NSG 6420 (ADULT GERO) FINAL EXAM STUDY REVIEW with QUESTIONS AND
ANSWERS
1. General Concepts in Geriatrics
Impact of physiological changes with aging: Kennedy Chapter 1.
The major impact of all of these physiological changes can be highlighted with three primary
points. First, there is a reduced physiological reserve of most body systems, particularly cardiac,
respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust
regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is
impaired immunological function: infection risk is greater, and autoimmune diseases are more
prevalent. Reduced renal function, particularly the glomerular filtration rate (GFR), affects the
clearance of many drugs, and creatinine clearance provides an index of renal function for use in
choosing doses of renally eliminated or nephrotoxic drugs (such as digoxin, H2 blockers,
lithium, and water-soluble antibiotics).
Normal age related changes:
Changes in kidney function begin in the fourth decade of life and continue to decline with each
subsequent decade. by age 70, an individual might reasonably have a 40% to 50% decrease in
renal function, even in the absence of disease.
With advancing age, the ability of the liver to metabolize drugs does not decline. Although
liversize and blood flow do decline with age, routine liver function test results are typically
normal when no disease exists. Decreased liver size and blood flow can result in decreased
first-passmetabolism.
Older adults often experience more sedation from central nervous system drugs than younger
persons at the same concentration.
Signs and symptoms of depression:
Altered presentation is another common feature in older adults. The patient with
depressionmay not present with a dysphoric mood but rather agitation and psychotic
features.
Questions
The major impact of the physiological changes that occur with aging is:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
All of the above
All of the following statements are true about laboratory values in olderadults
except
Reference ranges are preferable
Abnormal findings are often due to physiological aging
Normal ranges may not be applicable for older adults
Reference values are not necessarily acceptable values
, Mini Mental Status: Buttaro Chapter 13
Geriatric specialists have multiple assessment tools, such as the Folstein Mini-Mental State
Examination, the Mini-Cog screen for dementia, the Short Portable Mental Status
Questionnaire, the AD8 Dementia Screening Interview, and the Montreal Cognitive Assessment
(MoCa), to differentiate short-term memory loss from dementia and to observe the progression
of cognitive impairment.
Questions
When prescribing medications to an 80-year-old patient, the provider will
a. begin with higher doses and decrease according to the patient’s response.
b. consult the Beers list to help identify potentially problematic drugs.
c. ensure that the patient does not take more than five concurrent medications.
d. review all patient medications at the annual health maintenance visit.
The Beers list provides a list of potentially inappropriate medications in all patients age
65 and older and helps minimize drug-related problems in this age group. Older patients
should be started on lower doses with gradual increase of doses depending on response
and side effects. Patients who take five or more drugs are at increased risk for problems
of polypharmacy, but many will need to take more than five drugs; providers must
monitor their response more closely.Medications should be reviewed at all visits, not just
annually. REF: Polypharmacy/Consequences of Polypharmacy/Management
An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds.
She appears somewhat confused, according to her daughter, who is concerned that she
is developing dementia. The provider learns that the woman still drives, volunteers at
the local hospital, and attends a book club with several friends once a month. What is the
initial step in evaluating this patient?
a. Obtain a CBC, serum electrolytes, BUN, and glucose
b. Ordering a CBC, serum ferritin, and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. Referring the patient to a neurologist for evaluation for AD
Patients with weight loss, confusion, and lethargy are often dehydrated and this should
be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently
leading an active life, so the likelihood that recent symptoms are related to AD, although
this may be evaluated if dehydration is ruled out. Anemia would be a consideration
when dehydration is ruled out. Referrals are not necessary unless initial evaluations
suggest that malnutrition or AD ispresent. REF: Dehydration/Pathophysiology/Clinical
Presentation/Physical Examination
,The practitioner is establishing a plan for routine health maintenance for a new female
client whois 80 years old. The client has never smoked and has been in good health. What
will the practitioner include in routine care for this patient?
Select all that apply.
a. Annual hypertension screening
b. Baseline abdominal aorta ultrasound
c. Colonoscopy every 10 years
d. One-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza vaccine
For older clients a one-time pneumovax is given after age 65. Influenza vaccine should
be given every year. Hypertension screening should be performed at each office visit, not
just annually. An abdominal aorta US is performed once for every smoking male.
Colonoscopy is performed every10 years after age 50, but not after age 74. REF: Table 13-
1: Recommended Screening and Immunizations
2. HEENT
Pharyngitis Buttaro Chapter 101
In noninfectious pharyngitis the patient reports a sore throat and dryness; if environmental
allergens are the cause, symptoms often include rhinorrhea, watery eyes, and postnasal drip.
Viral causes are more common (rhinorivus) In viral pharyngitis, findings include fever, cough,
nasal symptoms, and mild erythema with little or no pharyngeal exudate. Treatment of viral
pharyngitis includes rest, fluids, humidification, voice rest, and warm saline gargles to ease
discomfort. 7 Acetaminophen or ibuprofen should be used for fever and general discomfort.
Bacterial pharyngitis is more common in children younger than 15. Streptococcus pyogenes is
the etiologic agent for acute pharyngitis. Group A β-hemolytic Streptococcus (GAS) is the most
important to identify because it is responsible for acute rheumatic fever (ARF) and
poststreptococcal glomerulonephritis. Patients may report a sudden onset of sore throat, painful
swallowing, fever (temperature higher than 38.5° C [101.3° F]), chills, headache, nausea,
vomiting, and abdominal pain. With bacterial pharyngitis, rhinitis, cough, conjunctivitis, and
myalgias are not typically present. Diagnostic studies used to detect GAS infection include a
throat culture, a rapid antigen detection test (RADT).
Penicillin V, 500 mg 2-3 times daily for 10 days) is indicated in GAS pharyngitis primarily to
prevent complications, such as suppurative tonsillitis, glomerulonephritis, and rheumatic fever.
Clarithromycin, 250 mg twice daily for 10 days, is indicated for patients with penicillin allergy.
Questions
, A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient’s symptoms?
a. Order an antistreptolysin O titer
b. Perform a rapid antigen detection test
c. Prescribe empiric penicillin
d. Refer to an otolaryngologist
The RADT is performed initially to determine whether GAS is present. The ASO titer is
not usedduring initial diagnostic screening. Penicillin should not be given empirically. A
referral to a specialist is not required for GAS infection.
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider
notes mild erythema of the pharynx and clear rhinorrhea without cervical
lymphadenopathy. What is the most likely cause of these symptoms?
a. Allergic pharyngitis
b. Group A streptococcus
c. Infectious mononucleosis
d. Viral pharyngitis
Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by
URI symptoms of cough and runny nose. Allergic pharyngitis usually also causes
dryness. GAS causes high fever, cervical adenopathy, and marked erythema with
exudate. Infectious mononucleosis will cause an exudate along with cervical adenopathy
A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the
previous year. The child’s parent asks the provider if the child needs a tonsillectomy.
What will the provider tell this parent?
a. Current recommendations do not support tonsillectomy for this child.
b. If there is one more episode in the next 6 months, a tonsillectomy is necessary.
c. The child should have radiographic studies to evaluate the need for tonsillectomy.
d. Tonsillectomy is recommended based on this child’s history.
Recommendations suggest 6 to 7 documented episodes of GAS within 1 year, 5/year for
2 consecutive years, or 3/year for 3 years. Radiographic studies are not indicated
Mononucleosis (Buttaro Chapter 233)
EBV-IM (Epstein-Bar Virus infectious mononucleosis) occurs most often in adolescents and
young adults, with the highest incident at ages 15 to 19. Transmission of EBV-IM occurs
throughexposure to oropharyngeal secretions. The classic triad of symptoms of acute IM
includes fever,pharyngitis, and lymphadenopathy. The typical adolescent with EBV-IM is seen
ANSWERS
1. General Concepts in Geriatrics
Impact of physiological changes with aging: Kennedy Chapter 1.
The major impact of all of these physiological changes can be highlighted with three primary
points. First, there is a reduced physiological reserve of most body systems, particularly cardiac,
respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust
regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is
impaired immunological function: infection risk is greater, and autoimmune diseases are more
prevalent. Reduced renal function, particularly the glomerular filtration rate (GFR), affects the
clearance of many drugs, and creatinine clearance provides an index of renal function for use in
choosing doses of renally eliminated or nephrotoxic drugs (such as digoxin, H2 blockers,
lithium, and water-soluble antibiotics).
Normal age related changes:
Changes in kidney function begin in the fourth decade of life and continue to decline with each
subsequent decade. by age 70, an individual might reasonably have a 40% to 50% decrease in
renal function, even in the absence of disease.
With advancing age, the ability of the liver to metabolize drugs does not decline. Although
liversize and blood flow do decline with age, routine liver function test results are typically
normal when no disease exists. Decreased liver size and blood flow can result in decreased
first-passmetabolism.
Older adults often experience more sedation from central nervous system drugs than younger
persons at the same concentration.
Signs and symptoms of depression:
Altered presentation is another common feature in older adults. The patient with
depressionmay not present with a dysphoric mood but rather agitation and psychotic
features.
Questions
The major impact of the physiological changes that occur with aging is:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
All of the above
All of the following statements are true about laboratory values in olderadults
except
Reference ranges are preferable
Abnormal findings are often due to physiological aging
Normal ranges may not be applicable for older adults
Reference values are not necessarily acceptable values
, Mini Mental Status: Buttaro Chapter 13
Geriatric specialists have multiple assessment tools, such as the Folstein Mini-Mental State
Examination, the Mini-Cog screen for dementia, the Short Portable Mental Status
Questionnaire, the AD8 Dementia Screening Interview, and the Montreal Cognitive Assessment
(MoCa), to differentiate short-term memory loss from dementia and to observe the progression
of cognitive impairment.
Questions
When prescribing medications to an 80-year-old patient, the provider will
a. begin with higher doses and decrease according to the patient’s response.
b. consult the Beers list to help identify potentially problematic drugs.
c. ensure that the patient does not take more than five concurrent medications.
d. review all patient medications at the annual health maintenance visit.
The Beers list provides a list of potentially inappropriate medications in all patients age
65 and older and helps minimize drug-related problems in this age group. Older patients
should be started on lower doses with gradual increase of doses depending on response
and side effects. Patients who take five or more drugs are at increased risk for problems
of polypharmacy, but many will need to take more than five drugs; providers must
monitor their response more closely.Medications should be reviewed at all visits, not just
annually. REF: Polypharmacy/Consequences of Polypharmacy/Management
An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds.
She appears somewhat confused, according to her daughter, who is concerned that she
is developing dementia. The provider learns that the woman still drives, volunteers at
the local hospital, and attends a book club with several friends once a month. What is the
initial step in evaluating this patient?
a. Obtain a CBC, serum electrolytes, BUN, and glucose
b. Ordering a CBC, serum ferritin, and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. Referring the patient to a neurologist for evaluation for AD
Patients with weight loss, confusion, and lethargy are often dehydrated and this should
be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently
leading an active life, so the likelihood that recent symptoms are related to AD, although
this may be evaluated if dehydration is ruled out. Anemia would be a consideration
when dehydration is ruled out. Referrals are not necessary unless initial evaluations
suggest that malnutrition or AD ispresent. REF: Dehydration/Pathophysiology/Clinical
Presentation/Physical Examination
,The practitioner is establishing a plan for routine health maintenance for a new female
client whois 80 years old. The client has never smoked and has been in good health. What
will the practitioner include in routine care for this patient?
Select all that apply.
a. Annual hypertension screening
b. Baseline abdominal aorta ultrasound
c. Colonoscopy every 10 years
d. One-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza vaccine
For older clients a one-time pneumovax is given after age 65. Influenza vaccine should
be given every year. Hypertension screening should be performed at each office visit, not
just annually. An abdominal aorta US is performed once for every smoking male.
Colonoscopy is performed every10 years after age 50, but not after age 74. REF: Table 13-
1: Recommended Screening and Immunizations
2. HEENT
Pharyngitis Buttaro Chapter 101
In noninfectious pharyngitis the patient reports a sore throat and dryness; if environmental
allergens are the cause, symptoms often include rhinorrhea, watery eyes, and postnasal drip.
Viral causes are more common (rhinorivus) In viral pharyngitis, findings include fever, cough,
nasal symptoms, and mild erythema with little or no pharyngeal exudate. Treatment of viral
pharyngitis includes rest, fluids, humidification, voice rest, and warm saline gargles to ease
discomfort. 7 Acetaminophen or ibuprofen should be used for fever and general discomfort.
Bacterial pharyngitis is more common in children younger than 15. Streptococcus pyogenes is
the etiologic agent for acute pharyngitis. Group A β-hemolytic Streptococcus (GAS) is the most
important to identify because it is responsible for acute rheumatic fever (ARF) and
poststreptococcal glomerulonephritis. Patients may report a sudden onset of sore throat, painful
swallowing, fever (temperature higher than 38.5° C [101.3° F]), chills, headache, nausea,
vomiting, and abdominal pain. With bacterial pharyngitis, rhinitis, cough, conjunctivitis, and
myalgias are not typically present. Diagnostic studies used to detect GAS infection include a
throat culture, a rapid antigen detection test (RADT).
Penicillin V, 500 mg 2-3 times daily for 10 days) is indicated in GAS pharyngitis primarily to
prevent complications, such as suppurative tonsillitis, glomerulonephritis, and rheumatic fever.
Clarithromycin, 250 mg twice daily for 10 days, is indicated for patients with penicillin allergy.
Questions
, A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient’s symptoms?
a. Order an antistreptolysin O titer
b. Perform a rapid antigen detection test
c. Prescribe empiric penicillin
d. Refer to an otolaryngologist
The RADT is performed initially to determine whether GAS is present. The ASO titer is
not usedduring initial diagnostic screening. Penicillin should not be given empirically. A
referral to a specialist is not required for GAS infection.
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider
notes mild erythema of the pharynx and clear rhinorrhea without cervical
lymphadenopathy. What is the most likely cause of these symptoms?
a. Allergic pharyngitis
b. Group A streptococcus
c. Infectious mononucleosis
d. Viral pharyngitis
Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by
URI symptoms of cough and runny nose. Allergic pharyngitis usually also causes
dryness. GAS causes high fever, cervical adenopathy, and marked erythema with
exudate. Infectious mononucleosis will cause an exudate along with cervical adenopathy
A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the
previous year. The child’s parent asks the provider if the child needs a tonsillectomy.
What will the provider tell this parent?
a. Current recommendations do not support tonsillectomy for this child.
b. If there is one more episode in the next 6 months, a tonsillectomy is necessary.
c. The child should have radiographic studies to evaluate the need for tonsillectomy.
d. Tonsillectomy is recommended based on this child’s history.
Recommendations suggest 6 to 7 documented episodes of GAS within 1 year, 5/year for
2 consecutive years, or 3/year for 3 years. Radiographic studies are not indicated
Mononucleosis (Buttaro Chapter 233)
EBV-IM (Epstein-Bar Virus infectious mononucleosis) occurs most often in adolescents and
young adults, with the highest incident at ages 15 to 19. Transmission of EBV-IM occurs
throughexposure to oropharyngeal secretions. The classic triad of symptoms of acute IM
includes fever,pharyngitis, and lymphadenopathy. The typical adolescent with EBV-IM is seen
