Chapter 16 Older Adults/Chapter 14 Select Health Issues in the Older Adult

102 to 104. Match the term with its correct definition. _____ 102. aphasia _____ 103. apraxia _____ 104. agnosia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function

102. B. language disturbance 103. C. impairment of motor activities despite intact motor function 104. A. failure to recognize objects despite intact sensory function

84 to 88. Identify the following as most likely associated with either delirium or dementia. _____ 84. insidious onset over months to years _____ 85. acute onset of change in mental status _____ 86. commonly associated with use of medications with systemic anticholinergic effect _____ 87. mental status potentially returns to baseline prior to acute illness _____ 88. no perceptual disturbances (i.e., hallucinations) until later disease

84. dementia 85. delirium 86. delirium 87. delirium 88. dementia

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).

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

A. hyponatremia

107. When managing depression in older adults, all of the following should be considered except: A. starting at the highest dose possible of antidepressant and 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 the highest dose possible of antidepressant and then titrating down once symptoms resolve. When initiating pharmacotherapy in the older adult population for various conditions, including depression, the general principles include "start low, go slow, but get to goal." Initiating treatment at the highest dose will increase the risk of potential drug-related adverse effects and compromise the safety of the patient.

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.

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

B. AD.

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

B. cardioselective β-adrenergic antagonists.

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.

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. Pseudodementia is the condition where the presenting symptoms are similar to dementia but is the result of depression.

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.

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.

98. Which of the following nutritional supplements is used to potentially slow cognitive decline in AD? A. vitamin B12 B. vitamin E C. ginkgo biloba D. St. John's wort

B. vitamin E

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.

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.

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.