Geriatrics- Practice questions Flashcards
Which of the following geriatric syndrome markers deserves immediate evaluation due to its potential to indicate a serious underlying condition in an older adult?
A) Occasional forgetfulness
B) Mild skin dryness
C) Evidence of frequent falls
D) Preference for a soft diet
Answer:** C) Evidence of frequent falls
Rationale: Frequent falls can be indicative of various serious conditions, such as neurological impairments, muscular degeneration, or balance issues stemmed from multiple potential causes (e.g., medication side effects, cognitive decline). Identifying the underlying cause is crucial as falls can significantly impact quality of life and increase morbidity.
Which potential cause of cognitive changes in an older adult is associated with reduced sensory input affecting the patient’s ability to think clearly?
A) Myocardial/Pulmonary issues
B) Electrolyte imbalance
C) Intracranial causes
D) Hearing loss
Answer:** D) Hearing loss
Rationale: Reduced sensory input, such as hearing loss, can significantly affect an elderly individual’s cognitive function. It may lead to miscommunication and increased social isolation, which can contribute to cognitive decline. Ensuring proper sensory input through aids like hearing aids can be key in maintaining cognitive health.
A patient reports problems with eating and has been identified using the SPICES list. Which of the following is the primary reason to evaluate this issue in geriatric patients?
A) It may compromise their posture.
B) It can lead to social isolation.
C) It may result in nutritional deficiencies.
D) It can improve the patient’s mood.
*Answer:** C) It may result in nutritional deficiencies.
Rationale: Problems with eating or feeding in older adults might lead to nutritional deficiencies, affecting the overall health, and may aggravate existing health problems. Assessing and addressing these issues can help improve nutritional intake and support better health outcomes.
An FNP is assessing an older adult with altered cognition and notes urinary retention. What is a likely contributory factor from the mnemonic ‘DELIRIUM’?
A) Myocardial issues
B) Urinary retention
C) Electrolyte imbalance
D) Intracranial pathologies
Answer:** B) Urinary retention
Rationale: Urinary retention can cause discomfort, disrupt sleep, and contribute to cognitive changes such as delirium. It is important to address retention to prevent the worsening of symptoms and to create an effective care plan tailored to the older patient’s specific needs.
During a routine check, an older adult reports experiencing new confusion. The FNP suspects a drug-related cause. Which of the following is an appropriate first step?
A) Increase dose of current medications
B) Review the current medication regimen
C) Prescribe a new sedative
D) Schedule follow-up in six months
Answer:** B) Review the current medication regimen
Rationale: In older adults, polypharmacy can cause drug interactions and adverse effects, leading to confusion and cognitive changes. Reviewing the medication regimen can help identify potential problematic drugs or interactions and guide appropriate adjustments or discontinuations.
What are the risk factors for falls in older adults that should be considered by a healthcare provider?
A) Recent travel and lifestyle changes
B) High consumption of dietary supplements
C) Previous falls and cognitive deficits
D) Consistent exercise and hydration
Answer:** C) Previous falls and cognitive deficits
Rationale: Consideration of previous falls and cognitive deficits is crucial as they are significant risk factors for future falls. Other contributory factors include age-related changes, medication effects, and environmental hazards.
In assessing an older adult for fall risk, which question is NOT considered a part of the three red-flag questions?
A) Have you fallen in the past year?
B) Do you worry about Alzheimer’s?
C) Do you feel unsteady when standing or walking?
D) Do you worry about falling?
Answer:** B) Do you worry about Alzheimer’s?
Rationale: While concerns about Alzheimer’s can be relevant in evaluating an older adult’s health, it is not directly related to the immediate assessment of fall risk. The primary red-flag questions focus on previous falls, unsteadiness, and concerns about falling.
Which of the following is NOT part of the ‘RITUAL’ tool for assessing fall risk in older adults?
A) Recommend cutting out all exercise
B) Review self-assessment from older adults
C) Identify risk factors
D) Apply interventions like installing bathroom grab bars
Answer:** A) Recommend cutting out all exercise
Rationale: Exercise, particularly balance and strength training, is important in reducing fall risk. The RITUAL tool emphasizes assessing and supporting gait and balance improvements, not eliminating exercise.
In patients concerned about falling, which program should FNP students recommend to improve strength, gait, and balance?
A) High-impact aerobics
B) Strength training and sleeping classes
C) Yoga, tai chi, or Zumba
D) Marathon running
Answer:** C) Yoga, tai chi, or Zumba
Rationale: These are suitable low-impact exercise programs known to improve strength, flexibility, coordination, and balance in older adults, thereby reducing the risk of falls.
When establishing a care plan for an older adult at risk of falls, what factor is least likely to significantly impact the approach and priorities of the plan?
A) Patient’s values and preferences
B) Initial temperature upon assessment
C) Social and financial support
D) Patient and caregiver health literacy
Answer:** B) Initial temperature upon assessment
Rationale: While vital signs are important, the patient’s values, preferences, social and financial support, and health literacy are more significant in long-term care planning and fall prevention strategies for older adults.
An older patient reports feeling dizzy when standing up, which is causing concern for falls. What is the most likely physiological condition contributing to this symptom?
A) Bradycardia
B) Chronic kidney disease
C) Orthostatic hypotension
D) Hyperglycemia
Answer:** C) Orthostatic hypotension
Rationale: Orthostatic hypotension is a common cause of dizziness upon standing in elderly patients due to the sudden drop in blood pressure, which increases the risk of falls and related injuries.
A 78-year-old female patient is having issues with constipation. What is a potential consequence of severe constipation related to physical functions?
A) Improved cognitive function
B) Overflow fecal incontinence
C) Enhanced appetite
D) Reduced risk of infection
Answer:** B) Overflow fecal incontinence
Rationale: Severe constipation can lead to fecal impaction, resulting in overflow fecal incontinence. This occurs when liquid stool leaks around the impacted fecal matter.
During an annual physical exam, an older adult has unexplained weight loss. Which of the following should be assessed first?
A) Frequency of social interactions
B) Access to food
C) Recent travel history
D) Amount of exercise
Answer:** B) Access to food
Rationale: Assessing access to food is crucial when unexplained weight loss is observed. This can pinpoint issues such as economic constraints, depression, or impaired cognitive function that may lead to malnutrition.
An older male comes to the clinic for routine follow-up and reports feeling unusually fatigued. His physical examination is unremarkable. The next step should be to assess for which geriatric syndrome?
A) Visual impairment
B) Depression
C) Constipation
D) Acute kidney injury
Answer:** B) Depression
Rationale: In older adults, symptoms like fatigue can be indicative of depression, which is often underdiagnosed in this population. Assessing mental health is essential when there are nonspecific symptoms like fatigue.
During your assessment, you find that your elderly patient has hearing difficulties. What additional health concern has been linked to hearing loss in this age group?
A) Increased risk of diabetes
B) Higher incidence of hypertension
C) Increased incidence of dementia
D) Lower risk of respiratory infections
*Answer:** C) Increased incidence of dementia
Rationale: Studies have shown an association between hearing difficulties and an increased incidence of dementia. Hearing loss can lead to social isolation, which is a risk factor for cognitive decline.
Your patient, a 79-year-old woman, mentions she has trouble sleeping and sometimes takes over-the-counter sleep aids. What risk should you discuss with her regarding this habit?
A) Enhanced kidney function
B) Increased risk of falls
C) Improved mental alertness in the morning
D) Reduced risk of hypertension
Answer:** B) Increased risk of falls
Rationale: Over-the-counter sleep aids can increase the risk of falls due to their sedative effects and potential exacerbation of orthostatic hypotension, especially problematic in older adults who are already at risk for balance issues.
One of your elderly patients has multiple comorbidities and is prescribed several medications. You want to minimize the risk of adverse drug reactions. What concept related to medication management should you prioritize?
A) Increasing the dosage for effectiveness
B) Decreasing the frequency of prescriptions
C) “Start low and go slow”
D) Using only over-the-counter medications
*Answer:** C) “Start low and go slow”
Rationale: The concept of “start low and go slow” is essential in geriatric care to prevent adverse drug reactions by starting with lower doses and cautiously adjusting the dose based on the patient’s response and tolerance.
An older patient is on five medications for different health conditions. This is an example of:
A) Drug synergy
B) Therapeutic duplication
C) Polypharmacy
D) Pharmacogenomics
*Answer:** C) Polypharmacy
Rationale: Polypharmacy is defined as the concurrent use of five or more medications. It is common in the management of multiple coexisting conditions in older adults but increases the risk of adverse drug reactions.
When considering diagnostic procedures for an older adult, what should be evaluated first to ensure patient-centered care?
A) The cost of the procedure
B) The feasibility and potential burden of the procedure
C) The approval by insurance
D) The physician’s preference
Answer:** B) The feasibility and potential burden of the procedure
Rationale: Evaluating the feasibility and burden of a diagnostic procedure is critical in older adults to avoid unnecessary stress, pain, and logistical challenges, ensuring the choice aligns with the patient’s goals and capacity.
While reviewing the safety of a new prescribing plan for an elderly patient, what resource is recommended for assessing potential inappropriate medications?
A) Physician’s personal experience
B) The patient’s family opinion
C) The AGS Beers Criteria
D) Public health guidelines
Answer:** C) The AGS Beers Criteria
Rationale: The AGS Beers Criteria is a comprehensive and widely-used guide that provides recommendations for potentially inappropriate medications to use in older adults, enhancing the safety of prescribing practices.
A healthcare provider aims to optimize the nonpharmacologic management of a geriatric syndrome. Which of the following actions aligns with this goal?
A) Increasing the prescription load
B) Evaluating and addressing lifestyle factors such as diet and exercise
C) Limiting social interactions to reduce exposure
D) Administering high doses of vitamins and supplements
Answer:** B) Evaluating and addressing lifestyle factors such as diet and exercise
Rationale: Optimizing nonpharmacologic options includes evaluating and addressing lifestyle factors like diet, exercise, and social engagement, assisting in managing geriatric syndromes effectively without relying solely on medications.
An elderly patient with declining renal function is being prescribed a new medication. Which pharmacokinetic change is most relevant to consider?
A) Decreased absorption
B) Altered drug metabolism
C) Impaired elimination
D) Increased protein binding
Answer:** C) Impaired elimination
Rationale: Impaired elimination due to declining renal function is crucial to consider when prescribing medications to older adults, as it affects drug clearance and may increase the risk of toxicity.
What is the primary purpose of using the Beers Criteria in clinical practice for older adults?
A) To promote the newest medication options available
B) To identify medications considered potentially inappropriate for older adults
C) To prioritize lower-cost medication options
D) To establish treatment protocols for all adults regardless of age
Answer:** B) To identify medications considered potentially inappropriate for older adults
Rationale: The Beers Criteria serves as a guideline to identify potentially inappropriate medications for older adults due to their higher risk of adverse effects, thus helping healthcare providers make safer prescribing decisions.
Which of the following is a key factor in implementing a plan to deprescribe medications for an elderly patient?
A) Ignoring patient preference to reduce medication use
B) Discussing every potential side effect exhaustively
C) Building a strong rapport and understanding patient priorities
D) Discontinuing all medications simultaneously
*Answer:** C) Building a strong rapport and understanding patient priorities
Rationale: Effectively deprescribing requires a thoughtful approach, prioritized by understanding patient preferences and priorities, building rapport, and having informed conversations to safely reduce or stop medications.