Adult-Gerontology CNS Test Gerontological Care & Age-Related Changes 2 — Questions and Answers
Question 1: The comprehensive geriatric assessment (CGA) is distinguished from standard medical assessment by:
- Focusing exclusively on medical diagnoses and laboratory results
- Evaluating functional status, cognition, mood, social support, and medical issues in an interdisciplinary format (Correct answer)
- Being performed only by geriatricians in inpatient settings
- Using only standardized questionnaires without physical examination
Correct answer: Evaluating functional status, cognition, mood, social support, and medical issues in an interdisciplinary format
CGA evaluates the whole older patient across physical, functional, cognitive, social, and environmental domains using an interdisciplinary team to develop individualized care plans.
Question 2: Malnutrition in hospitalized older adults is associated with:
- Improved wound healing from increased protein breakdown
- Increased infection risk, prolonged hospital stay, muscle wasting, and higher mortality (Correct answer)
- Reduced medication toxicity due to lower drug distribution volume
- Improved renal function from decreased nitrogenous waste
Correct answer: Increased infection risk, prolonged hospital stay, muscle wasting, and higher mortality
Malnutrition impairs immune defense, wound repair, and muscle mass maintenance, leading to higher rates of infection, pressure injuries, deconditioning, and death in hospitalized older patients.
Question 3: Presbycusis (age-related hearing loss) most commonly affects:
- Low-frequency sounds first due to cochlear base damage
- High-frequency sounds first due to progressive sensory hair cell loss at the cochlear base (Correct answer)
- Conductive hearing before sensorineural loss
- Balance more than auditory perception
Correct answer: High-frequency sounds first due to progressive sensory hair cell loss at the cochlear base
Sensory presbycusis begins with high-frequency loss because the basal cochlea processes high frequencies and experiences the greatest cumulative noise and vascular damage over time.
Question 4: The concept of frailty in older adults refers to:
- Chronological age over 85 years regardless of health status
- A biologically distinct syndrome of decreased physiological reserve and resistance to stressors increasing vulnerability to adverse outcomes (Correct answer)
- Cognitive impairment alone limiting daily function
- Dependence on others for all activities of daily living
Correct answer: A biologically distinct syndrome of decreased physiological reserve and resistance to stressors increasing vulnerability to adverse outcomes
Frailty is a clinical syndrome characterized by reduced physiological reserve across multiple systems, identified by criteria such as Fried's phenotype (weight loss, exhaustion, weakness, slowness, low activity).
Question 5: Age-related changes in renal function relevant to drug dosing include:
- Increased glomerular filtration rate with age
- Decreased GFR, reduced tubular secretion, and decline in creatinine clearance even with normal serum creatinine (Correct answer)
- Enhanced drug excretion due to reduced protein binding
- Increased nephron compensatory hypertrophy maintaining GFR
Correct answer: Decreased GFR, reduced tubular secretion, and decline in creatinine clearance even with normal serum creatinine
GFR declines approximately 1 mL/min/1.73m² per year after age 40; critically, serum creatinine may remain normal despite significant GFR loss due to reduced muscle mass reducing creatinine generation.
Question 6: Advance care planning discussions with older adults should focus primarily on:
- Ensuring all patients choose comfort-focused care
- Eliciting personal values, goals, and preferences to guide future medical decisions when the patient may lose decision-making capacity (Correct answer)
- Completing legal documents without individualized discussion
- Selecting a surrogate decision-maker only after cognitive decline
Correct answer: Eliciting personal values, goals, and preferences to guide future medical decisions when the patient may lose decision-making capacity
Effective advance care planning centers on understanding patient values and goals so that medical decisions align with what matters most to the individual across changing health circumstances.
Adult-Gerontology CNS Test Gerontological Care & Age-Related Changes 2
The comprehensive geriatric assessment (CGA) is distinguished from standard medical assessment by: