Geriatric Psychiatry: Optimizing Care for Older Adults, Exams of Nursing

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PMH 504

Psychiatric Management of Adult

& Geriatric Patients

MIDTERM EXAM REVIEW

1. Multiple Choice: Which medication is considered first-line treatment for a 70 - year-old patient with newly diagnosed schizophrenia? a) Haloperidol b) Clozapine c) Risperidone d) Olanzapine Correct Answer : c) Risperidone Rationale: Risperidone is often chosen for geriatric patients due to its lower risk of extrapyramidal symptoms and better tolerability.
2. True/False: Electroconvulsive therapy (ECT) is contraindicated in elderly patients with major depressive disorder. Answer : False Rationale: ECT can be safe and effective for geriatric patients, especially those who do not respond to medication or have severe depression.
3. Fill-in-the-Blank: The antipsychotic medication _______ has a high risk of causing metabolic syndrome, which is a significant consideration in managing geriatric patients.

Correct Answer : Olanzapine Rationale: Olanzapine is associated with weight gain, hyperglycemia, and dyslipidemia, which contribute to metabolic syndrome.

4. Multiple Response: Select all that apply. What are the potential side effects of benzodiazepines in geriatric patients? a) Increased risk of falls b) Cognitive impairment c) Respiratory depression d) All of the above Correct Answer s: a) Increased risk of falls, b) Cognitive impairment, c) Respiratory depression Rationale: Benzodiazepines can cause sedation, impaired motor coordination, and cognitive dysfunction, leading to an increased risk of falls and respiratory depression in the elderly.
5. Multiple Choice: A 65-year-old patient with bipolar disorder is experiencing a manic episode. Which of the following mood stabilizers is preferred due to its lower risk profile in older adults? a) Lithium b) Valproate c) Carbamazepine

d) Lamotrigine Correct Answer : d) Lamotrigine Rationale: Lamotrigine has a favorable side effect profile compared to other mood stabilizers and is less likely to cause renal or cognitive issues in the elderly. True/False: Antidepressants should be avoided in geriatric patients due to the high risk of side effects. Answer : False Rationale: While caution is necessary due to potential side effects, antidepressants are a critical component of treatment for depression in geriatric patients. The benefits often outweigh the risks when used judiciously Multiple Choice: Which of the following medications is considered a first-line treatment for generalized anxiety disorder (GAD)? A) Fluoxetine B) Diazepam C) Amitriptyline D) Sertraline Correct Answer : D) Sertraline

Rationale: Sertraline, a selective serotonin reuptake inhibitor (SSRI), is effective for the treatment of GAD, while other options are less preferred. Fill-in-the-Blank: The __ scale is commonly used to assess the severity of depression in geriatric patients. Correct Answer : Geriatric Depression Scale (GDS) Rationale: The GDS is specifically designed for older adults to evaluate depressive symptoms accurately. True/False: Cognitive Behavioral Therapy (CBT) is an effective treatment modality for both adult and geriatric populations. Correct Answer : True Rationale: CBT has been shown to be effective in treating various psychiatric disorders across different age groups. Multiple Response: Which of the following symptoms are indicative of delirium? (Select all that apply.) A) Fluctuating levels of consciousness B) Hallucinations

C) Persistent depressive mood D) Disorientation Correct Answer s: A) Fluctuating levels of consciousness, B) Hallucinations, D) Disorientation Rationale: Delirium is characterized by acute confusion and changes in consciousness, while persistent depressive mood is not a symptom of delirium. Multiple Choice: The most appropriate pharmacological intervention for a patient with severe agitation and psychosis due to dementia is: A) Haloperidol B) Sertraline C) Lithium D) Metformin Correct Answer : A) Haloperidol Rationale: Haloperidol, an antipsychotic, is often used to manage acute agitation and psychosis in dementia patients. Fill-in-the-Blank: The __ is a diagnostic tool used to assess cognitive function in older adults.

Correct Answer : Mini-Mental State Examination (MMSE) Rationale: The MMSE is widely utilized to evaluate cognitive impairment among the elderly. True/False: Electroconvulsive therapy (ECT) is contraindicated in geriatric patients. Correct Answer : False Rationale: ECT can be effective and is often used in geriatric patients with severe depression when other treatments fail. Multiple Response: Which of the following are potential side effects of antipsychotic medications in elderly patients? (Select all that apply.) A) Extrapyramidal symptoms B) Weight gain C) Hypertension D) Sedation Correct Answer s: A) Extrapyramidal symptoms, B) Weight gain, D) Sedation Rationale: Elderly patients are particularly susceptible to these side effects due to age-related physiological changes.

Multiple Choice: The primary goal of advance care planning in geriatric psychiatric patients is to: A) Ensure aggressive treatment B) Define patient preferences for future care C) Minimize medication side effects D) Prevent hospital admissions Correct Answer : B) Define patient preferences for future care Rationale: Advance care planning focuses on understanding and respecting the patient's wishes regarding their future medical care. Fill-in-the-Blank: __ is the term used to describe the increased sensitivity to medications often seen in older adults. Correct Answer : Pharmacodynamics Rationale: Pharmacodynamics explains how the effects of drugs may be amplified in elderly patients due to physiological changes. True/False: Anxiety disorders are more prevalent in geriatric populations than in younger adults.

Correct Answer : False Rationale: While anxiety can be significant in geriatric populations, it is not necessarily more prevalent than in younger adults. Multiple Response: Which of the following strategies are effective in managing behavioral symptoms in dementia? (Select all that apply.) A) Validation therapy B) Physical restraints C) Structured routines D) Environmental modifications Correct Answer s: A) Validation therapy, C) Structured routines, D) Environmental modifications Rationale: These strategies promote better behavioral management by addressing the emotional needs and environmental context of patients. Multiple Choice: The most common type of dementia among older adults is: A) Frontotemporal dementia B) Vascular dementia

C) Alzheimer's disease D) Lewy body dementia Correct Answer : C) Alzheimer's disease Rationale: Alzheimer's disease accounts for a significant majority of dementia cases in the elderly. Fill-in-the-Blank: The __ model emphasizes the importance of understanding the interaction between biological, psychological, and social factors in mental health. Correct Answer : Biopsychosocial Rationale: The biopsychosocial model provides a comprehensive approach to understanding mental health and its treatments. True/False: Depression in elderly patients often presents with typical symptoms such as sadness and hopelessness. Correct Answer : False Rationale: In older adults, depression may manifest with atypical symptoms such as fatigue, apathy, and cognitive impairments rather than classic symptoms. Multiple Response:

Which of the following are considered risk factors for suicide in geriatric patients? (Select all that apply.) A) Chronic illness B) Social isolation C) High socioeconomic status D) History of psychiatric disorders Correct Answer s: A) Chronic illness, B) Social isolation, D) History of psychiatric disorders Rationale: These factors significantly contribute to the risk of suicide among older adults. Multiple Choice: Which type of therapy focuses on improving communication and social skills among psychiatric patients? A) Supportive therapy B) Interpersonal therapy C) Family therapy D) Psychodynamic therapy Correct Answer : B) Interpersonal therapy Rationale: Interpersonal therapy centers on enhancing interpersonal relationships and social functioning.

Fill-in-the-Blank: __ is the term for a sudden change in cognition and attention in older adults, often reversible. Correct Answer : Delirium Rationale: Delirium is characterized by an acute onset of confusion and is often triggered by medical conditions. True/False: Medications for managing psychiatric conditions in geriatric patients should always be prescribed at the same dosage as for younger adults. Correct Answer : False Rationale: Dosage adjustments are often necessary due to age- related pharmacokinetic and pharmacodynamic changes. Multiple Response: Which of the following interventions can help prevent functional decline in elderly patients with mental health issues? (Select all that apply.) A) Regular physical activity B) Social engagement C) Medication adherence D) Cognitive stimulation

Correct Answer s: A) Regular physical activity, B) Social engagement, D) Cognitive stimulation Rationale: These interventions are essential for maintaining cognitive function and overall well-being in the elderly.

1. What is the first-line treatment for generalized anxiety disorder (GAD) in older adults? A) Benzodiazepines B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants D) Atypical antipsychotics Correct Answer : B Rationale: SSRIs are generally preferred over benzodiazepines due to their lower risk of dependence, especially in older adults.
2. In the management of major depressive disorder in geriatrics, which of the following should be considered before starting medication? A) Gender B) Cognitive status C) Family history of depression

D) Previous treatment failures Correct Answer : B Rationale: Cognitive status can significantly impact medication choices and patient safety in geriatric patients.

3. Which of the following medications is MOST likely to cause anticholinergic side effects? A) Sertraline B) Quetiapine C) Amitriptyline D) Lurasidone Correct Answer : C Rationale: Amitriptyline, a tricyclic antidepressant, has a high potential for anticholinergic side effects compared to the other options.
4. What is the proposed mechanism of action for esketamine nasal spray in treatment-resistant depression? A) Dopamine agonism B) NMDA receptor antagonism C) MAO inhibition D) Serotonin reuptake inhibition

Correct Answer : B Rationale: Esketamine acts as an NMDA receptor antagonist, which is a novel mechanism for treating depression.

Fill-in-the-Blank Questions

5. The __________ model emphasizes the importance of understanding the broad context including social, psychological, and biological factors in the treatment of psychiatric disorders. Correct Answer : bio-psycho-social Rationale: The bio-psycho-social model integrates various aspects that contribute to mental health.
6. In older adults, the use of __________ increases the risk of falls and fractures due to sedation and cognitive impairment. Correct Answer : benzodiazepines Rationale: Benzodiazepines can cause sedation and cognitive dysfunction more often in older patients.
7. The clinical treatment of delirium primarily requires interventions such as __________ and maintaining proper hydration and nutrition. Correct Answer : addressing the underlying cause

Rationale: Treating the underlying cause is essential in managing delirium effectively.

8. In treating patients with bipolar disorder, it is crucial to avoid the use of __________ as it may precipitate manic episodes. Correct Answer : antidepressants Rationale: Using antidepressants alone can trigger mania in individuals with bipolar disorder.

True/False Questions

9. True or False: Cognitive Behavioral Therapy (CBT) is as effective as medication for treating anxiety disorders in older adults. Correct Answer : True Rationale: CBT can be equally effective, especially considering its lack of side effects compared to pharmacotherapy.
10. True or False: Electroconvulsive Therapy (ECT) is considered a last-resort treatment for severe depression, even in elderly patients. Correct Answer : False Rationale: ECT can be a first-line treatment in severe depression and has been shown to be safe and effective in older adults.

11. True or False: Antidepressants may take weeks to show effects, requiring monitoring for side effects during the initial treatment phase. Correct Answer : True Rationale: Antidepressant effects typically take several weeks, necessitating vigilant observation for side effects initially.
12. True or False: Suicide risk is higher in elderly men compared to elderly women. Correct Answer : True Rationale: Elderly men are at a greater risk of suicide due to various factors, including social isolation and depression.

Multiple Response Questions

13. Which of the following symptoms are commonly seen in patients with dementia? (Choose all that apply) A) Memory loss B) Euphoria C) Disorientation D) Difficulty with language

Correct Answer s: A, C, D Rationale: Memory loss, disorientation, and language difficulties are hallmark symptoms of dementia.

14. For patients on antipsychotic medication, which of the following side effects should be regularly monitored? (Select all that apply) A) Extrapyramidal symptoms B) Hyperglycemia C) Insomnia D) Weight gain Correct Answer s: A, B, D Rationale: Patients on antipsychotics need monitoring for extrapyramidal symptoms, metabolic syndrome (including hyperglycemia), and weight gain.
15. Which of the following factors can contribute to medication non-adherence in older adults? (Choose all that apply) A) Cognitive decline B) Complex medication regimens C) Social support D) Physical limitations

Correct Answer s: A, B, D Rationale: Cognitive decline and complex regimens can hinder adherence, as can physical limitations.