FITZGERALD Ch16 - Older Adults

(((102 to 104. Match the term with its correct definition.))) 102. Aphasia --> (B) Language disturbance. 103. Apraxia --> (C) Impairment of motor activities despite intact motor function. 104. Agnosia --> (A) Failure to recognize objects despite intact sensory function.

102. Aphasia --> (B) Language disturbance. 103. Apraxia --> (C) Impairment of motor activities despite intact motor function. 104. Agnosia --> (A) Failure to recognize objects despite intact sensory function.

(((2 to 4. Match each demographic group with the correct age range.))) 2. Young old --> (B) 65 to 74 years. 3. Oldest old --> (D) 85 to 100 years. 4. Elite old --> (E) Over 100 years.

2. Young old --> (B) 65 to 74 years. 3. Oldest old --> (D) 85 to 100 years. 4. Elite old --> (E) Over 100 years.

(((56 to 60. Indicate (YES or NO) which of the following are identifiable risk factors for falls in the older adult.))) 56. Negative prior history of a fall --> NO. 57. History of a stroke --> YES. 58. Current diagnosis of osteoporosis --> YES. 59. Osteoarthritis of the hips --> YES. 60. Wearing a jogging-type shoe or sneaker --> YES.

56. Negative prior history of a fall --> NO. 57. History of a stroke --> YES. 58. Current diagnosis of osteoporosis --> YES. 59. Osteoarthritis of the hips --> YES. 60. Wearing a jogging-type shoe or sneaker --> YES.

62. Orthostatic hypotension is present in about ______ % of older adults A. 10 B. 20 C. 30 D. 40

B. 20

(((25 to 28. Indicate (YES or NO) which of the following adverse effects is associated with the use of systemic anticholinergic agents in older adults.))) 25. Confusion --> YES 26. Hypertension --> NO 27. Urinary retention --> YES 28. Constipation --> YES

25. Confusion --> YES 26. Hypertension --> NO 27. Urinary retention --> YES 28. Constipation --> YES

(((35 to 42. Match each potential drug-related adverse effect with the correct medication.))) 35. Amitriptyline --> (B) Highly anticholinergic. 36. Duloxetine --> (F) Nausea, diarrhea. 37. NSAIDs --> (G) Gl bleeding. 38. Gabapentin --> (A) Sedation. 39. Zolpidem --> (E) Delirium, falls. 40. TMP-SMX --> (D) Hyperkalemia risk. 41. Pioglitazone --> (C) Increased risk of heart failure. 42. Ranitidine --> (H) Need for dose adjustment in the older adult.

35. Amitriptyline --> (B) Highly anticholinergic. 36. Duloxetine --> (F) Nausea, diarrhea. 37. NSAIDs --> (G) Gl bleeding. 38. Gabapentin --> (A) Sedation. 39. Zolpidem --> (E) Delirium, falls. 40. TMP-SMX --> (D) Hyperkalemia risk. 41. Pioglitazone --> (C) Increased risk of heart failure. 42. Ranitidine --> (H) Need for dose adjustment in the older adult.

(((49 to 54. Indicate whether each of the following is a protective factor or risk factor for elder maltreatment within institutional settings.))) 49. Frequent visits by family or volunteers --> PROTECTIVE. 50. Staff burnout --> RISK. 51. Clear guidance on how durable power of attorney is to be used --> PROTECTIVE. 52. Stressful working conditions --> RISK. 53. Chronic staffing problems --> RISK. 54. Clear institutional policies on patient care --> PROTECTIVE.

49. Frequent visits by family or volunteers --> PROTECTIVE. 50. Staff burnout --> RISK. 51. Clear guidance on how durable power of attorney is to be used --> PROTECTIVE. 52. Stressful working conditions --> RISK. 53. Chronic staffing problems --> RISK. 54. Clear institutional policies on patient care --> PROTECTIVE.

(((78 to 81. Match each pressure ulcer stage with an appropriate treatment approach. (CHOOSE ALL THAT APPLY):))) 78. Stage 1 --> (D) Conservative (nonsurgical) approaches. 79. Stage 2 --> (D) Conservative (nonsurgical) approaches. 80. Stage 3 --> (A) Skin graft & (C) Debridement of nonvital skin. 81. Stage 4 --> (A) Skin graft & (C) Debridement of nonvital skin.

78. Stage 1 --> (D) Conservative (nonsurgical) approaches. 79. Stage 2 --> (D) Conservative (nonsurgical) approaches. 80. Stage 3 --> (A) Skin graft & (C) Debridement of nonvital skin. 81. Stage 4 --> (A) Skin graft & (C) Debridement of nonvital skin.

(((8 to 12. Match the following age-related changes in the senses with the problem reported by the older adult.))) 8. Difficulty with appreciating the content of conversation in noisy environment --> (B) Presbycusis. 9. Decline in sense of smell --> (A) Hyposmia. 10. Painless vision change that includes central vision distortion --> (D) Age-Related Maculopathy. 11. Results in near-vision blurriness --> (C) Presbyopia. 12. Can result in peripheral vision loss --> (E) Chronic Glaucoma.

8. Difficulty with appreciating the content of conversation in noisy environment --> (B) Presbycusis. 9. Decline in sense of smell --> (A) Hyposmia. 10. Painless vision change that includes central vision distortion --> (D) Age-Related Maculopathy. 11. Results in near-vision blurriness --> (C) Presbyopia. 12. Can result in peripheral vision loss --> (E) Chronic Glaucoma.

(((84 to 88. Identify the following as most likely associated with either delirium or dementia.))) 84. Insidious onset over months to years --> DEMENTIA. 85. Acute onset of change in mental status --> DELIRIUM. 86. Commonly associated with use of medications with systemic anticholinergic effect --> DELIRIUM. 87. Mental status potentially returns to baseline prior to acute illness --> DELIRIUM. 88. No perceptual disturbances (i.e., hallucinations) until later disease --> DEMENTIA.

84. Insidious onset over months to years --> DEMENTIA. 85. Acute onset of change in mental status --> DELIRIUM. 86. Commonly associated with use of medications with systemic anticholinergic effect --> DELIRIUM. 87. Mental status potentially returns to baseline prior to acute illness --> DELIRIUM. 88. No perceptual disturbances (i.e., hallucinations) until later disease --> DEMENTIA.

24. When dosing warfarin (Coumadin*) in older adults, it is important to consider that the dose needs to be adjusted in which of the following ways? A. A lower dose is usually needed due to lower serum albumin. B. A lower dose is usually needed due to higher serum albumin. C. A higher dose is usually needed due to lower serum albumin. D. A higher dose is usually needed due to higher serum albumin.

A. A LOWER dose is usually needed due to LOWER serum albumin.

5. Which of the following is most commonly reported as the largest single source of income for elderly people? A. Social Security B. public/private pension earnings C. asset income D. family financial support

A. Social Security

107. When managing depression in older adults, all of the following should be considered EXCEPT: A. Starting at the highest dose possible of antidepressant & then titrating down once symptoms resolve. B. Encouraging psychotherapy in addition to pharmacotherapy. C. Utilizing ECT for severe depression. D. Conducting a medication review to minimize potential drug-drug interactions.

A. Starting at highest dose possible of antidepressant and then titrating down once symptoms resolve.

105. The use of second-generation antipsychotic medications in older adults with dementia is associated with an increased risk for: A. Stroke and cardiovascular events. B. Hypoglycemia. C. Psychosis. D. Hypertension.

A. Stroke and cardiovascular events.

19. A person with cerumen impaction experiences: A. a general diminution of hearing. B. an unhampered ability to hear low-pitched sounds. C. pain when exposed to high-pitched sounds. D. an ability to hear but cannot understand a conversation in a noisy environme

A. a general diminution of hearing.

67. A 68-year-old man is taking multiple medications for various chronic conditions. Discontinuing or finding an alternative for which of the following medications will have the greatest impact in decreasing the potential for fall risk? A. amitriptyline B. sitagliptin C. atorvastatin D. aspirin

A. amitriptyline

101. Potential noncognitive reasons for behavioral issues observed in older adults include all of the following EXCEPT: A. attention-deficit hyperactivity disorder (ADHD). B. pain. C. infection. D. depression.

A. attention-deficit hyperactivity disorder (ADHD).

111. When considering the use of a chemical restraint in an older adult, the NP considers that chemical restraints: A. can include benzodiazepines and first- and second-generation antipsychotics. B. can be used as a form of discipline for unruly patients. C. are generally safe in older adults. D. are banned by federal agencies.

A. can include benzodiazepines and first- and second-generation antipsychotics.

92. Which of the following electrolyte disorders is commonly associated with delirium? A. hyponatremia B. hypernatremia C. hyperkalemia D. hypophosphatemia

A. hyponatremia

22. Anticipated age-related changes that can result in less drug effect include: A. loss of Beta-2-receptor sites. B. lower GI pH. C. increased renin-angiotensin production. D. increased Gl motility.

A. loss of Beta-2-receptor sites.

30. The study of biochemical and physiological effects of drugs on the body or disease is called: A. pharmacodynamics. B. pharmacokinetics. C. biotransformation. D. bioavailability.

A. pharmacodynamics.

68. An older adult who has recently fallen has a _____ times increased risk of falling again within the next year. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

B. 2 to 3

32. When prescribing a medication, the clinician considers that half-life is the amount of time needed decrease the serum concentration of a drug by: A. 25%. B. 50%. C. 75%. D. 100%.

B. 50%.

90. The most common etiology of dementia is: A. vascular disease. B. AD. C. traumatic head injury. D. drug-drug interaction induced.

B. AD.

71. Which of the following is a true statement with regard to driving and the elderly? A. The number of elderly drivers will decrease over the next decade. B. Crashes with elderly drivers tend to involve diminished speed of visual processing. C. There is a greater incidence of accidents involving right-hand turns compared with left-hand turns. D. There is no evidence to suggest, if the elder's health is preserved, that the skills needed for safe driving deteriorate with age.

B. Crashes with elderly drivers tend to involve diminished speed of visual processing.

82. To ensure adequate nutrition to prevent and hasten healing of pressure ulcers, all of the following are recommended EXCEPT: A. enteral nutrition. B. low-fat, low-sodium diet. C. parenteral nutrition. D. vitamin therapy.

B. Low-fat, low-sodium diet.

106. Dementia syndrome or cognitive impairment that is associated with severe depression is called: A. Delirium. B. Pseudodementia. C. AD. D. Bipolar disorder.

B. Pseudodementia.

97. An 81-year-old man who was recently diagnosed with AD is accompanied by his granddaughter for an office visit. The granddaughter reports that her grandfather often acts erratically with angry outbursts that can soon be followed by a more "normal" demeanor. She reports that the grandfather recently moved in with her, and she would like for this arrangement to continue as long as possible. In counseling the granddaughter, you consider all of the following EXCEPT that: A. Behavioral difficulties often arise in patients with AD if their usual routine is disrupted. B. Treatment with a cholinesterase inhibitor will maintain his cognitive ability to the current status for a protracted period of time. C. A home safety evaluation should be conducted and appropriate modification performed. D. Any sudden change in mental status should be reported to the health-care provider as soon as possible.

B. Treatment with a cholinesterase inhibitor will maintain his cognitive ability to the current status for a protracted period of time.

13. A 76-year-old woman is being treated for senile cataracts. The granddaughter who is accompanying the patient expresses concern that one day she could also develop cataracts. You explain that she can reduce the risk of senile cataracts by avoiding all of the following EXCEPT: A. tobacco use. B. alcohol abuse. C. corticosteroid therapy. D. sunlight exposure.

B. alcohol abuse.

70. With the use of a benzodiazepine in an older adult, the risk of fall is most likely to occur _____ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action

B. at the peak of action.

91. Medications that commonly contribute to delirium include all of the following EXCEPT: A. first-generation antihistamines. B. cardioselective beta-adrenergic antagonists. C. opioids. D. benzodiazepines.

B. cardioselective beta-adrenergic antagonists.

18. A common complaint for a person with presbycusis is: A. general diminution of hearing. B. diminution of high-frequency hearing. C. worsening hearing at night. D. inability to hear low-pitched sounds.

B. diminution of high-frequency hearing.

74. When counseling an older driver, you recommend all of the following EXCEPT: A. reviewing current medications for potential adverse effects. B. having the radio on to an enjoyable talk show to enhance driving skills. C. predetermining the route before driving. D. driving during the day and in good weather.

B. having the radio on to an enjoyable talk show to enhance driving skills.

6. The poverty rate among elderly people residing in the United States can best be described as: A. at approximately the same level across ethnic and age groups. B. highest among the old old. C. greatest among married couples. D. consistently increasing since the 1970s.

B. highest among the old old.

76. Complications of pressure ulcers include all of the following EXCEPT: A. sepsis. B. osteoporosis. C. bone and joint infections. D. cellulitis.

B. osteoporosis.

96. When assessing a 76-year-old man with new-onset mental status change, all of the following diagnostic tests are essential EXCEPT: A. serum glucose. B. positron emission tomography (PET) scan. C. CBC with white blood cell differential. D. ECG.

B. positron emission tomography (PET) scan.

21. A general principle of drug absorption in an elderly adult is best described as: A. amount of absorption is decreased. B. rate of absorption is changed. C. drug absorption is altered but predictable. D. bioavailability is altered.

B. rate of absorption is changed.

93. Older adults are at greater risk of subdural hematoma, even with minor head trauma, because of: A. lower bone density in the skull. B. relatively fragile blood vessels. C. decreased adipose tissue reserves. D. age-related reduction in circulating clotting factors.

B. relatively fragile blood vessels.

48. The daughter of a 76-year-old woman expresses concern regarding her mother's refusal of assistance in everyday living activities. The mother lives by herself and is often found with poor hygiene and reports eating one small meal a day. She also has poor adherence to her current medication regimens. This represents an example of: A. abandonment. B. self-neglect. C. early onset dementia. D. psychological abuse.

B. self-neglect.

17. An effective method to prevent presbycusis is: A. to avoid using cotton swabs in the ear canal. B. to use ear protection when exposed to loud noises. C. to avoid using hearing aids for a prolonged period of time. D. regular cerumen removal.

B. to use ear protection when exposed to loud noises.

98. Which of the following nutritional supplements is used to potentially slow cognitive decline in AD? A. vitamin B B. vitamin E C. ginkgo biloba D. St. John's wort

B. vitamin E

69. Which of the following is not part of the "Get Up and Go" criteria when evaluating gait and balance for a 72-year-old woman who normally uses a walker? A. rising from a straight-backed chair B. walking 10 feet without the use of a walking aid C. turning around after walking 10 feet D. returning to the chair and sitting down

B. walking 10 feet without the use of a walking aid

109. The use of physical restraints in older adults is appropriate: A. as a form of reinforcement to prevent future potentially dangerous behavior. B. when needed to meet a health-care need. C. to prevent wandering outside an institution. D. under no circumstances.

B. when needed to meet a health-care need.

65. Orthostatic (postural) hypotension is defined as an excessive decrease in BP with position change that results in characteristic signs and symptoms. The BP change is usually greater than _____ mmHg systolic and _______ mmHg diastolic. A. 10, 5 B. 15,7 C. 20, 10 D. 30, 15

C. 20, 10

33. Under ordinary circumstances, the presence of a medication in the body is needed for how many half-lives to reach steady state? A. 0.5 to 1 B. 1 to 3 C. 3 to 5 D. 5 to 7

C. 3 to 5

34. Compared with a healthy 40-year-old adult, CYP450 isoenzyme levels can decrease by _____ % in elderly adults after age 70 years. A. 10 B. 20 C. 30 D. 40

C. 30

7. Economic insecurity causes anxiety about affording housing, food, transportation, and health care. Approximately what percentage of older adults are economically insecure? A. 10% B. 20% C. 33% D. 50%

C. 33%

110. When considering end-of-life decisions, which of the following statements is FALSE? A. MOLST/POLST orders are considered to be forms of advance directives. B. A videotaped or audiotaped discussion can include advance directives. C. Advance directives are legally binding in all states. D. Advance directives are most often recognized when the patient is terminally ill where there is no clear path to recovery.

C. Advance directives are legally binding in all states.

108. Which of the following statements is TRUE with regard to decision making for the patient with cognitive impairment? A. Only a court or close family member can declare a person incompetent. B. Impaired judgment can be used to declare a person incompetent. C. Health-care providers have the ability to determine whether a patient can provide informed consent. D. Informed consent does not necessarily require disclosing the diagnosis to the patient.

C. Health-care providers have the ability to determine whether a patient can provide informed consent.

83. When evaluating a patient with a chronic pressure ulcer on the hip that has not shown signs of healing despite appropriate wound care, a possible diagnosis to consider is: A. zoster infection. B. impetigo. C. Marjolin's ulcer. D. actinic keratosis.

C. Marjolin's ulcer.

44. Which of the following statements is true concerning maltreatment in the older adult? A. This problem is found mainly in families of lower socioeconomic status. B. An elderly adult who is being mistreated usually seeks help. C. Routine screening is indicated as part of the care of an older adult. D. In most instances of elder maltreatment, a predictable cycle of physical violence directed at the older adult followed by a period of remorse on the part of the perpetrator is the norm.

C. Routine screening is indicated as part of the care of an older adult.

20. Age-related changes in an elderly adult include all of the following EXCEPT: A. total body water decreases by 10% to 15% between ages 20 and 80 years. B. body weight as fat increases from 18% to 36% in men and from 33% to 45% in women. C. an increase in serum albumin. D. an increase in gastric pH.

C. an increase in serum albumin.

45. Risk factors for becoming a perpetrator of elder maltreatment include all of the following EXCEPT: A. a high level of hostility about the caregiver role. B. poor coping skills. C. assumption of caregiving responsibilities at a later stage of life. D. maltreatment as a child.

C. assumption of caregiving responsibilities at a later stage of life.

46. Elder maltreatment is considered to be underreported, with an estimated _______ cases going unreported for each one case that is reported. A. three B. four C. five D. six

C. five

64. Lifestyle interventions for an older adult with orthostatic hypotension should include counseling about: A. avoiding the use of compression stockings. B. significantly restricting salt intake. C. flexing the feet multiple times before changing position. D. restricting fluids.

C. flexing the feet multiple times before changing position.

99. The NMDA-receptor antagonist memantine is recommended for use: A. in preventing dementia. B. at early stages of AD. C. in moderate to severe stages of AD. D. at any time following an AD diagnosis.

C. in moderate to severe stages of AD.

95. When managing dementia, cholinesterase inhibitors offer the greatest benefit: A. for prevention of AD. B. in patients with mild cognitive impairment. C. in patients with mild to moderate AD. D. in patients with severe AD.

C. in patients with mild to moderate AD.

23. Age-related changes in the GI system include all of the following except: A. decreased gastric acid production. B. decreased gastric motility. C. increased GI surface area. D. decreased gastric emptying.

C. increased Gl surface area.

31. When considering the properties of a drug in the body, which of the following does not change as a person ages? A. excretion B. biotransformation C. pharmacodynamics D. absorption

C. pharmacodynamics

29. The process of absorption, distribution, metabolism (biotransformation), and elimination of a drug is known as: A. pharmacodynamics. B. drug interactions study. C. pharmacokinetics. D. therapeutic transformation.

C. pharmacokinetics.

43. When making a home visit to an 89-year-old man who is bedridden, you note that he is cachectic, dehydrated, and cognitively intact. He states that he is not receiving his medications regularly and that his granddaughter is supposed to take care of him but mentions, "She seems more interested in my Social Security check?" The patient is unhappy but asks that you not "tell anybody" because he wants to remain in his home. The most appropriate action would be to: A. talk with the patient's granddaughter and evaluate her ability to care for the patient. B. visit the patient more frequently to ensure that his condition does not deteriorate. C. report the situation to the appropriate state or local agency. D. honor the patient's wishes because a competent patient has the right to determine care.

C. report the situation to the appropriate state or local agency.

77. A pressure ulcer that exhibits full-thickness skin loss with a crater-like appearance can be categorized as: A. stage 1. B. stage 2. C. stage 3. D. stage 4.

C. stage 3.

55. Most fatal falls in older adults occur in: A. a health-care institution. B. a public place. C. the patient's home. D. an outdoor setting.

C. the patient's home.

94. When discussing the use of a cholinesterase inhibitor with a 72-year-old woman with a recent diagnosis of AD and her family, you report that: A. this medication will help return memory to her pre-illness baseline. B. the risk associated with the use of this medication outweighs its benefits. C. this medication will likely afford clear, although minor and time-limited, benefits. D. the medication should have been started earlier to help prevent any change in cognition.

C. this medication will likely afford clear, although minor and time-limited, benefits.

16. Besides aging, a risk factor for age-related macular degeneration is: A. hypertension. B. hyperlipidemia. C. tobacco use. D. alcohol abuse.

C. tobacco use.

1. In the elderly population, the current fastest-growing group is composed of those in the age range: A. 71 to 75 years. B. 76 to 80 years. C. 81 to 84 years. D. 85 years and older.

D. 85 years and older.

72. Which of the following is a false statement with regard to driving and AD? A. Patients with AD typically continue to drive for at least 3 years following the diagnosis. B. Those with mild to moderate AD have an eightfold increase in the number of accidents. C. Those at early stages of AD can continue to drive safely, though driving should be monitored regularly. D. The National Transportation Safety Board (NTSB) recommends surrendering the driver's license for all individuals with an AD diagnosis.

D. The National Transportation Safety Board (NTSB) recommends surrendering the driver's license for all individuals with an AD diagnosis.

15. All of the following are consistent with normal age-related vision changes EXCEPT: A. a need for increased illumination. B. an increasing sensitivity to glare. C. a washing out of colors. D. a gradual loss of peripheral vision.

D. a gradual loss of peripheral vision.

61. The nurse practitioner (NP) is asked to evaluate a 77-year-old woman who recently had an unexpected fall. The patient is normally healthy and has no mobility limitations or other obvious risk factors. During the history, the NP learns that the patient did not attempt to break the fall, "I just suddenly found myself on the floor? This statement suggests: A. a previously undiagnosed cognitive impairment that requires further evaluation. B. that underlying sensory deficits (visual, hearing) are the most likely cause of the fall and require physical assessment. C. that a history of alcohol use or abuse should be explored. D. a syncopal episode requiring a cardiovascular and neurological evaluation.

D. a syncopal episode requiring a cardiovascular and neurological evaluation.

89. The most common trigger for delirium is: A. alcohol withdrawal. B. fecal impaction. C. head trauma. D. acute infection.

D. acute infection.

100. When considering the use of memantine with a cholinesterase inhibitor, the NP realizes: A. there are significant safety concerns with combination therapy. B. there is no additional benefit of combination therapy in AD. C. combination therapy can reverse cognitive decline in early stages of AD. D. combination therapy can have additive benefits in moderate to severe AD.

D. combination therapy can have additive benefits in moderate to severe AD.

66. In an older adult, the greatest risk of long-term complication is associated with fracture of the: A. forearm. B. spine. C. ankle. D. hip.

D. hip.

63. The use of which of the following medications is associated with the least risk of postural hypotension in the older adult? A. nifedipine B. furosemide C. clonidine D. lisinopril

D. lisinopril

47. The most commonly reported form of elder maltreatment is: A. physical abuse. B. sexual exploitation. C. financial exploitation. D. neglect.

D. neglect.

14. An 81-year-old woman has early bilateral senile cataracts. Which of the following situations would likely pose the greatest difficulty for her? A. reading the newspaper B. distinguishing between the primary colors C. following extraocular movements D. reading road signs while driving

D. reading road signs while driving

73. Common driving errors observed with older drivers include all of the following except: A. difficulty backing up and making turns. B. delayed glare recovery when driving at night. C. bumping into curbs and objects. D. tailgating

D. tailgating.

75. Risk factors for pressure ulcers include all of the following EXCEPT: A. malnutrition. B. dehydration C. smoking. D. weight gain.

D. weight gain.