NR601 Midterm Exam
The rules of fourths - answer clarifies that changes often attributed to normal aging by
the general public (and sometimes by medical professionals) are caused by disease,
disuse, misuse, and physiology—about one-fourth of the time for each.
Normal physiologic changes - answer• The age at which reading glasses are needed
because of reduced lens elasticity is between 42 and 50 years.
• Vestibular sensitivity gradually increases until about age 60 years, which is one of the
reasons why adults have increasing trouble on amusement park rides as they age.
• Fertility in women peaks between 15 and 25 years and declines thereafter, with
menopause typically occurring about age 50 years.
• Reaction time tends to increase with age (which explains why teenagers are usually
far better at games of speed—including many video games—than older persons).
• The amount of sway a person will experience if asked to stand still with eyes closed is
high in early childhood, is minimized between about ages 15 and 16 years, and then
gradually increases beyond age 60 years.
• Ankle jerk reflexes are increasingly diminished or absent with older age, in the
absence of detectable musculoskeletal pathology.
• Bone density plateaus between ages 20 and 50 years, then gradually declines, with
the slope of decline being more rapid in women than in men.
Iatrogenic disease - answer Illness caused by medical interventions, known as
iatrogenic illness, is one of the most common medical problems of older persons.
Which one of the following is most true about the rule of fourths?
a. One-fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three-fourths of the problems of aging.
c. For every medical complaint a patient presents with, a careful assessment can
identify three other diagnoses.
d. What used to be called normal aging can be largely explained by processes that are
not normal.
e. A good way to conduct a geriatric assessment is to use four categories: mental,
physical, psychosocial, and environmental - answerD
Which one of the following is most true about aging changes?
a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men. - answerA
An old woman who is cared for by attentive, cautious, concerned family is particularly
likely to suffer from which one of the following complications after an episode of
gastroenteritis?
, a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea - answerA
Which one of the following is most true about psychological aging?
a. Disengagement tends to promote better psychological health than continued
engagement.
b. Most older adults do not worry about memory loss.
c. Happiness declines starting in middle age.
d. Ageism can lead to isolation and depression. - answerD
Of the following conditions, which one is most common and most often preventable?
a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
e. Depression - answerD
Immunizations recommended for older Adults - answerInfluenza inactive (IIV), or
recombinant (RIV): 1 dose annually
Tetanus, diphtheria, pertussis (TDAP): 1 dose after age 65 years then Td every 10
years
Varicella recombinant (Shingrix): 2 doses 2-5 months apart. Give to those who had
zoster
Pneumococcal: 1 dose of PPSV23 (Polysaccharide, Pneumovax); consider 1 dose PCV
13 in high-risk patients
Hepatitis A/hepatitis B: Only if high risk, and at least once
Vaccine costs - answerMedicare Part B covers vaccines to prevent influenza and
pneumonia, as well as hepatitis B if the patient is at medium to high risk for this disease.
No copay is associated with these vaccines. All other vaccines are covered under
Medicare Part D; this includes the vaccine for zoster.
Zostavax - answercan be used when there is a Shingrix allergy, if a patient prefers the
Zostavax, or the patient wishes an immediate vaccination and Shingrix is unavailable.
The vaccination is recommended even if a patient is unsure about having chickenpox in
the past
The Five A's - answerAssess
Ask about behavioral health risks and other factors that affect health goal change.
Advise
Provide clear, targeted behavior change advice, along with information as to potential
harms/benefits.
Agree
The rules of fourths - answer clarifies that changes often attributed to normal aging by
the general public (and sometimes by medical professionals) are caused by disease,
disuse, misuse, and physiology—about one-fourth of the time for each.
Normal physiologic changes - answer• The age at which reading glasses are needed
because of reduced lens elasticity is between 42 and 50 years.
• Vestibular sensitivity gradually increases until about age 60 years, which is one of the
reasons why adults have increasing trouble on amusement park rides as they age.
• Fertility in women peaks between 15 and 25 years and declines thereafter, with
menopause typically occurring about age 50 years.
• Reaction time tends to increase with age (which explains why teenagers are usually
far better at games of speed—including many video games—than older persons).
• The amount of sway a person will experience if asked to stand still with eyes closed is
high in early childhood, is minimized between about ages 15 and 16 years, and then
gradually increases beyond age 60 years.
• Ankle jerk reflexes are increasingly diminished or absent with older age, in the
absence of detectable musculoskeletal pathology.
• Bone density plateaus between ages 20 and 50 years, then gradually declines, with
the slope of decline being more rapid in women than in men.
Iatrogenic disease - answer Illness caused by medical interventions, known as
iatrogenic illness, is one of the most common medical problems of older persons.
Which one of the following is most true about the rule of fourths?
a. One-fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three-fourths of the problems of aging.
c. For every medical complaint a patient presents with, a careful assessment can
identify three other diagnoses.
d. What used to be called normal aging can be largely explained by processes that are
not normal.
e. A good way to conduct a geriatric assessment is to use four categories: mental,
physical, psychosocial, and environmental - answerD
Which one of the following is most true about aging changes?
a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men. - answerA
An old woman who is cared for by attentive, cautious, concerned family is particularly
likely to suffer from which one of the following complications after an episode of
gastroenteritis?
, a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea - answerA
Which one of the following is most true about psychological aging?
a. Disengagement tends to promote better psychological health than continued
engagement.
b. Most older adults do not worry about memory loss.
c. Happiness declines starting in middle age.
d. Ageism can lead to isolation and depression. - answerD
Of the following conditions, which one is most common and most often preventable?
a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
e. Depression - answerD
Immunizations recommended for older Adults - answerInfluenza inactive (IIV), or
recombinant (RIV): 1 dose annually
Tetanus, diphtheria, pertussis (TDAP): 1 dose after age 65 years then Td every 10
years
Varicella recombinant (Shingrix): 2 doses 2-5 months apart. Give to those who had
zoster
Pneumococcal: 1 dose of PPSV23 (Polysaccharide, Pneumovax); consider 1 dose PCV
13 in high-risk patients
Hepatitis A/hepatitis B: Only if high risk, and at least once
Vaccine costs - answerMedicare Part B covers vaccines to prevent influenza and
pneumonia, as well as hepatitis B if the patient is at medium to high risk for this disease.
No copay is associated with these vaccines. All other vaccines are covered under
Medicare Part D; this includes the vaccine for zoster.
Zostavax - answercan be used when there is a Shingrix allergy, if a patient prefers the
Zostavax, or the patient wishes an immediate vaccination and Shingrix is unavailable.
The vaccination is recommended even if a patient is unsure about having chickenpox in
the past
The Five A's - answerAssess
Ask about behavioral health risks and other factors that affect health goal change.
Advise
Provide clear, targeted behavior change advice, along with information as to potential
harms/benefits.
Agree
