Geriatrics (Ch. 20) - Bates/Sullivan

Question 1

Decreased ___ and ___ production can impair responses to heat. Declines in thirst may cause ___. Physiologic drops in ___ ___, left ___ ___, and maximum ___ ___ may be impaired.

Answer 1

vasoconstriction, sweat, dehydration, cardiac output, ventricular filling, heart rate

Question 2

Systolic ___ w/a widened ___ ___ often ensues d/t the aorta and large arteries stiffening and becoming ___.

Answer 2

HTN, pulse pressure, atherosclerotic

Question 3

Changes in skin integrity and SQ tissue makes the elderly susceptible to ___.

Answer 3

hypothermia

Question 4

Eyes become unable to ___ and focus on nearby objects. Risk for ___, ___, and ___ ___ is higher.

Answer 4

accomodate, cataracts, glaucoma, macular degeneration

Question 5

Diminished ___ secretions and decreased sense of ___.

Answer 5

salivary, taste

Question 6

Chest wall becomes ___ and harder to move, ___ muscles weaken, and lungs lose some of their ___ ___, predisposing to ___ and ___.

Answer 6

stiffer, respiratory, elastic recoil, atelectasis, pneumonia

Question 7

The spine becomes more ___, producing kyphosis and barrel chest.

Answer 7

curved

Question 8

After age 40, an ___ heart sound strongly suggests HF.

Answer 8

S3

Question 9

Commonly have systolic ___ ___, where calcification follows, causing aortic ___ and aortic ___.

Answer 9

aortic murmur, sclerosis, stenosis

Question 10

A concern is possible ___ in the abdominal aorta in older adults w/___ or ___ pain, esp those who are ___, ___, and have ___ disease.

Answer 10

aneurysm, abdominal or back, male, smoke, coronary

Question 11

Fat tends to accumulate in the lower ___ and near the ___.

Answer 11

abdomen, hips

Question 12

___ may be less severe, ___ is often less pronounced, and signs of ___ inflam such as rebound tenderness may be diminished.

Answer 12

Pain, fever, peritoneal

Question 13

In males, the ___ decreases in size and the ___ drop lower in the scrotum.

Answer 13

penis, testicles

Question 14

In males, chronic dis such as diabetes, HTN, dyslipidemia, smoking, and s/e of meds all contribute to ___ ___.

Answer 14

erectile dysfunction

Question 15

Menstrual periods cease btwn ___-___.

Answer 15

45-52

Question 16

In females, ___ dryness, urge ___, and ___ may occur. The vagina becomes more ___ and the vaginal ___ becomes thin, pale, and dry. The ___ and ___ diminish in size.

Answer 16

vaginal, incontinence, dyspareunia, narrow, mucosa, ovaries, uterus

Question 17

___ ___ ___ results in urinary hesitancy, dribbling, and incomplete emptying of the bladder in males.

Answer 17

Benign prostatic hyperplasia

Question 18

Most loss of ht occurs in the ___ as intervertebral discs become thinner and shorten from ___.

Answer 18

trunk, osteoporosis

Question 19

Skeletal muscles decrease in ___ and ___, ligaments lose some of their ___. ___ decreases.

Answer 19

bulk, power, strength, ROM

Question 20

Brain ___ and # of ___ decrease and sometimes benign forgetfulness entails w/diff ___ things. Process things more ___.

Answer 20

volume, cells, recalling, slowly

Question 21

Sometimes, a benign essential tremor in the head, jaw, lips, or hands may be confused w/___. These are slightly ___ and disappear at ___ and there is no associated ___ rigidity.

Answer 21

parkinsonism, faster, rest, muscle

Question 22

Before beginning exam, ensure pt is wearing ___, ___ aids, and ___.

Answer 22

glasses, hearing, dentures

Question 23

Older pt’s w/infection are less likely to have accompanying ___.

Answer 23

fever

Question 24

More prone to have ___, ___ fibrillation, ___ intolerance, decreased ___.

Answer 24

anorexia, atrial, cold, sweating

Question 25

Be sure to assess for particular symptoms such as ___, loss of ___, ___, weight ___, and ___.

Answer 25

fatigue, appetite, dizziness, loss, pain

Question 26

The ETHNICS mnemonic stands for:

Answer 26

Explanation, tx, healers, negotiate, interventions, collaborate, spiruality

Question 27

Common concerns include: ___, ___, ___, acute/persistent ___, ___, ___, ___, ___, and advance ___.

Answer 27

ADL’s, IADL’s, meds, pain, smoking, alcohol, nutrition, frailty, directives

Question 28

Bathing, dressing, toileting, transferring, continence, and feedings are all considered ___.

Answer 28

ADL’s

Question 29

Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, and taking meds are considered ___.

Answer 29

IADL’s

Question 30

Ask about prescripts, OTC, vitamins, nutritional supplements, and mood-altering drugs such as ___, ___, and ___ substances.

Answer 30

narcotics, benzo’s, recreational

Question 31

Inquire about ___ every time when meeting w/an older pt. Assess its effects on ___ of life, ___ interactions, and ___ level.

Answer 31

pain, quality, social, functional

Question 32

No more than ___ drinks on any occasion or ___ drinks/wk are recommended.

Answer 32

3, 7

Question 33

___ is characterized by loss of muscle mass, decreased energy and exercise intolerance, and decreased physiological reserve w/increasing vulnerability to physiological stressors.

Answer 33

Frailty

Question 34

___ could be r/t unintentional wt loss, slow walking, exhaustion, low energy, and weakness.

Answer 34

Frailty

Question 35

Goal of ___ care is to relieve suffering and improve the quality of life for pt’s w/advanced illnesses and their families.

Answer 35

palliative

Question 36

3 factors should be considered on when to screen: ___ expectancy, time interval until ___ from screening accrues, and pt ___.

Answer 36

life, benefit, preference

Question 37

The ideal exercise program should include ___ exercise for endurance, ___ strengthening against resistance, and ___ exercises.

Answer 37

aerobic, muscle, flexibility

Question 38

Offer pt’s vaccines for:

Answer 38

influenza, pneum, zoster (shingles), and tetanus/diptheria

Question 39

___ vaccine should be given to pt’s > 50 and w/chronic pulmonary and cardiovascular disorders, those who are immunocompromised, residents of NH, and caregivers of children under 5.

Answer 39

Influenza

Question 40

___ vaccine should be given to pts > 65. Those vaccinated before 65 should be revaccinated at 65 or later if ___ yrs have passed since their last. Also appropriate for chronic cond of heart disease, lung disease, liver disease, smoking, and immunocompromised.

Answer 40

Pneumonia, 5

Question 41

___ vaccine should be given to pts > 60, regardless of whether they have already had either chicken pox or shingles. Should not be given to those w/HIV, leukemia, or those on high-dose ___ therapy.

Answer 41

Zoster, corticosteroid

Question 42

___ vaccine should be given to pts w/uncertain or incomplete hx of primary vaccination and should receive ___ doses, then a booster every ___ yrs.

Answer 42

Td, 3, 10

Question 43

Breast cancer screening recommends mammography every ___ rs for women ages ___-___. Cervical cancer recommends against routine screening for women > ___. Colorectal cancer recommends screening w/colonoscopy every ___ yrs.

Answer 43

2, 50-74, 65, 10

Question 44

___ is a decline in memory and at least one other cognitive domain such as language, visuospatial, or executive function sufficient to interfere w/social or occupational functioning in an alert person. ___ disease is the predominant form.

Answer 44

Dementia, Alzheimer’s

Question 45

Mild forgetfulness, difficulty remembering names, mildly reduced concentration is seen in ___-___ ___ decline.

Answer 45

age-related cognitive

Question 46

Memory impairment w/out cognitive deficits or functional decline is seen in ___ ___ impairment.

Answer 46

mild cognitive

Question 47

Normal alertness w/progressive global deterioration of cognition in multiple domains and inability to perform IADL’s is seen in ___ disease.

Answer 47

Alzheimer’s

Question 48

Mnemonics for incontinence include DIAPERS and DDRRIIPP which stand for:

Answer 48

Delirium, infection, atrophic urethritis/vaginitis, pharmaceuticals, excess u.o., restricted mobility, and stool impaction
Delirium, drug s/e, retention of feces, restricted mobility, infection of urine, inflam, polyuria, and psychogenic

Question 49

Those who are a high fall risk include those w/a single fall in the past ___ months w/abnormal ___ and ___, and those w/2 or more falls in the past ___ months, an acute fall, and/or difficulties w/___ and ___.

Answer 49

12, gait, balance, 12, gait, balance

Question 50

Assess the older pt for ___ ___, defined as a drop in SBP > 20 or DBP > 10 w/in 3 mins of standing.

Answer 50

orthostatic hypotension

Question 51

Skin may be ___ and ___. ___ ___ may be present, which are purple macules/patches.

Answer 51

dry, flaky, actinic purpura

Question 52

___ is the loss of near vision and inability to focus on objects.

Answer 52

Presbyopia

Question 53

Beginning in the ___ right interspace, listen for cardiac murmurs. A systolic crescendo-decrescendo suggests ___ ___ or ___ ___.

Answer 53

2nd, aortic sclerosis, aortic stenosis

Question 54

Purse-lipped breathing and dyspnea w/talking or minimal exertion suggest ___.

Answer 54

COPD

Question 55

A harsh holosystolic murmur at the apex suggests ___ ___.

Answer 55

mitral regurgitation

Question 56

What may bruits be suggestive of?

Answer 56

atherosclerotic vascular dis

Question 57

Ask the pt to bear down to detect uterine ___, ___, ___, or ___.

Answer 57

prolapse, cystocele, urethrocele, rectocele

Question 58

In the get up and go test, the pt is screened for ___ and the pt is instructed to get up from a ___, walk ___ ft, turn, and return to the ___. Normal would be to complete the task in ___ secs.

Answer 58

falls, chair, 10, chair

10, 20

Question 59

Difficulty walking heel-to-toe is seen in ___ disease.

Answer 59

Parkinson’s