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.
During a medication review for an elderly patient, you consider deprescribing. What outcome aids in justifying this decision?
A) Substantially new symptoms since medication start
B) Increased medication costs
C) Lingering treatment side effects leading to functional decline
D) Better patient compliance with added medications
*Answer:** C) Lingering treatment side effects leading to functional decline
Rationale: Deprescribing decisions are justifiable when medications pose risks that lead to functional decline, increased side effects, or further complications without proportional benefits.
For an elderly patient with dementia, what tool might be helpful to ensure proper medication management?
A) A smartphone application with texting reminders
B) A secured pill organizer with alarms and advanced locking mechanisms
C) Printed medication charts placed on the refrigerator
D) A caretaker to administer all doses
Answer:** B) A secured pill organizer with alarms and advanced locking mechanisms
Rationale: A secured pill organizer with alarms and locking mechanisms can prevent double dosing and ensure adherence, helping patients with dementia manage their medications with minimal error.
When performing medication reconciliation with an older adult, which step is crucial to avoid adverse drug reactions?
A) Guessing previous medications if the patient forgets
B) Reviewing and confirming allergies and past adverse reactions
C) Focusing only on new medications
D) Solely accepting patient-reported medication lists
Answer:** B) Reviewing and confirming allergies and past adverse reactions
Rationale: It is crucial to review and confirm a patient’s allergies and past adverse reactions during medication reconciliation to avoid potential drug-related issues and ensure safer prescribing practices.
What is an important consideration when educating an elderly patient about their medications?
A) Assuming the patient or caregiver understands instructions after one explanation
B) Using complex medical terminology to convey seriousness
C) Conducting medication education with clear instructions and return demonstrations
D) Encouraging patients to contact their pharmacy without teaching them
Answer:** C) Conducting medication education with clear instructions and return demonstrations
Rationale: Providing clear, concise instructions and having patients perform return demonstrations helps ensure understanding and adherence to the prescribed medication regimen, reducing errors and enhancing self-management skills.
Why are percutaneous feeding tubes generally not recommended for patients with advanced dementia?
A) They dramatically improve nutritional status
B) They decrease aspiration risks
C) They do not prolong life and may worsen suffering
D) They are cost-effective compared to oral-assisted feeding
Answer:** C) They do not prolong life and may worsen suffering
Rationale: In patients with dementia, percutaneous feeding tubes do not have a demonstrable effect on prolonging life and may increase pain, suffering, and aspiration risks compared to oral-assisted feeding, which maintains quality of life.
Which of the following is the primary reason for avoiding antipsychotics as a first-line option for behavioral symptoms in dementia?
A) They have a sedative effect that could reduce activity
B) They are approved for all behavioral conditions
C) Nonpharmacologic interventions are often more effective
D) They are frequently out of stock
Answer:** C) Nonpharmacologic interventions are often more effective
Rationale: Nonpharmacologic interventions can be more effective and carry less risk than antipsychotics, which are associated with increased risks of mortality in older adults with dementia.
In managing diabetes in older adults, what is prioritized to avoid inappropriately low blood sugar?
A) Meticulous control of A1c levels under 6.5%
B) Avoidance of hypoglycemia, which is more harmful than hyperglycemia
C) Maximizing the use of insulin regimens
D) Encouraging high-calorie intake at every meal
*Answer:** B) Avoidance of hypoglycemia, which is more harmful than hyperglycemia
Rationale: In older adults, preventing hypoglycemia is crucial due to its potentially severe consequences. Management focuses on avoiding symptoms and balancing glucose levels to prevent both hyperglycemia symptoms and hypoglycemia risks.
Why should benzodiazepines and sedative hypnotics generally be avoided for treating insomnia or agitation in older adults?
A) Because they are less effective than other treatments for dementia
B) They cause an increased risk of falls and cognitive impairment
C) They tend to resolve insomnia with prolonged use
D) They are ineffective compared to over-the-counter medications
Answer:** B) They cause an increased risk of falls and cognitive impairment
Rationale: Benzodiazepines and sedative hypnotics increase the risk of falls, accidents, and cognitive impairment, making nonpharmacologic approaches or alternative treatments safer for older adults.
Which element is necessary for informed consent?
A) Guarantee of a positive outcome
B) Verbal assurance without documentation
C) Patient’s understanding and autonomous agreement
D) Family member’s approval without patient input
Answer:** C) Patient’s understanding and autonomous agreement
Rationale: Informed consent requires that the patient understands the procedure and gives autonomous, voluntary agreement, based on adequate information regarding benefits, risks, and alternatives.
What essential information should be included when obtaining informed consent from a patient?
A) The age of the practitioner performing the procedure
B) Alternative treatments available to the patient
C) Personal opinions on the best course of action
D) Warranty against potential side effects
Answer:** B) Alternative treatments available to the patient
Rationale: Informed consent includes informing the patient about the procedure, risks, benefits, and alternative options, allowing them to make a well-reasoned decision regarding their care.
Which ethical principle is primarily concerned with respecting and supporting a patient’s independent decision-making?
A) Beneficence
B) Autonomy
C) Nonmaleficence
D) Justice
*Answer:** B) Autonomy
Rationale: Autonomy is the ethical principle that emphasizes respecting a patient’s right to make their own decisions about their healthcare, free from coercion or interference.
What is the term for the legal determination of a person’s ability to manage their own affairs and make decisions?
A) Capacity
B) Competence
C) Autonomy
D) Fidelity
Answer:** B) Competence
Rationale: Competence is a legal concept determined by a court that assesses a person’s ability to make decisions. It considers various factors, including medical, but is ultimately a legal judgment.
In clinical practice, how is decision-making capacity evaluated?
A) Through a written test administered by a judge
B) Using a clinical evaluation by a healthcare provider
C) By family members’ verbal reports
D) Through a patient’s previous medical history
Answer:** B) Using a clinical evaluation by a healthcare provider
Rationale: Decision-making capacity is evaluated clinically by healthcare providers. It involves assessing a patient’s ability to understand, appreciate, reason, and express a choice regarding their treatment.
What does the ethical principle of nonmaleficence mean?
A) Providing the greatest benefit to the greatest number
B) Doing no harm to the patient
C) Promoting fairness and equality
D) Maintaining patient confidentiality
Answer:** B) Doing no harm to the patient
Rationale: Nonmaleficence is the principle of avoiding harm to patients. Healthcare providers are required to refrain from causing unnecessary injury or suffering to patients under their care.
When assessing decision-making capacity, which of the following is NOT a required component?
A) Ability to craft and implement a will
B) Ability to understand information about treatment
C) Ability to appreciate how information applies to their situation
D) Ability to reason with the information
Answer:** A) Ability to craft and implement a will
Rationale: While creating a will involves decision-making, it is not directly related to the clinical evaluation of decision-making capacity in medical contexts. Capacities include understanding, appreciation, reasoning, and expressing a choice.
Which statement correctly describes the principle of justice in an ethical context?
A) Preventing harm to patients whenever possible
B) Ensuring a patient’s confidentiality is upheld
C) Distributing benefits and burdens fairly among patients
D) Fully disclosing treatment risks and alternatives
*Answer:** C) Distributing benefits and burdens fairly among patients
Rationale: Justice in healthcare ethics refers to the fair and equitable distribution of healthcare resources and balancing the needs of patients with the availability of resources.
What should be prioritized if a change in decision-making capacity is suspected due to an acute health change, such as delirium?
A) Immediate signing of consent forms
B) Reassessment of decision-making capacity
C) Legal proceedings to declare the person incompetent
D) Immediate implementation of any pending treatments
Answer:** B) Reassessment of decision-making capacity
Rationale: Capacity is dynamic and can be affected by health changes like delirium. In such cases, reassessing decision-making capacity is essential to ensure informed and appropriate care decisions.
What is the purpose of a Durable Power of Attorney (POA) in the context of end-of-life care?
A) It specifies the patient’s funeral arrangements.
B) It appoints someone to make medical decisions only.
C) It gives someone complete control over all the patient’s affairs.
D) It lists specific medical interventions for the patient.
Answer:** C) It gives someone complete control over all the patient’s affairs.
Rationale: A Durable Power of Attorney allows a designated person to make decisions across all aspects of a patient’s life, not just medical ones, in the event that the patient is unable to do so.
Which form allows patients to specify which medical interventions they want and what they want to avoid, in detail?
A) Durable Power of Attorney
B) Living Will
C) POLST (Physician Orders for Life Sustaining Treatment)
D) My Five Wishes
Answer:** C) POLST (Physician Orders for Life Sustaining Treatment)
Rationale: The POLST form is used to specify detailed preferences for medical interventions, including CPR, levels of treatment (full, limited, comfort measures only), and decisions about artificial nutrition and fluids.
Which document is specifically designed to facilitate communication and planning around spiritual and personal preferences for end-of-life care?
A) POLST
B) Advance Directive
C) DNR/Allow Natural Death (AND)
D) My Five Wishes
Answer:** D) My Five Wishes
Rationale: My Five Wishes is a document created by Aging with Dignity that helps individuals communicate their end-of-life care preferences, including spiritual and personal wishes, alongside more traditional healthcare directives
What is the primary focus of a Health Care Proxy?
A) Making legal and financial decisions for a patient
B) Making only medical decisions if the patient is unable
C) Organizing a patient’s funeral and posthumous wishes
D) Overseeing the patient’s entire life decisions, including housing and finances
Answer:** B) Making only medical decisions if the patient is unable
Rationale: A Health Care Proxy is tasked with making medical decisions when the patient is no longer capable of doing so. It does not extend to financial or legal decisions.
What does a Do Not Resuscitate (DNR) order indicate?
A) Patients do not wish to undergo any medical treatment should they become incapacitated.
B) Patients wish all medical interventions, except CPR, to be withheld.
C) Healthcare providers should not perform CPR if the patient’s heart stops.
D) The patient’s family should decide about CPR when the time comes.
*Answer:** C) Healthcare providers should not perform CPR if the patient’s heart stops.
Rationale: A DNR order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops or they stop breathing.
Where should patients keep their advance directives so they can be accessed by emergency personnel if necessary?
A) In a safe deposit box
B) In a drawer under the bed
C) On their refrigerator
D) At their lawyer’s office
Answer:** C) On their refrigerator
Rationale: Patients are recommended to keep a copy of their advance directives on the refrigerator, as emergency services personnel are trained to look there for such critical information.
Which document allows individuals to record specific messages to loved ones regarding their desires and thoughts on end-of-life care?
A) POLST
B) Advance Directive
C) Living Will
D) My Five Wishes
Answer:** D) My Five Wishes
Rationale: My Five Wishes is unique in providing sections where individuals can leave messages to their loved ones alongside their healthcare wishes, supporting emotional and personal communication.
Which of the following is a key domain of palliative care?
A) Achievement of a definitive cure
B) Facilitation of medical decision-making
C) Implementation of rigorous physical therapy
D) Conducting genetic testing
Answer:** B) Facilitation of medical decision-making
Rationale: Facilitation of medical decision-making is one of the three key domains of palliative care, alongside symptom management and psychosocial-spiritual support. This approach helps patients and families navigate complex medical decisions and align treatments with their goals.
Which statement accurately distinguishes hospice care from palliative care?
A) Hospice care allows for curative treatments, while palliative care does not.
B) Palliative care can include curative treatments, while hospice care does not.
C) Both hospice and palliative care prohibit curative treatments.
D) Both hospice and palliative care require a terminal diagnosis of less than six months to live.
*Answer:** B) Palliative care can include curative treatments, while hospice care does not.
Rationale: Palliative care is designed to improve quality of life and may be provided alongside curative treatments. By contrast, hospice care is focused on comfort when curative treatments are no longer pursued.
What are the primary goals of palliative care?
A) Fast-track recovery and extend hospital stay
B) Provide symptom relief, neither hasten nor postpone death, and support patient and family
C) Conduct frequent surgeries and introduce aggressive therapies
D) Ensure a daily physiotherapy regimen and create a community network
Answer:** B) Provide symptom relief, neither hasten nor postpone death, and support patient and family
Rationale: Palliative care aims to alleviate symptoms with compassion, maintain a natural progression toward death without accelerating or delaying it, and offer emotional and spiritual support to patients and their families.
How is reduced hospital cost associated with palliative care?
A) It ensures fewer hospital readmissions within the same cycle of the illness.
B) It necessitates costly medications, thereby offsetting basic hospital expenses.
C) It reduces overall costs, especially when initiated within three days of hospital admission for life-limiting illnesses.
D) It predominantly increases the hospital stay for more comprehensive care.
Answer:** C) It reduces overall costs, especially when initiated within three days of hospital admission for life-limiting illnesses.
Rationale: Implementing palliative care shortly after hospital admission can lower healthcare costs by focusing on patient comfort and appropriate resource utilization, reducing unnecessary interventions.
Which aspect does palliative care specifically integrate into patient management?
A) Frequent surgical assessments
B) Intensive physical training programs
C) Psychological and spiritual aspects
D) Strict dietary controls
Answer:** C) Psychological and spiritual aspects
Rationale: Palliative care integrates the psychological and spiritual dimensions of patient care into its comprehensive approach to managing active, progressive disease and improving quality of life
What certification might a healthcare provider pursue to enhance their knowledge of palliative care?
A) Registered Dietitian
B) Health Management
C) Certification in Palliative Care (HAPC)
D) Advanced Cardiac Life Support (ACLS)
Answer:** C) Certification in Palliative Care (HAPC)
Rationale: Healthcare providers can pursue certification in palliative care (such as HAPC) to specialize in the palliative approach and skills necessary for managing comfort-oriented and patient-centered care practices.
Which of the following is NOT a requirement for Medicare hospice eligibility?
A) The patient is eligible for Medicare Part A.
B) The patient has a documented life expectancy of exactly one year.
C) The hospice care must be from a Medicare-approved program.
D) The patient receives certification from their primary care provider and hospice medical director.
Answer:** B) The patient has a documented life expectancy of exactly one year.
Rationale: Medicare requires that the patient is terminally ill with an expected lifespan of six months or less, not a year. The criteria also include eligibility for Medicare Part A, informed consent, and care from a Medicare-approved hospice program.
What is a commonly overlooked aspect when estimating a patient’s prognosis?
A) Frequency of past medical check-ups
B) Patient’s dietary preferences
C) Providing a clear understanding of what “treatment working” means
D) Patient’s ethnicity
Answer:** C) Providing a clear understanding of what “treatment working” means
Rationale: Patients often lack understanding of what successful treatment means in relation to longevity and quality of life. It’s crucial for clinicians to clarify this during prognosis discussions.
Which level of hospice care provides short-term, in-home, around-the-clock care for actively dying patients with uncontrolled symptoms?
A) Routine home hospice care
B) Respite care
C) General inpatient hospice care
D) Crisis care
*Answer:** D) Crisis care
Rationale: Crisis care offers intensive, short-term assistance during periods of crisis when symptoms become unmanageable at home, addressing immediate needs with continuous care.
What is the primary reason providers might hesitate to discuss life expectancy with terminal patients?
A) Lack of time during appointments
B) Fear of diminishing patient hope
C) Insufficient training
D) Lack of communication skills
Answer:** B) Fear of diminishing patient hope
Rationale: Providers often avoid discussions of prognosis as they fear removing hope, even though clear communication is vital for planning and acceptance of illness progression.
In the context of hospice care, which item is covered by Medicare for patients with a hospice diagnosis?
A) Non-prescription vitamins
B) Experimental drugs
C) Durable medical equipment
D) Gym memberships
Answer:** C) Durable medical equipment
Rationale: Medicare hospice benefits cover durable medical equipment (e.g., hospital beds, bedside commodes) related to the hospice diagnosis, focusing on comfort and care support.
How does respite care benefit the family caregivers of hospice patients?
A) By providing advanced medical intervention
B) By delaying end-of-life decisions
C) By offering a scheduled break from caregiving duties
D) By increasing the frequency of hospital visits
Answer:** C) By offering a scheduled break from caregiving duties
Rationale: Respite care gives family caregivers a much-needed pause from constant caregiving responsibilities, helping prevent caregiver burnout and ensuring continued quality care.
Which question is most effective for understanding a patient’s current perspective on their illness?
A) How frequently do you experience symptoms?
B) What is your understanding of where things stand now with your illness?
C) How many medications are you currently taking?
D) Have you adjusted your diet recently?
Answer:** B) What is your understanding of where things stand now with your illness?
Rationale: This question invites the patient to share their own understanding and feelings about their current health, providing an opportunity for clinicians to assess awareness and guide subsequent conversations.
When discussing future hopes and expectations, which question helps to prioritize what matters to the patient?
A) Do you want to change your treatment plan?
B) Do you think you will recover from this illness?
C) As you think about the future, what is most important to you? What matters most to you?
D) Are you satisfied with your current living situation?
Answer:** C) As you think about the future, what is most important to you? What matters most to you?
Rationale: This question assists in understanding the patient’s core values and goals, crucial for aligning care and support with their wishes.
Why is it important to ask a patient about their spiritual beliefs during end-of-life care discussions?
A) To determine the need for dietary restrictions
B) To judge if they should be referred to mental health services
C) To involve their spiritual beliefs in the decision-making process, if they desire
D) To ensure they seek forgiveness
Answer:** C) To involve their spiritual beliefs in the decision-making process, if they desire
Rationale: Spiritual beliefs can significantly influence a patient’s end-of-life choices and emotional well-being. Understanding this helps tailor support to meet those needs.
Asking a patient about what they wish to accomplish with the time left is MOST related to which of the following?
A) Their legacy and meaningful activities
B) Medical interventions and adjustments
C) Nutrition and physical activity plans
D) Future work opportunities
*Answer:** A) Their legacy and meaningful activities
Rationale: This question helps identify activities or goals that the patient sees as significant, allowing the care team to focus on maximizing the quality of the remaining time according to the patient’s wishes.
Which question probes most deeply into how a patient perceives the emotional aspect of their illness?
A) What impact does your illness have on your physical activities?
B) How much discomfort is your illness causing?
C) What about this illness has been most difficult for you?
D) How can we improve your daily symptom management?
Answer:** C) What about this illness has been most difficult for you?
Rationale: This question allows patients to express the personal challenges they face, guiding the clinician in addressing specific emotional and psychological needs.
