,TESTBANK FOR Evidence-Based Geriatric Nursing
Protocols for Best Practice, 7th Edition Boltz
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,EVIDENCE-BASED GERIATRIC
NURSING PROTOCOLS FOR BEST
PRACTICE
Seventh Edition
Marie Boltz, PhD, RN, GNP-BC, FGSA, FAAN
EXECUTIVE EDITOR
Elizabeth A. Capezuti, PhD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN
EDITORS
Copyright © Springer Publishing Company
,Copyright © 2025 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
ISBN: 978-0-8261-5279-4
The author and the publisher of this Work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. Because medical science is continually advancing, our
knowledge base continues to expand. Therefore, as new information becomes available,
changes in procedures become necessary. We recommend that the reader always consult
current research and specific institutional policies before performing any clinical procedure or
delivering any medication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
2 © Springer Publishing Company, LLC
,Contents
CHAPTER 1: Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach 1
CHAPTER 2: Measuring Performance and Improving Quality 8
CHAPTER 3: Informational Technology: Embedding Geriatric Clinical Practice Guidelines 11
CHAPTER 4: Organizational Approaches to Promote Person-Centered Care 16
CHAPTER 5: Incorporating Principles of Diversity, Equity, Inclusion, and Access Into Practice 21
CHAPTER 6: Supporting Empowered Work Environments 24
CHAPTER 7: Environmental Approaches to Support Aging-Friendly Care 27
CHAPTER 8: Age-Related Changes in Health 31
CHAPTER 9: Healthcare Decision-Making and Advance Care Planning 36
CHAPTER 10: Assessing Cognitive Function in the Older Adult 39
CHAPTER 11: Assessing Physical Function and Promoting Safe Mobility in the Older Adult 45
CHAPTER 12: Promotion of Optimal Nutrition in the Older Adult 48
CHAPTER 13: Assessment and Management of Mealtime Behaviors, Function, and Nutrition in
Older Adults Living With Dementia 52
CHAPTER 14: Family Caregiving for the Older Adult 55
CHAPTER 15: Elder Mistreatment Detection 60
CHAPTER 16: LGBTQ Perspectives for Older Adult Care 65
CHAPTER 17: HIV Prevention and Care in the Older Adult 69
CHAPTER 18: Pain Management in the Older Adult 73
CHAPTER 19: Medication Management in the Older Adult Across Care Settings 78
CHAPTER 20: Dementia 81
CHAPTER 21: Delirium 86
CHAPTER 22: Depression 90
CHAPTER 23: Care and Management of Diabetes in Older Adults 93
CHAPTER 24: Urinary Incontinence 96
CHAPTER 25: Catheter-Associated Urinary Tract Infection 100
CHAPTER 26: Oral Healthcare 105
CHAPTER 27: Fluid Overload: Identifying and Managing Heart Failure Patients at Risk for
Hospital Readmission 110
CHAPTER 28: Care of the Older Adult with Fragility Hip Fracture 115
© Springer Publishing Company, LLC 3
,CHAPTER 29: Respiratory Care 119
CHAPTER 30: Pressure Injuries and Skin Tears 122
CHAPTER 31: Disorders of Sleep 126
CHAPTER 32: Alcohol and Substance Use in the Older Adult 130
CHAPTER 33: Serious Mental Illness in the Older Adult: Care and Treatment 135
CHAPTER 34: Comprehensive Assessment and Management of the Critically Ill Older Adult 138
CHAPTER 35: Comprehensive Assessment to Preserve Resilience in Older Adults with Cancer
143
CHAPTER 36: Perioperative Care of the Older Adult 148
CHAPTER 37: General Surgical Care of the Older Adult 152
CHAPTER 38: Care and Comfort at the End of Life 157
CHAPTER 39: Acute Care Models 160
CHAPTER 40: Transitional Care Models 165
CHAPTER 41: Palliative Care Models 169
CHAPTER 42: Care of the Older Adult in the Emergency Department 174
CHAPTER 43: Long-Term Care Models 179
CHAPTER 44: Community-Based and Primary Care Models 182
CHAPTER 45: Age-Friendly Health Systems 185
4 © Springer Publishing Company, LLC
, CHAPTER 1
Developing and Evaluating Clinical
Practice Guidelines: A Systematic
Approach
MULTIPLE CHOICE TEST QUESTIONS
1. Models of evidence-based practice (EBP) involve which of the following steps when
determining the process of developing protocols? Select all that apply.
*a. Develop an answerable question.
b. Compare the evidence to what one feels to be true.
*c. Critically appraise the evidence.
*d. Locate the best evidence.
Rationale: Evidence-based practice (EBP) involves five steps:
1. Develop an answerable question.
2. Locate the best evidence.
3. Critically appraise the evidence.
4. Integrate evidence into practice using clinical expertise with attention to the patient’s
values and perspectives.
5. Evaluate the outcome(s).
Comparing the evidence to what one feels to be true is not a part of evidence-based
practice.
2. When critically evaluating the evidence used in a study, which level of evidence is at the
bottom of the level of evidence (LOE) hierarchy pyramid?
*a. Opinions of respected authorities
b. Systematic reviews of clinical practice guidelines (CPGs)
c. Single experimental studies (randomized controlled trials)
d. Nonexperimental studies
Rationale: The level of evidence (LOE) hierarchy pyramid highlights six levels of evidence.
Opinions of respected authorities, internationally or nationally known, based on their clinical
experience or the opinions of an expert committee, including regulatory or legal opinions, form
© Springer Publishing Company, LLC 1
,the lowest level of evidence (i.e., Level VI, at the bottom of the LOE pyramid). The highest level
of evidence, at the top of the pyramid, comprised systematic reviews, meta-analyses, or
structured integrative reviews of evidence. Evidence judged to be at Level II comes from a
single randomized controlled trial. Nonexperimental studies are considered Level IV evidence.
3. Which of the following questions are based on the PICO format? Select all that apply.
*a. In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?
*b. For obese children, does the use of community recreation activities compared with
educational programs on lifestyle changes reduce the risk of diabetes mellitus?
*c. For deep vein thrombosis, is D-dimer testing or ultrasound more accurate for diagnosis?
d. Do adults who binge-drink have higher mortality rates?
Rationale: PICO stands for:
P - Population or patient problem
I - Intervention
C - Comparison group or standard practice
O - Outcomes
PICO format is used to frame the research question and facilitate literature search. Each
research question is narrowed down to clearly state the population or the patient problem, the
intervention being studied, the comparison group, and the outcome measures. In the question
“In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?”, patients with osteoarthritis form the population, hydrotherapy
is the intervention that is being compared with traditional physiotherapy, and pain relief is the
expected outcome. In the question “For obese children, does the use of community recreation
activities compared with educational programs on lifestyle changes reduce the risk of diabetes
mellitus?”, obese children form the study population, use of community recreation services is
the intervention, being compared with educational programs on lifestyle changes, and reducing
the risk of diabetes mellitus is the expected outcome. In the question “For deep vein thrombosis,
is D-dimer testing or ultrasound more accurate for diagnosis?”, deep vein thrombosis is the
patient problem, D-dimer testing is the intervention, being compared with ultrasound for
accuracy of diagnosis, which is the expected outcome. The question “Do adults who binge-drink
have higher mortality rates?” does not follow the PICO format. In this question, adults form the
population being studied, binge drinking is the intervention, and higher mortality rate is the
2 © Springer Publishing Company, LLC
,outcome being studied. However, the comparison group is not defined and stated in the
question.
4. Which of the following statements regarding the AGREE II instrument are true? Select all
that apply.
*a. The AGREE instrument has 6 quality domains with 23 items divided among these
domains.
*b. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to “strongly
agree” by a number of appraisers.
c. The six domain scores are aggregated into a single quality score.
d. The reliability of the AGREE instrument is decreased when each guideline is appraised by more
than one appraiser.
Rationale: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument has
six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity
and presentation, application, and editorial independence. A total of 23 items are divided into
these domains. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to
“strongly agree” by a number of appraisers. Appraisers evaluate how well the guideline they are
assessing meets the criteria of the six quality domains. The six domain scores are independent
and should not be aggregated into a single quality score. The reliability of the AGREE
instrument is increased, not decreased, when each guideline is appraised by more than one
appraiser.
5. Four appraisers give the following scores, as shown in the table below, for domain 1 (Scope
and Purpose) in the AGREE II instrument. What will be the scaled domain score?
Item 1 Item 2 Item 3 Item 4
Appraiser 1 5 6 6 17
Appraiser 2 6 6 7 19
Appraiser 3 2 4 3 9
Appraiser 4 3 3 2 8
16 19 18 53
a. 53%
*b. 57%
© Springer Publishing Company, LLC 3
, c. 47%
d. 19%
Rationale:
Maximum possible score = 7 (strongly agree) × 3 (items) × 4 (appraisers) = 84
Minimum possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12
The scaled domain score will be:
Obtained score − Minimum possible score
Maximum possible score − Minimum possible score
53 − 12 × 100 = 41 × 100 = 0.5694 × 100 = 57%
84 − 12 72
6. A 59-year-old patient is diagnosed with acute biliary pancreatitis and noninfected pancreatic
necrosis on contrast-enhanced CT scan. The clinician plans to start a course of prophylactic
antibiotics. Which study design is appropriate to evaluate if antibiotics prevent infection of
noninfected pancreatic necrosis and decrease mortality?
a. Case–control study
b. Randomized controlled trial
*c. Systematic review and meta-analysis
d. Prospective cohort study
Rationale: Systematic review and meta-analysis of previous randomized control trials to
evaluate use of antibiotics in preventing infection of noninfected pancreatic necrosis and
decreasing mortality will be the appropriate study design in this case. Systematic reviews and
meta-analysis constitute the highest level of evidence (Level I according to the level of evidence
hierarchy pyramid).
Case–control studies are observational studies used to identify factors that may contribute to a
medical condition by comparing subjects who have that condition/disease (the “cases”) with
subjects who do not have the condition/disease but are otherwise similar (the “controls’).
Case–control studies require fewer resources but more time; also the evidence obtained is
inferior to other types of study designs (Level IV on the level of evidence hierarchy pyramid).
Thus, this will not be an appropriate study design in this case. A randomized controlled trial is a
study design with two study groups: the experimental group, where the intervention being
studied is applied; and the control group, where no intervention is used or a placebo is used
instead. A randomized controlled trial can be used in this case to evaluate if antibiotics prevent
infection of noninfected pancreatic necrosis and decrease mortality. However, it will be difficult
4 © Springer Publishing Company, LLC
Protocols for Best Practice, 7th Edition Boltz
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,EVIDENCE-BASED GERIATRIC
NURSING PROTOCOLS FOR BEST
PRACTICE
Seventh Edition
Marie Boltz, PhD, RN, GNP-BC, FGSA, FAAN
EXECUTIVE EDITOR
Elizabeth A. Capezuti, PhD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN
EDITORS
Copyright © Springer Publishing Company
,Copyright © 2025 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
ISBN: 978-0-8261-5279-4
The author and the publisher of this Work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. Because medical science is continually advancing, our
knowledge base continues to expand. Therefore, as new information becomes available,
changes in procedures become necessary. We recommend that the reader always consult
current research and specific institutional policies before performing any clinical procedure or
delivering any medication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
2 © Springer Publishing Company, LLC
,Contents
CHAPTER 1: Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach 1
CHAPTER 2: Measuring Performance and Improving Quality 8
CHAPTER 3: Informational Technology: Embedding Geriatric Clinical Practice Guidelines 11
CHAPTER 4: Organizational Approaches to Promote Person-Centered Care 16
CHAPTER 5: Incorporating Principles of Diversity, Equity, Inclusion, and Access Into Practice 21
CHAPTER 6: Supporting Empowered Work Environments 24
CHAPTER 7: Environmental Approaches to Support Aging-Friendly Care 27
CHAPTER 8: Age-Related Changes in Health 31
CHAPTER 9: Healthcare Decision-Making and Advance Care Planning 36
CHAPTER 10: Assessing Cognitive Function in the Older Adult 39
CHAPTER 11: Assessing Physical Function and Promoting Safe Mobility in the Older Adult 45
CHAPTER 12: Promotion of Optimal Nutrition in the Older Adult 48
CHAPTER 13: Assessment and Management of Mealtime Behaviors, Function, and Nutrition in
Older Adults Living With Dementia 52
CHAPTER 14: Family Caregiving for the Older Adult 55
CHAPTER 15: Elder Mistreatment Detection 60
CHAPTER 16: LGBTQ Perspectives for Older Adult Care 65
CHAPTER 17: HIV Prevention and Care in the Older Adult 69
CHAPTER 18: Pain Management in the Older Adult 73
CHAPTER 19: Medication Management in the Older Adult Across Care Settings 78
CHAPTER 20: Dementia 81
CHAPTER 21: Delirium 86
CHAPTER 22: Depression 90
CHAPTER 23: Care and Management of Diabetes in Older Adults 93
CHAPTER 24: Urinary Incontinence 96
CHAPTER 25: Catheter-Associated Urinary Tract Infection 100
CHAPTER 26: Oral Healthcare 105
CHAPTER 27: Fluid Overload: Identifying and Managing Heart Failure Patients at Risk for
Hospital Readmission 110
CHAPTER 28: Care of the Older Adult with Fragility Hip Fracture 115
© Springer Publishing Company, LLC 3
,CHAPTER 29: Respiratory Care 119
CHAPTER 30: Pressure Injuries and Skin Tears 122
CHAPTER 31: Disorders of Sleep 126
CHAPTER 32: Alcohol and Substance Use in the Older Adult 130
CHAPTER 33: Serious Mental Illness in the Older Adult: Care and Treatment 135
CHAPTER 34: Comprehensive Assessment and Management of the Critically Ill Older Adult 138
CHAPTER 35: Comprehensive Assessment to Preserve Resilience in Older Adults with Cancer
143
CHAPTER 36: Perioperative Care of the Older Adult 148
CHAPTER 37: General Surgical Care of the Older Adult 152
CHAPTER 38: Care and Comfort at the End of Life 157
CHAPTER 39: Acute Care Models 160
CHAPTER 40: Transitional Care Models 165
CHAPTER 41: Palliative Care Models 169
CHAPTER 42: Care of the Older Adult in the Emergency Department 174
CHAPTER 43: Long-Term Care Models 179
CHAPTER 44: Community-Based and Primary Care Models 182
CHAPTER 45: Age-Friendly Health Systems 185
4 © Springer Publishing Company, LLC
, CHAPTER 1
Developing and Evaluating Clinical
Practice Guidelines: A Systematic
Approach
MULTIPLE CHOICE TEST QUESTIONS
1. Models of evidence-based practice (EBP) involve which of the following steps when
determining the process of developing protocols? Select all that apply.
*a. Develop an answerable question.
b. Compare the evidence to what one feels to be true.
*c. Critically appraise the evidence.
*d. Locate the best evidence.
Rationale: Evidence-based practice (EBP) involves five steps:
1. Develop an answerable question.
2. Locate the best evidence.
3. Critically appraise the evidence.
4. Integrate evidence into practice using clinical expertise with attention to the patient’s
values and perspectives.
5. Evaluate the outcome(s).
Comparing the evidence to what one feels to be true is not a part of evidence-based
practice.
2. When critically evaluating the evidence used in a study, which level of evidence is at the
bottom of the level of evidence (LOE) hierarchy pyramid?
*a. Opinions of respected authorities
b. Systematic reviews of clinical practice guidelines (CPGs)
c. Single experimental studies (randomized controlled trials)
d. Nonexperimental studies
Rationale: The level of evidence (LOE) hierarchy pyramid highlights six levels of evidence.
Opinions of respected authorities, internationally or nationally known, based on their clinical
experience or the opinions of an expert committee, including regulatory or legal opinions, form
© Springer Publishing Company, LLC 1
,the lowest level of evidence (i.e., Level VI, at the bottom of the LOE pyramid). The highest level
of evidence, at the top of the pyramid, comprised systematic reviews, meta-analyses, or
structured integrative reviews of evidence. Evidence judged to be at Level II comes from a
single randomized controlled trial. Nonexperimental studies are considered Level IV evidence.
3. Which of the following questions are based on the PICO format? Select all that apply.
*a. In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?
*b. For obese children, does the use of community recreation activities compared with
educational programs on lifestyle changes reduce the risk of diabetes mellitus?
*c. For deep vein thrombosis, is D-dimer testing or ultrasound more accurate for diagnosis?
d. Do adults who binge-drink have higher mortality rates?
Rationale: PICO stands for:
P - Population or patient problem
I - Intervention
C - Comparison group or standard practice
O - Outcomes
PICO format is used to frame the research question and facilitate literature search. Each
research question is narrowed down to clearly state the population or the patient problem, the
intervention being studied, the comparison group, and the outcome measures. In the question
“In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?”, patients with osteoarthritis form the population, hydrotherapy
is the intervention that is being compared with traditional physiotherapy, and pain relief is the
expected outcome. In the question “For obese children, does the use of community recreation
activities compared with educational programs on lifestyle changes reduce the risk of diabetes
mellitus?”, obese children form the study population, use of community recreation services is
the intervention, being compared with educational programs on lifestyle changes, and reducing
the risk of diabetes mellitus is the expected outcome. In the question “For deep vein thrombosis,
is D-dimer testing or ultrasound more accurate for diagnosis?”, deep vein thrombosis is the
patient problem, D-dimer testing is the intervention, being compared with ultrasound for
accuracy of diagnosis, which is the expected outcome. The question “Do adults who binge-drink
have higher mortality rates?” does not follow the PICO format. In this question, adults form the
population being studied, binge drinking is the intervention, and higher mortality rate is the
2 © Springer Publishing Company, LLC
,outcome being studied. However, the comparison group is not defined and stated in the
question.
4. Which of the following statements regarding the AGREE II instrument are true? Select all
that apply.
*a. The AGREE instrument has 6 quality domains with 23 items divided among these
domains.
*b. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to “strongly
agree” by a number of appraisers.
c. The six domain scores are aggregated into a single quality score.
d. The reliability of the AGREE instrument is decreased when each guideline is appraised by more
than one appraiser.
Rationale: The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument has
six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity
and presentation, application, and editorial independence. A total of 23 items are divided into
these domains. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to
“strongly agree” by a number of appraisers. Appraisers evaluate how well the guideline they are
assessing meets the criteria of the six quality domains. The six domain scores are independent
and should not be aggregated into a single quality score. The reliability of the AGREE
instrument is increased, not decreased, when each guideline is appraised by more than one
appraiser.
5. Four appraisers give the following scores, as shown in the table below, for domain 1 (Scope
and Purpose) in the AGREE II instrument. What will be the scaled domain score?
Item 1 Item 2 Item 3 Item 4
Appraiser 1 5 6 6 17
Appraiser 2 6 6 7 19
Appraiser 3 2 4 3 9
Appraiser 4 3 3 2 8
16 19 18 53
a. 53%
*b. 57%
© Springer Publishing Company, LLC 3
, c. 47%
d. 19%
Rationale:
Maximum possible score = 7 (strongly agree) × 3 (items) × 4 (appraisers) = 84
Minimum possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12
The scaled domain score will be:
Obtained score − Minimum possible score
Maximum possible score − Minimum possible score
53 − 12 × 100 = 41 × 100 = 0.5694 × 100 = 57%
84 − 12 72
6. A 59-year-old patient is diagnosed with acute biliary pancreatitis and noninfected pancreatic
necrosis on contrast-enhanced CT scan. The clinician plans to start a course of prophylactic
antibiotics. Which study design is appropriate to evaluate if antibiotics prevent infection of
noninfected pancreatic necrosis and decrease mortality?
a. Case–control study
b. Randomized controlled trial
*c. Systematic review and meta-analysis
d. Prospective cohort study
Rationale: Systematic review and meta-analysis of previous randomized control trials to
evaluate use of antibiotics in preventing infection of noninfected pancreatic necrosis and
decreasing mortality will be the appropriate study design in this case. Systematic reviews and
meta-analysis constitute the highest level of evidence (Level I according to the level of evidence
hierarchy pyramid).
Case–control studies are observational studies used to identify factors that may contribute to a
medical condition by comparing subjects who have that condition/disease (the “cases”) with
subjects who do not have the condition/disease but are otherwise similar (the “controls’).
Case–control studies require fewer resources but more time; also the evidence obtained is
inferior to other types of study designs (Level IV on the level of evidence hierarchy pyramid).
Thus, this will not be an appropriate study design in this case. A randomized controlled trial is a
study design with two study groups: the experimental group, where the intervention being
studied is applied; and the control group, where no intervention is used or a placebo is used
instead. A randomized controlled trial can be used in this case to evaluate if antibiotics prevent
infection of noninfected pancreatic necrosis and decrease mortality. However, it will be difficult
4 © Springer Publishing Company, LLC
