FNP Geriatric Assessment Practice Questions

Under coding guidelines, the use of an independent historian combined with ordering or reviewing at least two unique tests easily meets the criteria for moderate data complexity. Low data complexity requires only two tests or an independent historian, but not both categories simultaneously. High data complexity requires the independent interpretation of tests or discussion of management with external providers, which did not occur here. Straightforward data involves minimal or no test review, ignoring the comprehensive workup performed.

When a patient experiences recurrent hypoglycemia without a clear precipitating cause, the basal insulin dose should be decreased by 10-20%. Option A is correct because reducing the 24-unit dose by 4 units (approximately 15-20%) safely mitigates the hypoglycemia risk, which is particularly dangerous in CKD due to delayed insulin clearance. Option B is incorrect because "feeding the insulin" with extra carbohydrates promotes weight gain and erratic glycemic control. Option C is incorrect because a 10-unit drop is nearly a 40% reduction, which is too drastic and risks rebound hyperglycemia. Option D is incorrect because sulfonylureas carry a high risk of severe, prolonged hypoglycemia, especially in older adults with reduced renal function.

Diphenhydramine is a first-generation antihistamine with strong anticholinergic properties. According to the Beers Criteria, it is highly inappropriate for older adults because it causes dizziness, confusion, and significantly increases fall risk. Discontinuing the medication is the safest and most necessary action. Increasing the dosage would only exacerbate his dizziness and cognitive impairment. Adding caffeine is counterproductive for a patient suffering from chronic insomnia and does not remove the offending agent. Switching to a benzodiazepine is also contraindicated, as these medications carry a similarly high risk for sedation, cognitive blunting, and falls in the geriatric population.

The Timed Up and Go test is a validated tool for assessing functional mobility, and a time greater than 12 seconds indicates an increased risk for falls. For an independent community-dwelling older adult, enrolling in a Tai Chi program is highly effective for balance and strength training, significantly reducing fall incidence. Referring for a home safety evaluation is a good secondary measure, but improving the patient's intrinsic physical conditioning is the most direct intervention for her identified mobility deficit. Prescribing a daily oral vitamin B12 supplement is unnecessary unless a specific deficiency has been diagnosed. Ordering a dual-energy x-ray absorptiometry scan is appropriate for monitoring her osteopenia, but it is a diagnostic screening tool that does not actively prevent falls from occurring.

Lithium is a renally cleared drug that is handled similarly to sodium in the kidneys. During dehydration from gastroenteritis with vomiting, the older adult experiences decreased renal perfusion, which triggers the kidneys to aggressively reabsorb sodium and lithium in the proximal tubule. This leads to rapid lithium toxicity. Option A is incorrect because lithium is not hepatically metabolized. Option C is wrong because reduced absorption would lower serum levels, not cause toxicity. Option D is incorrect because dehydration decreases the volume of distribution, which would concentrate rather than dilute the drug.

In mild Alzheimer's dementia, when a patient has gotten lost driving, the standard of care is a formal driving evaluation to objectively assess safety. Option A is too abrupt and can cause severe conflict without an objective assessment to support the decision. Option C is incorrect because medications do not reliably restore complex motor skills or spatial navigation required for driving. Option D is unsafe because getting lost indicates cognitive mapping deficits, not just visual issues related to nighttime driving.

This patient presents with subclinical hypothyroidism, which is characterized by a mildly elevated TSH in the presence of a normal free T4. In asymptomatic older adults, particularly those over the age of 80, a mildly elevated TSH is frequently a normal physiologic age-related shift rather than a true pathology. Current guidelines recommend that you monitor thyroid function rather than initiate treatment if the TSH remains less than 10 mIU/L. Starting levothyroxine therapy in this population can be dangerous, potentially precipitating arrhythmias or worsening angina in patients with underlying coronary artery disease. Ordering a radioactive iodine uptake scan is indicated for hyperthyroidism, not hypothyroidism. Referring to endocrinology for immediate further evaluation is unnecessary and not cost-effective for an asymptomatic, mild laboratory abnormality that can be safely monitored in primary care.

This patient is experiencing a high symptom burden but still wants to continue life-prolonging therapies like milrinone. Palliative care is the best choice because it focuses on symptom management and quality of life while allowing the patient to receive concurrent life-prolonging therapies. Option A is incorrect because hospice requires the patient to forgo curative or life-prolonging treatments for their terminal diagnosis. Option C is inappropriate because the patient's goals of care explicitly include continuing the infusion, and forcing discontinuation violates patient autonomy. Option D ignores the primary need for specialized symptom management and goals of care alignment.

A patient returning home with significant weakness and a fall history requires immediate durable medical equipment to ensure a safe environment. Ordering a commode and walker addresses the acute fall risk and mobility deficits. A multivitamin will not acutely resolve generalized weakness or prevent falls. Recommending assisted living is a major life change that requires extensive discussion, not a unilateral discharge order. A DEXA scan is appropriate for osteoporosis screening but does not address immediate transitional safety.

The primary goal of cholinesterase inhibitor therapy is to temporarily stabilize symptoms and slow cognitive decline, rather than to cure the disease or significantly restore lost memory. It is crucial to manage caregiver expectations regarding the realistic outcomes of pharmacologic treatment. Switching to donepezil is unlikely to yield different results since both drugs share the same mechanism and limitations. Discontinuing galantamine to start memantine monotherapy deprives the patient of the potential stabilizing benefits of the current regimen. Adding transdermal rivastigmine to galantamine creates inappropriate and dangerous cholinergic toxicity without providing any additional cognitive benefit.

When an older adult describes intermittent episodes of rapid heartbeats but the resting 12-lead ECG shows normal sinus rhythm, the APRN should strongly suspect paroxysmal atrial fibrillation. To capture this transient arrhythmia, it is necessary to order a continuous Holter monitor. Reassuring the patient and monitoring clinically is inappropriate because undiagnosed atrial fibrillation carries a significant stroke risk that must be addressed. Prescribing an empiric beta blocker without a documented arrhythmia diagnosis violates standard clinical guidelines and risks adverse effects. Referring for a cardiac catheterization is excessively invasive and unwarranted without prior noninvasive diagnostic evidence of ischemia.

Surgical interventions in the pelvis can significantly alter urinary function. A radical prostatectomy frequently disrupts or weakens the external urinary sphincter, directly leading to stress urinary incontinence. This condition is classically characterized by small-volume leakage during specific activities that increase intra-abdominal pressure, such as lifting heavy groceries or coughing. Urge urinary incontinence presents quite differently, featuring a sudden, uncontrollable urge to void driven by bladder spasms, which this patient does not report. Overflow urinary incontinence involves continuous dribbling and incomplete emptying, typically seen with outlet obstruction like benign prostatic hyperplasia rather than sphincter incompetence following prostate removal. Functional urinary incontinence is strictly related to physical or cognitive impairments that prevent timely toilet access, which clearly does not apply to this active, community-dwelling individual.

When a patient experiences predictable end-of-dose akinesia but cannot adhere to a more frequent dosing schedule, adding a COMT inhibitor like entacapone is appropriate. This extends the half-life of levodopa, prolonging its clinical effect without requiring more frequent pill taking. Switching entirely to dopamine agonist monotherapy is ineffective for advanced disease. Anticholinergics are poorly tolerated in older adults and do not directly address wearing off. Increasing the individual levodopa dose significantly increases the risk of peak-dose dyskinesia.

The TUG test involves both quantitative timing and qualitative observation of gait mechanics. Although the patient's time of 10 seconds is normal, the fact that they uses the armrests to push up and pivot hesitantly indicates potential deficits in proximal muscle strength and balance. Therefore, the NP should perform a targeted physical examination to evaluate these specific areas. Option A is incorrect because ignoring the qualitative deficits misses an opportunity for early intervention to prevent future falls. Option B is an inappropriate overutilization of resources, as there are no acute neurological deficits indicating a need for urgent imaging. Option D is contraindicated, as muscle relaxants can increase fall risk in older adults and do not address the underlying biomechanical issues observed during the test.

The presentation of high fever, severe headache, and a rash beginning on the distal extremities following a tick bite in an endemic region is highly suspicious for Rocky Mountain spotted fever. You must establish a clinical diagnosis and initiate empiric doxycycline immediately to prevent severe morbidity or mortality. Option A is incorrect because waiting for serology, which often remains negative during the first week of infection, dangerously delays life-saving treatment. Option B is incorrect as anaplasmosis typically presents without a rash and features prominent leukopenia and thrombocytopenia. Option D is incorrect because a peripheral blood smear is used to identify intraerythrocytic parasites like Babesia, not the intracellular bacteria responsible for this spotted fever. Immediate clinical recognition is the cornerstone of managing this potentially fatal disease.