CHAPTER 18- Geriatrics

Question 1

Mr. Jones, an 89-year-old man, has recently relocated from the West Coast to be closer to his daughter who is also a patient in your office. He wants to establish a new PCP. His daughter reports that he has multiple comorbidities and is on seven prescribed medications. What medications should be assessed?

1. His prescription drugs only
2. Whatever he decides to bring to the office
3. All of his medications, including prescription drugs, OTCs, and nutritional and herbal supplements
4. Only his OTCs, because these can contribute to adverse events

Answer 1

3. All of his medications, including prescription drugs, OTCs, and nutritional and herbal supplements

Medication review of all OTC (e.g., nutritional supplements, herbals, vitamins, etc.) and prescription medications at each patient encounter is fundamental to health maintenance. In addition to the family nurse practitioner, older adults may see additional providers.

Question 2

Mr. Jones, an 89-year-old man, has recently relocated from the West Coast to be closer to his daughter who is also a patient in your office. He wants to establish a new PCP. His daughter reports that he has multiple comorbidities and is on seven prescribed medications. His medication list includes Digoxin (Lanoxin) 0.25 mg by mouth daily, which was prescribed by his previous PCP for control of his CHF and atrial fibrillation. As the new PCP, what would you exclude from your plan?

1. Measure a digoxin level.
2. Do nothing because he looks fine.
3. Consider decreasing his dose.
4. Discuss with his previous HCP.

Answer 2

1. Measure a digoxin level.

The best response is to measure his digoxin level. All of the other responses should also be considered with the exception of doing nothing. Older adults are at increased risk for digoxin toxicity, with dosages of > 0.125 mg/day.

Question 3

Mr. Jones, an 89-year-old man, has recently relocated from the West Coast to be closer to his daughter who is also a patient in your office. He wants to establish a new PCP. His daughter reports that he has multiple comorbidities and is on seven prescribed medications.His daughter, who was not present for the exam, calls at the end of the day to discuss his visit. She is concerned that her father did not provide her with all of the details. What should be the next step?

1. Provide her with a summary of the visit.
2. Ask her to come into your office to discuss it.
3. Tell her that the information can only be discussed with the patient.
4. Request a copy of his advanced directives.

Answer 3

3. Tell her that the information can only be discussed with the patient.

The Health Insurance Portability and Accountability Act (HIPPA) provides health care consumers with protection with respect to their private health information. A patient who has the mental capacity to make his/her medical decisions is not required to agree to sharing personal/medical information with family members.

Question 4

When should the medication reconciliation be done?

1. Upon request of the patient’s health care plan
2. Upon discharge from the hospital or post-acute rehab center
3. During each visit
4. Annually

Answer 4

3. During each visit

Medication reconciliation should be done at each visit. Older adults, on average, take six prescription drugs in addition to over-the-counter remedies. Also, older adults may have additional health care providers who prescribe medications. Therefore, it is essential that the family nurse practitioner reconcile medications at each visit.

Question 5

All of the following are covered under Medicare Part A EXCEPT:

1. Inpatient hospital care.
2. Hospice services.
3. Durable medical equipment.
4. Short-term rehab.

Answer 5

3. Durable medical equipment.

Durable medical equipment is covered under Medicare Part B.

Question 6

Delirium in the elderly is associated with functional decline, increased use of chemical and physical restraints, prolonged delirium post hospitalization, and increased mortality. Predisposing risk factors for delirium include older age, multiple comorbidities, a recent severe illness, past ETOH abuse, hearing or vision impairments, and a past history of delirium. Which of the following is the best tool to assess a patient for delirium?

1. Geriatric Depression Scale
2. MMSE (Mini Mental State Exam)
3. CAGE Test
4. CAM (Confusion Assessment Method)

Answer 6

4. CAM (Confusion Assessment Method)

The best way to assess for delirium is the CAM (Confusion Assessment Method). The CAGE is used to assess ETOH abuse. The MMSE is used to assess cognition in older adults.

Question 7

Mrs. White is 85 years old and lives in her own house. Her husband died about 3 years ago. Mrs. White has two daughters who live about 30 minutes from her. Although she talks to them daily, she has not seen them in over 2 weeks. On her most recent visit to the office, she reports that she continues to experience considerable pain from her left hip and has been more and more disabled by this for the past 6 months. She states that she is on a waiting list for a hip replacement. In general, she states, “I feel miserable and I no longer enjoy reading or gardening. I have no energy and everything is an effort.”

1. Tell her that the symptoms she is experiencing are likely due to old age.
2. Check a UA if positive C and S.
3. Perform a Geriatric Depression Scale.
4. Recommend that she move to an assisted living facility because there will be staff that can assist her with her ADLs.

Answer 7

3. Perform a Geriatric Depression Scale.

The Geriatric Depression Scale is a valid and reliable assessment tool to screen for depression in the clinical setting. It is available in a short and long form. It does not assess for suicide risk.

Question 8

Mr. Sanchez is a 76-year-old Hispanic male hospitalized for a right total knee replacement. Prior to his discharge, he was diagnosed with a deep vein thrombosis (DVT) in his right lower extremity. His nurse reports increased confusion in the past 13 hours. Mr. Sanchez has been trying to climb out of bed, is agitated, tugging on his Foley catheter, pushing at the staff, calling out for his family, and has not responded to redirection. His labs are reported “within normal limits.” His vital signs are stable. The most likely cause is:

1. Mr. Sanchez is agitated that he can’t go home as promised.
2. He developed an infection post-surgery.
3. Depression, which he should be screened for.
4. Hospital-acquired delirium.

Answer 8

4. Hospital-acquired delirium.

Hospital-acquired delirium is the most likely cause. Elderly patients who are hospitalized are at increased risk of delirium. Precipitating factors include medications, psychological stressors, sensory overload, nutritional deficiencies, etc.

Question 9

Which of the following statements is the most accurate description of Alzheimer’s disease (AD)?

1. The disease is reversible with pharmacological treatment modalities, including Aricept (donepezil) and Namenda.
2. The disease is progressive.
3. The disease is characterized by remissions and exacerbations.
4. Over 50% of older adults will develop AD at some time.

Answer 9

2. The disease is progressive.

Alzheimer’s disease is a progressive disease. There is no cure available at this time.

Question 10

The Geriatric Comprehensive Assessment (GCA) includes all of the following EXCEPT:

1. Functional health.
2. Physical health.
3. Quality of life measures.
4. Exercise regimen.

Answer 10

4. Exercise regimen.

The domains of the Geriatric Comprehensive Assessment include physical health, functional health, physiological health, socio-environmental supports, and quality of life measures.

Question 11

The only acetyl cholinesterase inhibitor (ACHI) approved to treat moderate to severe dementia is:

1. Exelon (rivastigmine).
2. Aricept (donepezil).
3. Namenda (memantine).
4. Razadyne (galantamine).

Answer 11

2. Aricept (donepezil).

The only acetyl cholinesterase inhibitor approved to treat moderate to severe dementia is Aricept (donepezil).

Question 12

JNC 8 recommends:

1. lowering BP
2. SBP
3. ETOH intake at 2 ounces/day.
4. Anaerobic exercise of up to 30 minutes most days.

Answer 12

2. SBP

The JNC 8 recommends that older adults 60++ without chronic kidney disease or diabetes should have a SBP < 150 mmHg or DBP < 90 mmHg.

Question 13

The FNP is preparing to do a round on hospital patients in the a.m., prior to going to your office. Which of these hospitalized patients should be checked on first?

1. A 67-year-old male who had a Right BKA yesterday, following a motor vehicle accident who is complaining of phantom pain
2. A 76-year-old female, who is less than 24 hours post, complaining of back pain with a new onset of urinary incontinence
3. An 80-year-old male who received 2 units of packed red blood cells (PRBCs) the previous day for a suspected upper gastrointestinal bleed (GI)
4. A 90-year-old nursing home patient who is scheduled for an endoscopy later in the day, who demands that she have her breakfast

Answer 13

2. A 76-year-old female, who is less than 24 hours post, complaining of back pain with a new onset of urinary incontinence

The patient that should be evaluated first is the 76-year-old female who is less than 24 hours post op, complaining of back pain with a new onset of urinary incontinence. This is a red flag and should be further evaluated. All of the other responses, although important, are secondary to this scenario.

Question 14

The FNP has just seen Mr. Lyons, an elderly patient in the practice with suspected osteoarthritis of the hip. What is the most distinguishing characteristic of the physical examination?

1. Gait abnormality
2. Pain with external or internal rotation
3. Joint instability
4. Crepitus

Answer 14

1. Gait abnormality

The most distinguishing characteristic of the physical examination for suspected osteoarthritis of the hip is gait abnormality. Patients with osteoarthritis of the hip routinely present with an antalgic gait to avoid pain in the affected hip.

Question 15

Recommended immunizations for adults 65+ include:

1. An annual influenza vaccine, TDAP vaccine every 5 years, shingles vaccination, pneumococcal vaccine(s) 13 and 23
2. TDAP vaccine every 10 years, annual influenza vaccine, shingles vaccine after age 60, pneumococcal vaccine(s) 13 and 23
3. An annual influenza vaccine, annual pneumococcal vaccines, TDAP every 10 years, and shingles vaccine after age 60
4. Shingles vaccine—2 doses given 6 months apart, TDAP every 10 years, annual influenza vaccine, pneumococcal vaccines 13 and 23

Answer 15

2. TDAP vaccine every 10 years, annual influenza vaccine, shingles vaccine after age 60, pneumococcal vaccine(s) 13 and 23

Recommended immunizations for adults 65+ include TDAP every 10 years, an annual influenza vaccine, a shingles vaccine after the age of 60, and pneumococcal vaccines 13 and 23. The other responses are not correct.

Question 16

A patient presents to the office who has multiple comorbidities and is taking multiple prescription medications to manage his chronic diseases. He is concerned about the rising cost of his medications. He will soon be enrolling in Medicare. Which Medicare Plan would help cover his prescription drugs?

1. Medicare A
2. Medicare B
3. Medicare C
4. Medicare D

Answer 16

4. Medicare D

Medicare Part D is referred to as the Medicare prescription drug benefit and helps to offset the costs associated with outpatient drug coverage. Medicare Part A covers hospitalization, skilled nursing services, and hospice care. There is no cost to enroll if the beneficiary has worked and paid Social Security taxes for a minimum of 40 calendar quarters. If the beneficiary has not contributed, there may be a monthly premium required. Medicare Part B covers outpatient services (e.g., diagnostics, visits to health care providers, etc.) and durable medical equipment. Medicare Part C allows private insurance companies to provide health benefits (e.g., Medicare Advantage plans).

Question 17

The prevalence of elder abuse in this country is estimated to be approximately __________, according to epidemiological studies.

1. 50–60%
2. less than 1%
3. 2–10%
4. 12–35%

Answer 17

3. 2–10%

The prevalence of elder abuse in this country is estimated to be 2 to 10%. Unfortunately, this is a fraction of the cases that should be reported to Protective Services for the elderly. The family nurse practitioner should be aware of mandated reporting of elder abuse in the state of practice.

Question 18

Which of the following is NOT included in the definition of elder abuse, according to the National Center of Elder Abuse?

1. Physical abuse
2. Abandonment
3. Financial exploitation
4. All of these can be considered in the definition.

Answer 18

4. All of these can be considered in the definition.

These are all included in the definition of elder abuse.

Question 19

Therapeutic communication with older adults include:

1. Talking to family members who are present to elicit a comprehensive health history.
2. Speaking slowly in a deep tone and addressing your questions to the patient.
3. Standing close to ensure they will hear you.
4. Addressing the patient by their first name to create a “friendly atmosphere.”

Answer 19

2. Speaking slowly in a deep tone and addressing your questions to the patient.

The most appropriate response is to speak slowly in a deep tone and address your questions to the patient. When interviewing the patient, the family nurse practitioner should be seated face to face with the patient. Do not assume that the patient wants to be called by his/her first name. It is important to ask how they wish to be addressed.

Question 20

Goals of geriatric care include:

1. Maintaining function and quality of life.
2. Having a signed advance directive.
3. An aggressive plan of care that is curative.
4. Complying with the family’s requests.

Answer 20

1. Maintaining function and quality of life.

The goals of geriatric care are to provide safe, comprehensive, and cost-effective quality health care based on evidence-based practice to maintain and/or optimize function and improve the quality of life.

Question 21

When prescribing for an older adult, all should be considered EXCEPT:

1. Beer’s Criteria.
2. Pharmacodynamics.
3. McGeer’s Criteria.
4. Pharmacokinetics.

Answer 21

3. McGeer’s Criteria.

McGeer’s criteria utilizes guiding principles that define infections (e.g., UTIs) in the long-term care setting using specific benchmarks. All of the other responses should be considered.

Question 22

Anatomical and physiological changes occur as a result of the aging process. Which is a normal, non-pathological change related to the respiratory system?

1. Improved coughing reflex
2. Increase in A/P chest diameter
3. Decreased residual volume
4. Tissue elasticity increased

Answer 22

2. Increase in A/P chest diameter

Increase in A/P chest diameter is a normal, non-pathological change related to the respiratory system.

Question 23

Screening instruments used to evaluate cognition include all of the following EXCEPT:

1. Clock drawing test.
2. MRI of brain.
3. MMSE.
4. SLUMS.

Answer 23

2. MRI of brain.

The use of an MRI of the brain for screening is not supported. All of the other responses can be done by the family nurse practitioner and are considered to be an important part of the screening process.

Question 24

According to the American Geriatrics Society, the hemoglobin A1C (HgbA1C) goal for an older adult with 3 multiple comorbidities or mild to moderate cognitive impairment should be:

1. Individualized for each patient.
2. HgbA1C
3. HgbA1C between 6.5–7.0.
4. HgbA1C between 7.5–8.0.

Answer 24

4. HgbA1C between 7.5–8.0.

The American Geriatric Society supports the HgbA1c recommendation of the American Diabetes Association for older adults with 3 or more multiple comorbidities or mild to moderate cognitive impairment. The final decision for each patient should involve patient and provider goals.

Question 25

Which class of drug should be used cautiously in older adults with diabetes, due to the increased risk of hypoglycemia?

1. Biguanides
2. Sulfonylureas
3. DPP-IV
4. SGLT2

Answer 25

2. Sulfonylureas

Sulfonyureas should not be used as a first choice for treating diabetes. The first-generation sulfonylureas have been shown to increase the risk of hypoglycemia in older adults. The second-generation sulfonylureas, which include glipizide, are a better choice, in addition to other treatment options.

Question 26

The USPSTF recommends primary, secondary, and tertiary preventive services. Which of the following is not considered a primary preventive service?

1. Smoking cessation
2. Mammogram
3. Immunizations
4. Physical activity

Answer 26

2. Mammogram

A mammogram is a secondary form of prevention. The intent of primary prevention is to implement measures to avert the onset of disease or illness. Secondary preventive practices include those activities aimed at early detection to prevent or slow down the disease process, as well as disability.

Question 27

Visible signs of intrinsic aging related to the integumentary system include all of the following EXCEPT:

1. Increased melanin production.
2. Decreased pigmentation.
3. Ridging of nail.
4. Loss or increase of subcutaneous fat deposition.

Answer 27

1. Increased melanin production.

Increased melanin production is an extrinsic cause of aging. Decreased pigmentation, ridging of nails, and the loss or increase of subcutaneous fat deposits are all related to intrinsic aging changes that occur in the integumentary system.

Question 28

Older adults are at increased risk for abuse. Risk factors for elder abuse do NOT include:

1. Substandard living arrangements to meet the needs of older adults.
2. The education level of caregivers.
3. Social isolation.
4. Family stressors.

Answer 28

2. The education level of caregivers.

The education level of caregivers is not considered. The family nurse practitioner must understand that elder abuse does not discriminate by level of education. The increased risk for elder abuse is multifactorial and includes societal, relational, community, as well as individual factors that lead to abuse.

Question 29

Which of the following is the most common form of anemia diagnosed in older adults?

1. Iron (Fe) deficiency anemia
2. Cooley’s anemia
3. Anemia of chronic kidney disease
4. Vitamin B12 deficiency

Answer 29

3. Anemia of chronic kidney disease

Anemia of chronic disease is the most common anemia found in older adults. Cooley’s anemia is the most severe type of beta thalassemia, often requiring blood transfusions. Iron deficiency anemia can be found in older adults. It is a microcytic anemia which can be the result of acute blood loss due to malignancy or gastrointestinal pathology. Vitamin B12 deficiency is a macrocytic anemia. It is treatable and usually presents with another underlying medical illness.

Question 30

Which of the following statements is true regarding suicide rates?

1. Non-married women are more at risk.
2. Caucasian men 85 and older are more at risk.
3. Hispanic men of any age are more at risk.
4. African American widowers are more at risk.

Answer 30

2. Caucasian men 85 and older are more at risk.

The greatest suicide rate occurs in Caucasian males 85+.

Question 31

The FNP is seeing Mr. Larson, a 65-year-old male, for the “Welcome to Medicare” exam. As required by Medicare guidelines, the FNP begins the discussion regarding end-of-life planning. Mr. Larson becomes visibly shaken and states, “I plan on being around for a while. Look at me. I am as fit as a teenager.” Which of the following responses is best?

1. End-of-life care planning is mandatory in all 50 states once you go on Medicare.
2. You are right, Mr. Larson, you are a healthy man. Therefore, there is no further need for discussion at this time.
3. Once they are written, they cannot be changed.
4. End-of-life care planning, which includes designating a Health Care Proxy and Advance Directives, ensures that your preferences for end-of-life care are specified if you are unable to make medical decisions or speak for yourself.

Answer 31

4. End-of-life care planning, which includes designating a Health Care Proxy and Advance Directives, ensures that your preferences for end-of-life care are specified if you are unable to make medical decisions or speak for yourself.

Advance care planning is an ongoing process that should begin in the primary care setting and be addressed periodically whether the patient is young and healthy, is managing a chronic disease, or is living with a terminal illness. Advance care planning, or end-of-life care planning ensures that the patients’ preferences for end-of-life care treatment are specified and followed if the patient is no longer able to make health care decisions or speak for themselves. Although the signing of an Advance Directive is encouraged, the role of the family nurse practitioner should include providing education to ensure a clearer understanding of the process.

Question 32

The family nurse practitioner is seeing Mrs. Watson, an elderly woman who appears much older than her stated age. Mrs. Watson is accompanied by her son, John. Over the past few weeks, Mrs. Watson has been seen in the ER multiple times after falling and using her Life Alert to call for help. The discharge planner recommended she be seen for a follow-up after her recent admission for a subdural hematoma. The FNP reviews her discharge summary, including consults, labs, and other diagnostics. Her visit today is not significantly different from her baseline, with the exception of bilateral lower extremity weakness. The next step is:

1. Instruct the patient to keep a “fall diary.”
2. Order durable medical equipment (e.g., bedside commode, walker).
3. Perform the “get up and go test.”
4. Report her to Social Services because she is not able to care for herself.

Answer 32

3. Perform the “get up and go test.”

The best response is to perform the “Get up and Go Test.” The purpose of the test is to check mobility. A patient that scores a 3 or more is at increased risk for falls.

Question 33

Which of the following statements is correct? By the year 2040,

1. There will be about 100 million older people, twice the number seen in 2000.
2. There will be a decrease in ethnic and minority populations.
3. The number of people who are 85+ is projected to triple from 6 million in 2013 to 14.6 million in 2040.
4. There will be no significant changes.

Answer 33

3. The number of people who are 85+ is projected to triple from 6 million in 2013 to 14.6 million in 2040.

It is estimated that the population growth for those 85+ will triple from 6 million in 2013 to 14.6 million by 2040. Ethnic and minority populations will continue to grow.

Question 34

The major sources of income for older adults include all of the following EXCEPT:

1. “Gifting” by family members, as allowed by the Internal Revenue Service.
2. Social Security.
3. Assets.
4. Pensions.

Answer 34

1. “Gifting” by family members, as allowed by the Internal Revenue Service.

Gifting is not a major source of income for older adults. Social Security, pensions, and assets provide income for older adults.

Question 35

The underlying characteristics of Alzheimer’s disease includes:

1. Atrophy of the brain.
2. Atherosclerotic changes in the cerebral and carotid arteries.
3. Amyloid plaques and neurofibrillary tangles.
4. Multi-microvascular infarcts of the cerebellum.

Answer 35

3. Amyloid plaques and neurofibrillary tangles.

Amyloid plaques and neurofibrillary tangles are the hallmark characteristics of Alzheimer’s disease.

Question 36

Which of the following is NOT a concern when caring for the elderly?

1. Visual changes
2. Increased sensitivity to heat or pain
3. Gait or balance instability
4. Diminished reaction time when behind the wheel of a car

Answer 36

2. Increased sensitivity to heat or pain

Older adults often present with a decreased sensitivity to heat or pain due to physiological changes secondary to normal aging that affect the structure and function of the nervous system.

Question 37

Which of the following is a common skin condition seen in older adults?

1. Contact dermatitis
2. Pressure ulcers
3. Stasis dermatitis
4. Fifth Disease

Answer 37

3. Stasis dermatitis

Stasis dermatitis is a common skin condition in older adults. It is characterized by pruritus, discoloration or hyperpigmentation of lower extremities, and edema. Contact dermatitis is a rash that occurs when the skin comes in contact with a foreign substance. Fifth Disease is a virus that is more common in children than older adults.

Question 38

Contributing factors associated with an increased risk of falls in older adults include all of the following EXCEPT:

1. Osteoporosis.
2. Auditory changes.
3. Urinary incontinence.
4. Cardiovascular disease.

Answer 38

2. Auditory changes.

Auditory changes do not increase the risk for falls. The risk for falls increases in older adults due to underlying comorbidities, medications, and contributing risk factors.

Question 39

The first-line drugs for treating hypertension in older adults includes all of the following EXCEPT:

1. ACEI or ARB.
2. Thiazide diuretic.
3. Beta-blockers.
4. Calcium channel blockers.

Answer 39

3. Beta-blockers.

Beta-blockers are not typically used for first-line treatment of hypertension in older adults, unless they have ischemic heart disease or heart failure.

Question 40

Health care providers working with older adults refer to activities of daily living (ADLs) and instrumental activities of daily living (IADLs) to assess independent living skills. Which of the following is NOT considered to be an activity of daily living (ADL)?

1. Feeding
2. Medication management
3. Dressing
4. Bathing

Answer 40

2. Medication management

Medication management is an example of an IADL. ADLs include bathing, continence, dressing, eating, toileting, and transfer. IADLs include the ability to use a phone, shopping, food preparation, housekeeping, laundry, transportation, medication management, and the ability to manage one’s finances.

Question 41

Osteoporosis is a disease in which decreased bone mass results in an increased risk for bone fracture and bone frailty. What is the most common fracture associated with osteoporosis?

1. Hip fracture
2. Vertebral fracture
3. Distal radial fracture (Colles fracture)
4. All of these have the same incidence of occurrence.

Answer 41

2. Vertebral fracture

The most common fracture associated with osteoporosis is a vertebral fracture. It is estimated that more than 700,000 new vertebral fractures occur in this country, accounting for expenditures close to 1.5 billion dollars annually, as well as an increase in hospital admissions.

Question 42

What is the leading cause of blindness in older adults?

1. Cataracts
2. Detached retina
3. Glaucoma
4. Macular degeneration

Answer 42

4. Macular degeneration

Macular degeneration is the leading cause of vision loss in adults 65 and over. It causes vision loss in the center of the vision field.

Question 43

Hearing loss impacts an estimated one-third of older adults between the ages of 61 and 74 and continues to rise as one ages. Which of the following is presbycusis most commonly associated with?

1. Cholesteatoma
2. Ototoxic drugs
3. Cerumen impaction
4. Loss of high-frequency sounds

Answer 43

4. Loss of high-frequency sounds

Presbycusis is a hearing loss in older adults. It is associated with a failure to hear high-frequency sounds.

Question 44

Which of the following is characterized by a waxy papule with a stuck-on appearance?

1. Basal cell carcinoma
2. Sebaceous cyst
3. Seborrheic keratosis
4. Squamous cell carcinoma

Answer 44

3. Seborrheic keratosis

A seborrheic keratosis is a benign finding and can appear anywhere on the body. It can vary in color and has a stuck-on appearance. Basal cell carcinoma is a malignant finding that appears as a pearly white, dome-shaped papule with a bleeding, crusted ulcerative center. A sebaceous cyst is a circumscribed dermal lesion with overlying punctum. Squamous cell carcinoma is found on the head, neck, hands, and sun-exposed areas. It is red on a poorly defined base with a necrotic crusted center.

Question 45

Which of the following drugs is least likely to cause ototoxicity (resulting in hearing loss)?

1. Sildenafil (Viagra)
2. Salicylates
3. Loop diuretics (e.g., Lasix [furosemide])
4. Acetyl cholinesterase inhibitors (e.g., Aricept, Exelon, Rivastigmine)

Answer 45

4. Acetyl cholinesterase inhibitors (e.g., Aricept, Exelon, Rivastigmine)

Acetyl cholinesterase inhibitors do not cause ototoxicity. Commonly used prescription and non-prescription medications can cause ototoxicity. The list includes non-steroidal, salicylates, acetaminophen, sildenafil, macrolides, aminoglycosides, topical preparations containing neomycin/polymixin B, and some chemotherapeutic drugs.

Question 46

Physiological and anatomical changes related to normal aging can present atypically with symptomatology not observed in other populations. Older adults with a UTI may exhibit:

1. Urinary incontinence and dehydration.
2. A change in mental status, falls, and dehydration.
3. Complaints of pain, urinary incontinence, and a change in appetite.
4. Dementia, weight gain, and a change in appetite.

Answer 46

2. A change in mental status, falls, and dehydration.

Atypical presentations of acute illness in older adults is common given the physiological changes of aging complicated by underlying comorbidities. Changes in cognition and/or physical function provide the family nurse practitioner with “clues” of an acute illness. Atypical symptoms associated with a UTI in an older adult can include increased confusion, falls, lethargy, cough, weakness, abdominal pain, anorexia, and dehydration.

Question 47

The guiding principles that define the decision “to treat or not to treat” a suspected UTI in an older adult residing in a skilled nursing facility is based on multiple factors. Using McGeer’s criteria for a voided urine, which of the following should not be considered?

1. New or increased incontinence
2. Characteristic changes of urine
3. Single oral temperature of >100 degrees Fahrenheit
4. Dysuria

Answer 47

2. Characteristic changes of urine

Characteristic changes in the urine are no longer included. The McGeer criteria, developed in 1991 and updated in 2012, defines the guiding principles “to treat or not to treat” a suspected UTI in an older adult residing in a skilled nursing facility. It includes fever (e.g., single temperature greater than 100 degrees Fahrenheit or repeated temperatures greater than 99 degrees Fahrenheit), leukocytosis (>14,000 wbc/mm3, shift to the left > or > to 1500 bands/mm3), an acute change in mental status from the baseline, and acute functional decline.

Question 48

Which of the following statements is true?

1. The USPSTF recommends that colorectal screening continue to age 85.
2. The use of computed tomographic colonography is preferred over colonoscopy and yields better results in older adults.
3. The USPSTF recommends against routine screening for colorectal cancer in older adults age 76 to 85 years old.
4. Screening for colorectal cancer should continue throughout one’s lifetime, beginning at age 50.

Answer 48

3. The USPSTF recommends against routine screening for colorectal cancer in older adults age 76 to 85 years old.

The USPSTF recommends against routine screening for colorectal cancer in older adults age 76 to 85 years old. The decision to screen should be individualized to the patient.

Question 49

The components of a nutritional assessment for an older adult includes all the following EXCEPT:

1. A food intake diary of 1 to 3 days.
2. A physical assessment including anthropometric measures.
3. A meal preparation assessment.
4. Use of a valid nutritional screening tool.

Answer 49

3. A meal preparation assessment.

Meal preparation assessment may be included with an occupational therapy evaluation. The components of a nutritional assessment include: a food intake diary, the use of a valid screening tool, physical assessment including anthropometric measures, and biomarkers.