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NURS 5400- GERIATRICS/HYPONATREMIA PROCTORED
FINAL RETAKE EXAM COMPLETE QUESTIONS & CORRECT
ANSWERS WITH RATIONALES GRADED A+
In patients with glaucoma what medications do you want to avoid? **- CORRECT ANSWER
** anti cholinergics
- antihistatimes
- inhalers/nebulizers What is the percentage of older individuals that have hearing loss? - CORRECT ANSWER >>> 33% of people over the age of 65 and 50% of people over 85 years old Do all older patients have to be screened by an audiologist? - CORRECT ANSWER >>> No US Task force does not recommend this What meds shouldn't you put into an ear with membrane that is not intact? - CORRECT ANSWER >>> Gentamycin or neomycin How can epigenetic alterations be caused by medications? - CORRECT ANSWER >>> An example is Valproic acid, used for bipolar disorder and seziures. It can demethalate DNA and speed up aging Examples of loss of proteostasis - CORRECT ANSWER >>> Neuropathy (nerves can't be rejunvinated) Also loss of cardiac cells and brain cells (ischemia) They can't form new cells like RBCs
When shouldn't you do cancer screenings? - CORRECT ANSWER >>> When a patient has a life expectancy of less than 10 years When to consider Palliative care? - CORRECT ANSWER >>> Palliative care services considered when the prognosis is less than 18 months What effect does aging have with renal function? - CORRECT ANSWER >>> All older adults have some decline in renal function What are some renal toxin meds? - CORRECT ANSWER >>> Aminoglycoside antibiotics, NSAIDs, radiocontrast dyes CURB 65 - CORRECT ANSWER >>> A clinical decision making tool Severity score to predict mortality secondary to community acquired PNA
- Confusion
- BUN>
- RR>
- BP<90/
- 65yo One or less indicates patient can be treated outpatient, >1 =hospitalization Basic level coding - CORRECT ANSWER >>> 10 minutes - coordinating care / stable patient Low complexity coding - CORRECT ANSWER >>> 15 minutes - ordering an OTC med / stable, unlikely to become unstable
Is there a benefit of Aspirin in combination with anticoagulant in patients with atrial fibrillation?
- CORRECT ANSWER >>> No added benefit from aspirin, d/c it What medications should you d/c for current or recurrent hyponatremia? **- CORRECT ANSWER
** SSRIs & thiazide diuretics What diabetic med should you avoid in LTC - CORRECT ANSWER >>> - Insulin with sliding scale
- avoid using medication other than metformin to achieve A1C less than 7.5% How to determine A1C appropriate for elderly patients? - CORRECT ANSWER >>> Use their age, 8.0% for 80 year old etc ** Hypoglycemia in the elderly is more dangerous than hyperglycemia How often do you monitor renal function in a patient with an A1C>8%? **- CORRECT ANSWER
** Every 3 months Also monitor A1C every 3 months until it gets to goal and then monitor every 6 months What is the BEERs criteria? - CORRECT ANSWER >>> Intended for patients 65 years or older, on inappropriate medications for them. This excludes palliative and hospice patients Some medications of the BEERS list - CORRECT ANSWER >>> - First-generation antihistamines
- Tertiary tricyclic antidepressants (eg, amitriptyline)
- Antipsychotics for behavioral problems of dementia unless nonpharmacologicoptions have failed and patient is a threat to self or others
- Benzodiazepines
- Long-acting sulfonylureas (eg, glyburide, chlorpropamide)
- Skeletal muscle relaxants Examples of meds that have first generation antihistamines in it - CORRECT ANSWER >>> - Benadryl, Tylenol PM, cold medications Why should you avoid Tertiary tricyclic antidepressants in the elderly? **- CORRECT ANSWER
** Meds like amitriptyline, can cause prolonged QTC Why should you avoid Skeletal muscle relaxants in the elderly? - CORRECT ANSWER >>> Increase risk for falls What meds is elevated transaminases found in? - CORRECT ANSWER >>> Tylenol, cold medicine, arthritis meds What is red yeast rice? - CORRECT ANSWER >>> A supplement that lowers cholestrol - lovastatin What can valerian root cause? - CORRECT ANSWER >>> sedating effects What type of effects do the supplements gingko, valerian root and St. John's wort have? - CORRECT ANSWER >>> psychogenic effects Stem cell therapies & aging - CORRECT ANSWER >>> No legitimate stem cell therapies in clinical use for aging What is the most common electrolyte disturbance in the elderly? **- CORRECT ANSWER ** Hyponatremia
Why would you avoid bactrim for a UTI? - CORRECT ANSWER >>> It can cause hyperkalemia, make sure not to give with spironolactone or lisinopril Why would you avoid cipro for a UTI? - CORRECT ANSWER >>> not good for joints SAD PERSONS Suicide Risk Assessment - CORRECT ANSWER >>> - S: Sex - Male
- A: Age (<19 or >45 years)
- D: Depression
- P: Previous attempt
- E: Excess alcohol or substance use
- R: Rational thinking loss
- S: Social supports lacking
- O: Organized plan
- N: No spouse• Death of loved one
- S: Sickness• Assessing for with terminal diagnosis Who can write PECs and what are they? - CORRECT ANSWER >>> Physician Emergency Certificate (72 hour psych hold) Only MDs can write them How frequent do people >65 years old renew driver's license in CT? **- CORRECT ANSWER
** In people >65 years old, must renew driver's license every 2 years in Connecticut Egress Test - CORRECT ANSWER >>> Risk of fall assessment
- lift butt off bed, sit to stand twice
- three steps marching in place
- step one foot forward and return to starting position (1x each leg) What are some medications that would be appropriate for insomnia in the elderly? - CORRECT ANSWER >>> - suvorexant (Belsomra) - (more selective) orexin antagonist
- trazodone (Desyrel) - serotonin modulator
- doxepin (Silenor) - Tricyclic Antidepressant What is a medication on the BEERs list that is an appetite stimulant? **- CORRECT ANSWER
** Megace - risk DVT and fluid retention, increased risk of death (doesn't work) What might elevated protein indicate? - CORRECT ANSWER >>> Myeloma How should you speak to people with hearing loss? - CORRECT ANSWER >>> Speak in a low tone, don't shout What antibiotics interacts with alcohol? - CORRECT ANSWER >>> Flagyl What derivatives does heparin have? - CORRECT ANSWER >>> Bovine or porcine What derivatives should you avoid in Hindu patients? - CORRECT ANSWER >>> Bovine How does a splenectomy effect A1C? - CORRECT ANSWER >>> Causes A1C to be falsely high What is MOLST? - CORRECT ANSWER >>> - Medical Orders for Life-Sustaining Treatment (MOLST)
How does cellulitis present? - CORRECT ANSWER >>> unilateral, NOT bilateral
What severity of pain is most concerning in the elderly? - CORRECT ANSWER >>> Mild pain What might it mean if you feel ovaries in a pt 10 years after menopause? **- CORRECT ANSWER
** It is abnormal to feel ovaries 10 years after menopause Suggestive of cancer sacropenia - CORRECT ANSWER >>> the loss of muscle mass, strength, and function that comes with aging What is common to happen with the knees in the elderly? - CORRECT ANSWER >>> Loss of vibratory sense below the knees is common What does non-focal mean? - CORRECT ANSWER >>> It means cranial nerves are intact What should you expect with DTR in the elderly? - CORRECT ANSWER >>> DTR should be symmetric and normal What can cause hypervolemic hyponatremia? - CORRECT ANSWER >>> - CHF
- Cirrhosis
- Nephrotic syndome What can cause hypovolemic hyponatremia? - CORRECT ANSWER >>> Volume depletion with appropriate ADH increase What can cause euvolemic hyponatremia? - CORRECT ANSWER >>> - SIADH
- Hypothyroidism
- Poor osmolar intake (toast and tea diet)
What is the relationship between urine osmolality and water restriction? **- CORRECT ANSWER
** The higher the urine osmolality, the less effect water restriction has on serum sodium levels What are some exceptions of antipsychotics to avoid in patients with Parkinson's disease? - CORRECT ANSWER >>> quetiapine, clozapine, and pimavanserin What medication should be avoided in heart failure of any kind in older adults? - CORRECT ANSWER >>> Cilostazol What medications should be avoided in pt with delirium? - CORRECT ANSWER >>> - H2 - receptor antatongists
- the "Z drugs" = zolpidem, eszopiclone, and zaleplon When should Xarelto be used with caution? - CORRECT ANSWER >>> Rivaroxaban (xarelto) should be used with caution for treatment of VTE or afib in adults 75 years or older What is a side effect of Tramadol in the elderly? - CORRECT ANSWER >>> - Hyponatremia
- syndrome of inappropriate antidiuretic hormone secretion Why were vasodilators removed from the BEERs criteria? - CORRECT ANSWER >>> Because syncope is not unique to older adults What does POLST stand for? - CORRECT ANSWER >>> Portable medical orders How does POLST compare to advance directive or DNR orders? - CORRECT ANSWER
>>> POLST gives seriously ill or frail people more specific direction over their health care treatments compared to advance directives and more options than Do Not Resuscitate (DNR) orders Do all states have POLST programs? - CORRECT ANSWER >>> No How often should you have dilated eye exams if you are over 50? - CORRECT ANSWER >>> Every year, even if you have good vision and don't wear glasses What is low vision? - CORRECT ANSWER >>> eyesight that cannot be corrected with eyeglasses, contact lenses, drugs, or surgery What to look for when buying sunglasses - CORRECT ANSWER >>> When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation What is the MIND diet? - CORRECT ANSWER >>> Combining the mediterrean with the DASH diet What are the recommendations for exercise? - CORRECT ANSWER >>> At least 150 minutes per week of moderate- to vigorous-intensity physical activity What are the most commonly used medications in the eldery? - CORRECT ANSWER >>> Meds for cholesterol, high blood pressure, or diabetes What is the Minimum Criteria toolkit? - CORRECT ANSWER >>> aims to reduce unnecessary prescribing for the three infections where antibiotics are most frequently prescribed in nursing homes: (1) urinary tract infections (UTIs) (2) lower respiratory tract infections (3) skin and soft tissue infections
