorus intake can worsen CKD.
7. In elderly patients, the most common cause of secondary hypertension is __________. (Correct Answer: renal artery stenosis) Rationale: Renal artery stenosis is a key reversible cause of secondary hypertension in older adults.
8. The __________ scale is utilized to assess the severity of dementia symptoms in older adults. (Correct Answer: Clinical Dementia Rating (CDR)) Rationale: CDR is a widely used scale to quantify dementia severity.
9. A decrease in bone density leading to an increased risk of fractures in the elderly is most commonly due to __________. (Correct Answer: osteoporosis)

Rationale: Osteoporosis directly impacts bone density and fracture risk.

10. The primary medication class used for initial management of anxiety disorders in the elderly is __________. (Correct Answer: SSRIs (Selective Serotonin Reuptake Inhibitors)) Rationale: SSRIs are preferred due to their safety profile in elderly patients.

True/False

11. Polypharmacy is a significant issue in the elderly due to the increased risk of adverse drug reactions and interactions. (Correct Answer: True) Rationale: Polypharmacy increases the risk of adverse effects in older adults.
12. Atrial fibrillation is less prevalent in the elderly compared to younger populations. (Correct Answer: False) Rationale: Atrial fibrillation is more common in older adults.

13. Functional status assessment is less important than disease-specific measures in geriatric care. (Correct Answer: False) Rationale: Functional status assessment is crucial in geriatric care to ensure quality of life.
14. Depression in the elderly is often underdiagnosed and undertreated. (Correct Answer: True) Rationale: Depression symptoms in the elderly can be subtle and mistaken for other conditions.
15. Exercise interventions are not recommended for older adults with osteoarthritis of the knee. (Correct Answer: False) Rationale: Exercise is beneficial for managing osteoarthritis in older adults.

Multiple Choice

16. Which of the following is least likely to cause delirium in a 75-year-old hospitalized patient?

a) Electrolyte imbalance b) Dementia c) Environmental changes (Correct Answer: b) Rationale: While dementia is a risk factor, acute changes such as electrolyte imbalance and environmental changes are more direct causes of delirium.

17. Which biomarker is most useful in diagnosing heart failure in older adults? a) Troponin b) B-type natriuretic peptide (BNP) c) C-reactive protein (CRP) (Correct Answer: b) Rationale: BNP is specifically related to heart failure.
18. The Beers Criteria is used to: a) Assess nutritional status b) Identify inappropriate medications in the elderly c) Evaluate fall risk (Correct Answer: b) Rationale: The Beers Criteria lists potentially inappropriate medications for older adults.

19. A 65-year-old patient with atrial fibrillation comes in for a routine check. Which medication is crucial to prevent stroke in this patient? a) Beta-blockers b) Anticoagulants c) Diuretics (Correct Answer: b) Rationale: Anticoagulants reduce the risk of thromboembolic events, including stroke.
20. In managing chronic pain in older adults, the first-line pharmacologic treatment is typically: a) Opioids b) Nonsteroidal anti-inflammatory drugs (NSAIDs) c) Acetaminophen (Correct Answer: c) Rationale: Acetaminophen is preferred due to the lower risk of side effects in the elderly.

Fill-in-the-Blank

21. Patients with severe dementia often exhibit __________ behavior, which includes confusion and agitation during late afternoon and evening. (Correct Answer: sundowning)

Rationale: Sundowning is a common phenomenon in severe dementia.

22. A score of less than __________ on the Mini-Mental State Examination (MMSE) is typically indicative of cognitive impairment. (Correct Answer: 24) Rationale: An MMSE score below 24 suggests cognitive impairment.
23. An advanced directive in healthcare is a legal document that outlines a patient's __________. (Correct Answer: end-of-life care preferences) Rationale: Advanced directives specify the patient's wishes regarding medical treatment.
24. In treating Parkinson's disease, __________ is the primary medication used to replace deficient dopamine levels. (Correct Answer: Levodopa) Rationale: Levodopa is the standard treatment to supplement dopamine in Parkinson's.

25. For a diabetic patient, the target Hemoglobin A1c level is typically less than __________%. (Correct Answer: 7) Rationale: Maintaining HbA1c below 7% is recommended to reduce complications.

True/False

26. Screening for colorectal cancer is not recommended for patients aged 85 years and older. (Correct Answer: True) Rationale: Benefits of screening do not generally outweigh the risks in patients over 85.
27. Age-related macular degeneration is the leading cause of severe vision loss in people over 60. (Correct Answer: True) Rationale: Macular degeneration is a major cause of vision impairment in older adults.
28. Frailty syndrome in the elderly is characterized by unintentional weight gain and increased activity levels.

(Correct Answer: False) Rationale: Frailty generally involves weight loss, exhaustion, and reduced physical activity.

29. Regular weight-bearing exercise has no effect on bone density in older adults with osteoporosis. (Correct Answer: False) Rationale: Weight-bearing exercises can help to increase or maintain bone density.
30. Beta-blockers are the first-line treatment for hypertension in older adults. (Correct Answer: False) Rationale: First-line treatments often include thiazide diuretics, ACE inhibitors, or calcium channel blockers. Beta-blockers are not typically first- line unless there are other specific indications. Multiple Choice: A 65-year-old male presents with chest pain, shortness of breath, and diaphoresis. Which diagnostic test is most appropriate to confirm a suspected acute myocardial infarction? A. Echocardiogram

B. Electrocardiogram (ECG) C. Chest X-ray D. Cardiac catheterization Correct Answer: B. Electrocardiogram (ECG) Rationale: An ECG is the gold standard for diagnosing acute myocardial infarction by showing characteristic changes in the heart's electrical activity. Fill-in-the-Blank: The primary pharmacological intervention for a patient with Type 2 diabetes mellitus is __. Correct Answer: Metformin Rationale: Metformin is the first-line medication for managing Type 2 diabetes due to its efficacy, safety profile, and potential cardiovascular benefits. True/False: Acute respiratory distress syndrome (ARDS) is primarily characterized by hypercapnia. Correct Answer: False Rationale: ARDS is characterized by hypoxemia, not hypercapnia, due to impaired gas exchange in the lungs. Multiple Choice: A patient presents with acute abdominal pain, rebound tenderness, and guarding. Which condition should be suspected?

A. Cholecystitis B. Appendicitis C. Pancreatitis D. Diverticulitis Correct Answer: B. Appendicitis Rationale: Appendicitis typically presents with these symptoms and requires prompt surgical intervention to prevent complications. Fill-in-the-Blank: The Glasgow Coma Scale assesses a patient's level of __. Correct Answer: Consciousness Rationale: The Glasgow Coma Scale is used to evaluate a patient's level of consciousness based on their eye, verbal, and motor responses. True/False: Antibiotics are the first-line treatment for viral infections. Correct Answer: False Rationale: Antibiotics are ineffective against viral infections and should only be used for bacterial infections to prevent antibiotic resistance. Multiple Choice: Which of the following is a common complication of uncontrolled hypertension?

A. Cerebrovascular accident B. Hypoglycemia C. Hyperthyroidism D. Osteoporosis Correct Answer: A. Cerebrovascular accident Rationale: Uncontrolled hypertension can lead to serious complications like stroke due to the increased pressure on blood vessel walls. Fill-in-the-Blank: The presence of __ is a hallmark sign of acute kidney injury. Correct Answer: Oliguria Rationale: Oliguria, or decreased urine output, is a common sign of acute kidney injury and indicates impaired renal function. True/False: A positive Babinski reflex is a normal finding in adults. Correct Answer: False Rationale: A positive Babinski reflex in adults may indicate neurological dysfunction and requires further evaluation. Multiple Choice: Which of the following is a common side effect of long-term corticosteroid use?

A. Hypotension B. Hyperglycemia C. Hypokalemia D. Bradycardia Correct Answer: B. Hyperglycemia Rationale: Corticosteroids can lead to hyperglycemia by increasing blood glucose levels through various mechanisms. Fill-in-the-Blank: The most common arrhythmia seen in clinical practice is __. Correct Answer: Atrial Fibrillation Rationale: Atrial fibrillation is the most common sustained cardiac arrhythmia and increases the risk of stroke and heart failure. True/False: Chronic obstructive pulmonary disease (COPD) is characterized by reversible airflow obstruction. Correct Answer: False Rationale: COPD is characterized by persistent, progressive airflow limitation that is not fully reversible. Multiple Choice: Which of the following laboratory findings is indicative of iron-deficiency anemia?

A. High serum iron levels B. High ferritin levels C. Low transferrin saturation D. High total iron-binding capacity Correct Answer: D. High total iron-binding capacity Rationale: High total iron-binding capacity is a common finding in iron- deficiency anemia due to the body's attempt to increase iron absorption. Fill-in-the-Blank: The first-line treatment for anaphylaxis is __. Correct Answer: Epinephrine Rationale: Epinephrine is the first-line treatment for anaphylaxis due to its rapid onset and ability to reverse severe allergic reactions. True/False: Inflammatory bowel disease (IBD) includes conditions such as Crohn's disease and ulcerative colitis. Correct Answer: True Rationale: Inflammatory bowel disease encompasses chronic inflammatory conditions of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. Multiple Choice:

Which of the following imaging modalities is best suited for visualizing soft tissues and blood vessels? A. X-ray B. Magnetic Resonance Imaging (MRI) C. Computed Tomography (CT) D. Ultrasound Correct Answer: B. Magnetic Resonance Imaging (MRI) Rationale: MRI provides detailed images of soft tissues and blood vessels without using ionizing radiation. Fill-in-the-Blank: The primary goal of treatment in heart failure is to reduce __. Correct Answer: Afterload Rationale: By reducing afterload, the heart's workload decreases, improving cardiac function in heart failure. True/False: A positive Homan's sign is a reliable indicator of deep vein thrombosis. Correct Answer: False Rationale: Homan's sign is nonspecific and not a reliable indicator of deep vein thrombosis, requiring further diagnostic testing. Multiple Choice:

Which of the following is a common pharmacological intervention for managing hypertension in older adults? A. Lisinopril B. Atenolol C. Hydrochlorothiazide D. Metoprolol Correct Answer: A. Lisinopril Rationale: Lisinopril is often preferred for older adults due to its renal protective effects and minimal side effects. Fill-in-the-Blank: The first-line treatment for a patient with a pulmonary embolism is __. Correct Answer: Heparin Rationale: Heparin is the initial treatment for pulmonary embolism to prevent further clot propagation and embolization.

1. Multiple Choice: Which of the following is a primary concern when evaluating a geriatric patient for medication management? A) Polypharmacy B) Cost of medication C) Patient's preference D) All of the above

Correct Answer: D) All of the above Rationale: In geriatric patients, polypharmacy can lead to increased risks of adverse drug reactions and interactions. Cost can be a barrier to medication adherence, and patient preference is crucial to ensure compliance.

2. True/False: In adult gerontology, patient education should be standardized and not tailored to the individual. Answer: False Rationale: Patient education should be tailored to the individual to accommodate different learning styles, health literacy levels, and cultural backgrounds.
3. Fill-in-the-Blank: The ________ model is a framework for understanding the multifaceted nature of patients' health status and outcomes. Correct Answer: Biopsychosocial Rationale: The biopsychosocial model considers biological, psychological, and social factors in patient care, which is essential for holistic treatment.
4. Multiple Choice: When considering end-of-life care, a nurse practitioner must: A) Discuss advanced directives early in the care process B) Wait for the patient to bring up the topic C) Focus solely on the physical symptoms D) Avoid the topic unless the family initiates it Correct Answer: A) Discuss advanced directives early in the care process

Rationale: Early discussion of advanced directives ensures that patient wishes are understood and respected, facilitating patient-centered care.

5. True/False: Comprehensive geriatric assessment is a time-consuming process that has little impact on clinical outcomes. Answer: False Rationale: While comprehensive, these assessments are crucial for identifying risks and needs, leading to improved clinical outcomes and personalized care plans.
6. Fill-in-the-Blank: ________ is a common syndrome in older adults characterized by a decline in cognitive function and the ability to perform daily activities. Correct Answer: Dementia Rationale: Dementia affects memory, thinking, and social abilities significantly enough to interfere with daily functioning.
7. Multiple Choice: A nurse practitioner's role in pain management for an elderly patient includes: A) Prescribing the highest dose of analgesics as a precaution B) Assessing for both physical and psychological aspects of pain C) Ignoring mild complaints as they are common in old age D) Focusing on pharmacological interventions only Correct Answer: B) Assessing for both physical and psychological aspects of pain

Rationale: A comprehensive approach to pain includes understanding its physical and psychological dimensions to provide effective and empathetic care.

8. True/False: Delirium and depression have distinct symptoms that are easily distinguishable in geriatric patients. Answer: False Rationale: Delirium and depression can present with overlapping symptoms, making careful assessment crucial for accurate diagnosis and treatment.
9. Fill-in-the-Blank: The term ________ refers to the unintended weight loss and muscle wasting seen in older adults. Correct Answer: Sarcopenia Rationale: Sarcopenia can lead to frailty, falls, and decreased quality of life, making its recognition important in geriatric care.
10. Multiple Choice: In managing chronic diseases in older adults, the nurse practitioner should prioritize: A) Aggressive treatment to prolong life at all costs B) Quality of life and patient-centered goals C) The same protocols used for younger adults D) Non-pharmacological treatments only Correct Answer: B) Quality of life and patient-centered goals

Rationale: Management should focus on quality of life and align with the patient's goals and preferences, especially in the context of chronic conditions.

11. True/False: Cognitive screening is an optional part of the geriatric assessment. Answer: False Rationale: Cognitive screening is a vital component of the geriatric assessment to detect cognitive impairment early and manage it appropriately.
12. Fill-in-the-Blank: In geriatric patients, the risk of ________ increases due to changes in drug metabolism and excretion. Correct Answer: Drug toxicity Rationale: Age-related changes in pharmacokinetics can lead to increased sensitivity to drugs and a higher risk of toxicity.
13. Multiple Choice: The concept of 'aging in place' refers to: A) The process of adjusting the home environment to the patient's needs B) The ability to stay in a hospital for as long as needed C) Moving to a facility that provides higher levels of care D) The natural physiological changes that occur with aging Correct Answer: A) The process of adjusting the home environment to the patient's needs

Rationale: 'Aging in place' supports the desire of many elderly patients to live in their own home safely, independently, and comfortably, regardless of age or income.

14. True/False: Polypharmacy is an inevitable part of aging and should be accepted as such. Answer: False Rationale: Polypharmacy can often be avoided or managed through careful medication review and consideration of non-pharmacological interventions.
15. Fill-in-the-Blank: ________ care is a holistic approach that focuses on relief from the symptoms and stress of a serious illness. Correct Answer: Palliative Rationale: Palliative care aims to improve quality of life for both the patient and the family by addressing the physical, emotional, and spiritual needs associated with serious illness.
16. Multiple Choice: The most effective approach to fall prevention in the elderly includes: A) Limiting physical activity to reduce the risk of falls B) Comprehensive assessment and multifactorial interventions C) Solely focusing on environmental modifications D) Encouraging the use of assistive devices at all times Correct Answer: B) Comprehensive assessment and multifactorial interventions

Rationale: A multifaceted approach including assessment of risk factors, physical therapy, and environmental changes is most effective in preventing falls.

17. True/False: In gerontology, social determinants of health are less significant than medical conditions. Answer: False Rationale: Social determinants of health, such as socioeconomic status and community support, play a crucial role in the health and well-being of older adults.
18. Fill-in-the-Blank: An interdisciplinary team approach in geriatric care often includes a ________, who can assist with social and emotional challenges. Correct Answer: Social worker Rationale: Social workers play a key role in addressing the social and emotional aspects of patient care, which are integral to the holistic treatment of older adults.
19. Multiple Choice: When considering the ethical principles in geriatric care, autonomy is defined as: A) The right of the healthcare provider to make decisions for the patient B) The patient's right to make informed decisions about their own care C) The obligation to do no harm to the patient D) The duty to act in the best interest of the patient

Correct Answer: B) The patient's right to make informed decisions about their own care Rationale: Autonomy respects the patient's right to self-determination and their ability to make choices about their own health and future.

20. True/False: Geriatric syndromes, such as falls, incontinence, and delirium, are best managed in isolation rather than in the context of the patient's overall health. Answer: False Rationale: Geriatric syndromes are often interconnected and should be managed in the context of the patient's overall health to ensure comprehensive care.