Geriatric

Question 1

What intervention will the provider implement when prescribing medications to an
80-year-old patient?
a. Beginning with higher doses and decrease according to the patient’s response
b. Consulting the Beers list to help identify potentially problematic drugs
c. Ensuring that the patient does not take more than five concurrent medications
d. Reviewing all patient medications at the annual health maintenance visit

Answer 1

ANS: B
The Beers list provides a list of potentially inappropriate medications in all patients aged 65
and older and helps minimize drug-related problems in this age group. Older patients should
be started on lower doses with gradual increase of doses depending on response and side
effects. Patients who take five or more drugs are at increased risk for problems of
polypharmacy, but many will need to take more than five drugs; providers must monitor their
response more closely. Medications should be reviewed at all visits, not just annually.

Question 2

An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She
appears somewhat confused, according to her daughter, who is concerned that she is
developing dementia. The provider learns that the woman still drives, volunteers at the local
hospital, and attends a book club with several friends once a month. What is the initial step in
evaluating this patient?
a. Obtaining a CBC, serum electrolytes, BUN, and glucose
b. Ordering a CBC, serum ferritin, and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. Referring the patient to a neurologist for evaluation for AD

Answer 2

ANS: A
Patients with weight loss, confusion, and lethargy are often dehydrated and this should be
evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leading
an active life, so the likelihood that recent symptoms are related to AD, although this may be
evaluated if dehydration is ruled out. Anemia would be a consideration when dehydration is
ruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition or
AD is present.

Question 3

When should palliative care be initiated by a primary care provider?

a. After an ill patient asks for Hospice services
b. As part of routine health maintenance
c. When a patient is diagnosed with a serious disease
d. When an interdisciplinary team is formed to manage a disease

Answer 3

ANS: B
Palliative care support begins with an understanding of a patient’s preferences and helping the
patient to identify goals of care. Health care providers should initiate such discussions as a
component of the initial history of adults regardless of age or health status. Palliative care
services may be ordered when a patient is diagnosed with a serious disease; waiting until the
patient asks for Hospice services or when an interdisciplinary team is formed increases the
chances of providing end-of-life care that does not meet the patient’s needs.

Question 4

When using the “Five Wishes” approach to documenting patient preferences for end-of-life
care, the provider will document which types of preferences? (Select all that apply.)
a. A directive to avoid calling 911 at the time of death
b. A specific list of treatments the patient does not want
c. How much information to give various family members
d. The level of sedation versus alertness the patient desires
e. The people designated to make care decisions for the patient

Answer 4

ANS: C, D, E
The Five Wishes approach addresses the type of care a patient wants as a disease progresses
and is less defensive than the traditional advance directive which indicates the type of care a
patient does not want. Calling 911 may be done without requiring resuscitation if the patient
has an appropriate advanced directive in place.

Question 5

An older adult has marked decrease in muscle strength without weight loss. Which condition
does the provider suspect in this patient?
a. Cachexia
b. Kwashiorkor
c. Marasmus
d. Sarcopenia

Answer 5

ANS: D
Sarcopenia is reduced muscle mass. Cachexia includes muscle wasting following weight and
fat loss. Kwashiorkor is due to protein deficiency and marasmus is insufficient calories.

Question 6

Which non-pharmacologic intervention may be of most benefit in frail older adults to restore
physical function and improve appetite?
a. Calorie dense foods
b. Exercise
c. Increased protein
d. Nutritional drinks

Answer 6

ANS: B
Exercise may be the most beneficial intervention in frail elders because nutritional
interventions are less reliable.

Question 7

What factors may contribute to weight loss from functional anorexia in older adults? (Select
all that apply.)
a. Apathy
b. Delayed gastric emptying
c. Malabsorption
d. Pain with elimination
e. Urinary frequency

Answer 7

ANS: A, B, D
Weight loss from functional anorexia may occur because of apathy, delayed gastric emptying,
and pain with elimination, which are behavioral adaptations to unsatisfactory eating
experiences. Decreased calorie absorption causing weight loss may be due to malabsorption
and urinary frequency.