SFSU N324: Geriatric Nursing Theory Midterm

March 30, 2010

1. The Beers criteria specify drugs and classes of drugs

a. that are appropriate for use by older adults.
b. that create dangerous interactions with each other.
c. whose use is unnecessary for the person screened.
d. whose associated risks might outweigh their benefits.

2. According to a national survey, what percentage of women ages 65 and older took 5 or
more prescription drugs?
a. 12%
b. 19%
c. 23%
d. 31%

3. One reason why older adults metabolize drugs differently than younger people is that
they tend to have
a. less blood flow to the kidneys.
b. more total body fluid.
c. increased lean body mass.
d. increased serum albumin levels.

4. A recent study of Medicare- and Medicaid-eligible older adults in California indicated

that they take a mean of how many drugs per day?
a. 7
b. 8
c. 9
d. 10

5. According to one evidence-based guideline, medication assessment should be done at

least every
a. month.
b. 3 months.
c. 6 months.
d. year.

6. The usual method for compiling a list of an older adult's medications is to

a. consult with the patient's pharmacy.
b. have the patient bring in all medications used.
c. ask the patient's primary care provider.
d. interview the patient about medication use.

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7. According to the American Medical Directors Association and the American Society of
Consultant Pharmacists, the Beers criteria should not be used as
a. a first step in a nursing assessment of medication use.
b. a means of identifying off-label and alternative drug usage.
c. an aid to finding safer alternatives to high-risk drugs.
d. an absolute prohibition against prescribing certain medications.

8. A type of drug listed in the Beers criteria that is noted to cause confusion, urinary
retention, and other adverse effects in older adults is
a. anticholinergics.
b. antibiotics.
c. antiarrhythmics.
d. antitussives.

9. A review of the evidence supported designating most of the medications identified in the
1997 Beers criteria as
a. appropriate after screening for dosage safety.
b. inappropriate when goals are not met.
c. inappropriate for use in older adults.
d. appropriate when not combined with other cited drugs.

10. The Katz Index of Independence in Activities of Daily Living is a tool for assessing an
older adult's baseline abilities in 6 areas, including
a. following instructions.
b. using the telephone.
c. preparing simple meals.
d. remaining continent.

11. In addition to measuring functional status, the Katz index is also used in residential care
settings to
a. determine family involvement.
b. measure nursing workload.
c. estimate community resources.
d. evaluate communication problems.

12. Using the Katz index can help hospital nurses

a. prevent functional deterioration.
b. develop standardized protocols.
c. focus on acute-care interventions.
d. develop critical pathways.

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13. In a 2002 survey, what percentage of women between the ages of 65 and 74 reported an
inability to perform at least one activity of daily living (ADL)?
a. 10%
b. 20%
c. 30%
d. 40%

14. A 2004 study of 1,147 adults ages 66 and older found that functional dependence
significantly predicted
a. chronic illness.
b. cognitive decline.
c. later institutionalization.
d. death.

15. It is recommended that the Katz index be administered on admission to an acute care
facility and then repeated
a. daily.
b. right before discharge.
c. at regular intervals.
d. on admission to another facility.

16. A score of 6 on the Katz index indicates that the patient

a. needs help with every activity.
b. requires help with most ADLs.
c. can manage most ADLs without help.
d. is independent in all ADLs.

17. The central element in scoring the Katz index is the patient's ability to
a. report her or his functional capacity in each area.
b. demonstrate functional independence to a clinician.
c. appear appropriately groomed, dressed, and mobile.
d. describe the steps involved in each ADL.

18. What type of scale is used in the Katz instrument?

a. dichotomous (yes-or-no)
b. visual analog
c. multi-item Likert scale
d. single-trait Guttman scale

19. Assessment of instrumental ADLs (IADLs) may be preferable to the assessment of ADLs
for identifying incipient or early functional decline because
a. IADLs are more essential for survival.
b. IADLs are easier to assess than ADLs are.
c. IADL function is more helpful for care planning.
d. IADL function is usually lost before ADL function.

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20. In community-dwelling older adults not previously diagnosed with dementia, Cromwell
and colleagues found an association between reduced cognitive functioning and
dependence in which of these items on the Lawton IADL scale?
a. Shopping
b. managing finances
c. housekeeping
d. preparing food

21. When the Lawton IADL scale first came into use, which of these domains was excluded
when the scale was used to assess men?
a. Shopping
b. food preparation
c. transportation
d. finance management

22. When using the Lawton IADL scale to assess a patient who has dementia, it is important
to
a. give instructions in one- or two-part commands.
b. accept that their responses are generally true.
c. be sure to speak as loudly and clearly as possible.
d. interview the patient while her or his family is not present.

23. With all assessments of older adults, Lach and Smith specifically suggest taking which
type of approach?
a. Direct
b. Relaxed
c. matter-of-fact
d. authoritative

24. Ward and colleagues have noted that IADL scales have the potential to
a. identify hidden knowledge deficits.
b. overestimate functional abilities.
c. undermine older patients' confidence.
d. overestimate dependency in men.

25. One study found that the impact of item-response bias “on group differences in cognitive
IADL” is highest for
a. ethnicity.
b. gender.
c. age.
d. dementia.

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26. An example of an advanced ADL is
a. laundry.
b. telephone use.
c. hobbies.
d. transferring.

27. An example of a Katz ADL is

a. communication.
b. intimacy.
c. ambulation.
d. continence.

28. On the Folstein Mini-Mental State Exam, which area of cognitive function pertains to the
patient's ability to name objects?
a. recognition
b. registration
c. language
d. orientation

29. A disadvantage of the Folstein Mini-Mental Status Exam is that

a. it lacks adequate copyright protection.
b. it is not widely used by health care professionals.
c. its results may be influenced by patients' literacy.
d. it takes about 40 minutes to administer.

30. Executive function, as tested by the Mini-Cog, includes the patient's ability to
a. manage time.
b. pay attention.
c. follow instructions.
d. perform calculations.

31. According to the Alzheimer's Association, about how many people in the United States
over the age of 65 have Alzheimer's disease?
a. 4.9 million
b. 5.5 million
c. 6.3 million
d. 7.1 million

32. The Mini-Cog begins with the examiner asking the patient to
a. remember 3 spoken words and then repeat them aloud.
b. perform a simple arithmetic function.
c. recall an event of the previous day.
d. describe how to cook an egg.

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 33. Studies have shown that, when patients are asked to draw a time on a clock face, the time
most sensitive for revealing deficits is
a. 2:40.
b. 5:30.
c. 8:15.
d. 11:10.

34. A score of 1 or 2 on the first portion of the Mini-Cog, combined with an accurate clock
drawing, indicates
a. that the patient should repeat the first portion.
b. a negative screen for dementia.
c. that the patient should repeat the entire test.
d. a positive screen for dementia.

35. Someone whose Mini-Cog results indicate dementia should first be referred to
a. a primary care provider for a full workup.
b. a mental health facility for a full psychiatric evaluation.
c. a geriatrician for evaluation of age-related changes.
d. community resources such as the Alzheimer's Association.

36. The Mini-Cog's specificity refers to its ability to

a. generate similar scores with different raters.
b. identify those who probably have dementia.
c. show consistency in scoring regardless of educational levels.
d. identify those who do not have dementia.

37. The Mini-Cog's sensitivity refers to its ability to

a. generate similar scores with different raters.
b. identify those who probably have dementia.
c. show consistency in scoring regardless of educational levels.
d. identify those who do not have dementia.

38. According to Lindau and colleagues, what percentage of Americans

between the ages of 75 and 85 are sexually active?
a. 6%
b. 16%
c. 26%
d. 36%

39. Sexual activity

a. decreases with advancing age.
b. increases with advancing age.
c. is unaffected by advancing age.
d. has less relevance with advancing age.

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40. Age-related changes in women include
a. shrinking of the cervix.
b. atrophy of the labia.
c. lengthening of the vagina.
d. thickened vaginal wall.

41. In older women, orgasms tend to be less pleasurable because of

a. thinning of vaginal mucus.
b. the use of oral medications.
c. a slower return to a prearoused state.
d. less frequent uterine contractions.

42. Age-related changes in men include

a. increased testosterone levels.
b. more frequent erections.
c. weaker erections.
d. shorter refractory periods.

43. Sexual dysfunction is especially common with the use of which of the
following types of medications?
a. selective serotonin reuptake inhibitors
b. antiinfectives
c. corticosteroids
d. cardiac glycosides

44. The first step in using the PLISSIT model is to

a. present basic information about sexual functioning.
b. ask permission to begin the sexual assessment.
c. inquire about any medications the patient is taking.
d. ask the patient about sexual activity and practices.

45. The SS phase of the PLISSIT model refers to

a. specific suggestions.
b. sexual socialization.
c. simulation scenarios.
d. sharing and sensitivity.

46. One of the phases of the sexual response cycle is

a. stimulation.
b. intimacy.
c. excitement.
d. refraction.

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47. An appropriate way to begin a sexual assessment of an older adult
is to ask
a. How has your sexual function changed as you have become older?
b. "Do you find it embarrassing to talk about sexual activity?"
c. "Do you ever feel pressured or unsatisfied during sexual activity?"
d. "Would it be okay if I asked you some questions about your sexual
health?"

48. Which of the following questions should the nurse ask only after
establishing a level of trust with the patient?
a. "What thoughts have you had about enhancing your sexual relationship?"
b. "What concerns do you have about your sexual health?"
c. "What changes have you noticed in your sexual feelings since you've
gotten older?"
d. "What do you think you can gain from us discussing your sexual
dysfunction?"

49. According to Higgins and colleagues, what percentage of older

adults with dementia exhibit sexual disinhibition?
a. 3% to 8%
b. 9% to 14%
c. 15% to 20%
d. 21% to 26%

50. In patients with mild cognitive impairment, an area of the PLISSIT

model that may be helpful is
a. participating in role-playing.
b. communicating with families.
c. providing limited information.
d. communicating with other clinicians.

51. In older adults with dementia, participation in sexual

relationships must be
a. strongly discouraged.
b. carefully monitored.
c. weighed ethically.
d. allowed infrequently.

52. According to Araujo and colleagues, the number of erections among

men in their 60s declined per month by
a. 10.
b. 13.
c. 16.
d. 19.

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53. Which statement about the psychometric properties of the PLISSIT
model is correct?
a. Its sensitivity ranges from 86% to 100%.
b. It has high internal consistency.
c. All of the psychometric properties of this model are solid.
d. There are no psychometric testing results because PLISSIT is a
model, not an instrument or a tool.

Mauk Test Chapters 11, 12, 13

54. According to the Merck Institute on Aging and Health, older adults fell short of the
Healthy People 2000 goals in all but which of the following area?
a. physical activity
b. influenza vaccination
c. eating fruits and vegetables
d. overweight

55. The nurse is counseling a patient regarding Medicare prevention efforts. Which of the
following is included?
a. initial physical examination
b. smoking cessation counseling
c. nutrition therapy for everyone
d. a and b only

56. The nurse chooses to use a health contract/calendar as a behavior-changing tool for an
older adult client who wants to lose weight. Which of the following principles should the
nurse keep in mind when choosing this tool?
a. it relies on the self-management capability of a client, after initial assistance is
provided by a clinician or health educator
b. it relies on the ability and skill of the educator
c. it has been shown to be less effective with females who are older and widowed
d. it cannot be used in older adults with less than a high school education

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57. The advantages of using a health contract for behavior change include all of the following
except:
a. it identifies and enhances motivation
b. it assures that change will occur
c. it clarifies measurable and modest goals
d. it suggests tips to remember new behaviors
58. The nurse is instructing a new patient on the benefits of exercise. She would include
which of the following in providing the most current recommendations for older adults?

a. the emphasis is on being more physically active rather than a narrow adherence
to a rigid exercise regimen
b. older adults should exercise one solid hour per day to achieve benefits
c. research has shown that older adults need to burn more calories than younger
adults in order to obtain cardiac benefit from exercise
d. all of the above are true

59. An older client is discussing his desire to continue walking during the winter months, but
expresses fear of being out in the colder weather. The nurse appropriately recommends
for him to:

a. suspend all walking activities until the weather is favorable

b. walk inside at the local shopping mall
c. join a health club and walk on the treadmill
d. continue to walk outside no matter what the weather

60. Nutrition counseling is thought to be important for older adults because of which factors?

a. older adults are more vulnerable to obesity than other age groups
b. older adults are more vulnerable to malnutrition than other age groups
c. eating and drinking habits are linked to several leading causes of death
d. all of the above

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 61. Which of the following foods should the nurse encourage the older client to eat 5 – 13
servings of per day?

a. grains
b. meat/eggs
c. dairy
d. fruits/vegetables

62. The nurse is investigating a model health program to recommend to a client who needs
help with ADLs and is unable to live alone. Which of the following models would be
most appropriate for the nurse to help the client explore?
a. Healthwise handbook
b. Green house
c. Project enhance
d. Ornish program

63. Mr. Thin is a 5 foot 8 inch, 79 year old male with a history of hyperlipidemia.
Which of the following risk factors does not fit with his diagnosis?

a. he drinks four glasses of Jack Daniels per day

b. history of hypertension
c. smokes 1 pack of cigarettes per day
d. weight of 125 pounds

64. Which of the following screenings would the nurse not routinely recommend to an older
adult?

a. mammogram every 1 – 2 years for females

b. annual physical
c. dementia
d. flexible sigmoidoscopy and FOBT

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65. The nurse would follow all of the following guidelines when doing nutritional counseling
with an older female except:

a. limit alcohol to 1 drink per day

b. limit water intake to 1000 cc per day
c. limit fat and cholesterol
d. ensure adequate calcium and vitamin D intake

66. The nurse is assessing an older woman with dementia, brought to the emergency room
by her adult son caregiver. Which of the following signs most alert the nurse to the
possibility that the woman may be abused?

a. the woman has bruises of various colors on many inner aspects of her body
b. the woman is confused
c. the woman is stiff when she walks
d. the son says his mother does dangerous things sometimes

67. The health care professional working in an outpatient clinic notices that an older woman
he is seeing as a patient in the clinic has multiple small bruises and burns on the inner
aspects of the thighs. When the patient sat down, she did so slowly and seemed to wince.
What should these signs prompt the health care professional to do first?

a. ask some more specific questions related to the home situation of the patient
b. immediately make a report to adult protective services
c. call a doctor into the room to make a report
d. accuse the caregiver of physical abuse

68. An elderly woman has sent thousands of dollars to a company that promises her chances
to win prizes and large sums of money. She has won a small radio and now is asked to
send $1,000 more to the company to be in the drawing for the “grand prize”.
This is most likely an example of:

a. violation of personal rights

b. financial abuse
c. a great marketing strategy
d. a legitimate lottery

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69. When an elderly person is adequately physically cared for in the home by adult children,
but socially isolated and expresses no purpose or will to live, this is a sign of:

a. psychological or emotional neglect

b. psychological or emotional abuse
c. direct physical abuse
d. physical neglect
70. Registered Nurses are mandated reporters for elder abuse.
1. T
2. F

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