Deck 55: Geriatric Patients

Question 1

All of the following statements about the Beers list are true except:

A)It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.
B)It is derived from the expert opinion of one geriatrician and is not evidence based.
C)These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.
D)These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Answer 1

It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.

Question 2

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?

A)Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs.
B)Decreased tubular secretion of medication will require dosage adjustments.
C)Thin skin will cause increased elimination via sweat.
D)Decreased lung capacity will lead to measurable decreases in lung excretion of drugs.

Answer 2

Decreased tubular secretion of medication will require dosage adjustments.

Question 3

You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. A decrease in which of the following is the most common cause of adverse drug reactions in older adults?

A)Body fat content
B)Liver function
C)Renal function/clearance
D)Plasma albumin levels

Answer 3

Renal function/clearance

Question 4

When an elderly diabetic patient is constipated the best treatment options include:

A)Mineral oil
B)Bulk-forming laxatives such as psyllium
C)Stimulant laxatives such as senna
D)Stool softeners such as docusate

Question 5

Patients who plan to retire to warm, sunny climates are at risk for which adverse reaction not typical in cooler, cloudier climates?

A)Over-hydration
B)Increased risk of falls
C)Photodermatitis
D)Failing thyroids

Question 6

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

A)Increased volume of distribution
B)Decreased lipid solubility
C)Decreased plasma proteins
D)Increased muscle-to-fat ratio

Question 7

Principles of prescribing for older adults include:

A)Avoiding prescribing any newer high-cost medications
B)Starting at a low dose and increasing the dose slowly
C)Keeping the total dose at a lower therapeutic range
D)All of the above

Question 8

The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1 and for a 202 pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft-Gault formula are:

A)25 and 133 mL/min, respectively
B)25 and 103 mL/min, respectively
C)22 and 133 mL/min, respectively
D)22 and 103 mL/min, respectively

Question 9

The 2019 Beers list removed some medications because:

A)They do not truly impact geriatric patients.
B)They are no longer available in countries outside the United States.
C)They now come in less anticholinergic formulations.
D)They do not only impact geriatric patients, but all patients.

Question 10

Specialty consultation summaries need to be reviewed for:

A)Altered dosing of current medications
B)Recommendations for interventions that will require medication regimen changes
C)Interventions that will conflict with another specialty plan
D)All of the above

Question 11

Topical medication efficacy may be impacted by which common aging change?

A)Decreased peripheral vascular flows
B)Increased ratio of water to fat in the skin
C)Dropping renal clearance
D)Loss of vellus hair
E) Geriatric Patients

Question 12

Steps to avoid polypharmacy include:

A)Prescribing two or fewer drugs from each drug class
B)Reviewing a complete drug history every 12 to 18 months
C)Encouraging the elderly patient to coordinate their care with all of their providers
D)Evaluating for duplications in drug therapy and discontinuing any duplications

Question 13

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?

A)Keep the dose of oxycodone low to prevent development of tolerance.
B)Acetaminophen is the first-line drug of choice.
C)Avoid prescribing nonsteroidal anti-inflammatory drugs (NSAIDs).
D)Add in a short-acting benzodiazepine for a synergistic effect on pain.

Question 14

In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?

A)A lipid-soluble medication will be eliminated more quickly and will not work as well.
B)A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.
C)Absorption of lipid-soluble drugs is impaired in older adults.
D)The bioavailability of the lipid-soluble drug is increased in older adults.

Question 15

Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:

A)Diuretics
B)Trazodone
C)Clonazepam
D)Levodopa

Question 16

Which of the following is not consistent with the rules for geriatric prescribing?

A)Half-life will be longer in older adults.
B)Steady state is reached more quickly in the older adult.
C)Reduce the number of drugs in the patient's regimen whenever possible.
D)Adverse drug responses present atypically in the older adult.

Question 17

A medication review of an elderly person's medications involves:

A)Asking the patient to bring a list of current prescription medications to the visit
B)Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit
C)Asking what other providers are writing prescriptions for them
D)All of the above

Question 18

Timely posthospitalization medication reconciliation helps clarify:

A)Which medications stopped in the acute setting require return to use
B)Evaluation of new side effects associated with dose changes or new prescriptions
C)Which medications require more patient education
D)All of the above

Question 19

To improve positive outcomes when prescribing for the elderly the nurse practitioner should:

A)Assess cognitive functioning in the elder.
B)Encourage the patient to take a weekly "drug holiday" to keep drug costs down.
C)Encourage the patient to cut drugs in half with a knife to lower costs.
D)All of the above

Question 20

Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including:

A)Use of another person's medications
B)Hoarding medications
C)Changing his medication regimen without telling his provider
D)All of the above