MCQ Quiz-Geriatric Sensitivity

MCQ Quiz: Geriatric Sensitivity

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Providing care to older adults requires more than just clinical knowledge; it demands geriatric sensitivity—a deep understanding of the unique physiological, social, and psychological aspects of aging. Pharmacists must be adept at navigating polypharmacy, altered pharmacokinetics, and patient-centered communication to ensure safe and effective outcomes. This quiz, designed for PharmD students, will test your ability to apply these sensitive and essential principles to the care of geriatric patients.

1. A key pharmacokinetic change in many older adults is a decrease in renal function. This primarily affects the:

  • Absorption of oral drugs.
  • First-pass metabolism of drugs.
  • Elimination of renally cleared drugs.
  • Distribution of drugs into fatty tissues.

Answer: Elimination of renally cleared drugs.

2. The common prescribing principle “start low, go slow” in geriatric patients is a practice that accounts for:

  • The fact that older adults prefer lower doses.
  • The high cost of medications.
  • Altered pharmacokinetics and an increased sensitivity to drug effects in older adults.
  • The difficulty older adults have with swallowing large tablets.

Answer: Altered pharmacokinetics and an increased sensitivity to drug effects in older adults.

3. When communicating with an older adult who has hearing impairment, a best practice is to:

  • Shout the information loudly.
  • Speak clearly in a low-pitched tone and face the patient directly.
  • Write everything down and avoid verbal communication.
  • Ask a family member to explain everything later.

Answer: Speak clearly in a low-pitched tone and face the patient directly.

4. Polypharmacy is a major concern in geriatric patients because it increases the risk of:

  • Medication adherence.
  • Positive clinical outcomes.
  • Drug-drug interactions and adverse drug events.
  • Lower healthcare costs.

Answer: Drug-drug interactions and adverse drug events.

5. The Beers Criteria is a tool designed to help clinicians identify:

  • The most cost-effective medications for older adults.
  • Potentially inappropriate medications (PIMs) for use in older adults.
  • The correct dose of antibiotics for pediatric patients.
  • Patients who are eligible for Medicare Part D.

Answer: Potentially inappropriate medications (PIMs) for use in older adults.

6. Which of the following is a normal age-related change in body composition that affects drug distribution?

  • Increased total body water and decreased body fat.
  • Decreased total body water and increased body fat.
  • Increased muscle mass.
  • Decreased serum albumin.

Answer: Decreased total body water and increased body fat.

7. A “prescribing cascade” in a geriatric patient occurs when:

  • A medication is prescribed to treat the side effect of another medication, which is mistaken for a new medical condition.
  • A patient is prescribed fewer than five medications.
  • A physician refuses to prescribe a necessary medication.
  • A patient receives all their medications from a single pharmacy.

Answer: A medication is prescribed to treat the side effect of another medication, which is mistaken for a new medical condition.

8. Older adults are particularly sensitive to the adverse effects of drugs with strong __________ properties, such as diphenhydramine.

  • Anticholinergic
  • Beta-blocking
  • Anti-inflammatory
  • Antibiotic

Answer: Anticholinergic

9. When assessing a geriatric patient’s medication regimen, it is most important to consider:

  • Only the evidence from clinical trials in young adults.
  • The patient’s individual goals of care, functional status, and life expectancy.
  • The number of pills the patient can swallow at one time.
  • The pharmacy’s profit margin on the medications.

Answer: The patient’s individual goals of care, functional status, and life expectancy.

10. A sensitive approach to medication reconciliation with an elderly patient involves:

  • Assuming the pharmacy record is 100% accurate.
  • A non-judgmental “brown bag review” and patient interview to get the most accurate possible list.
  • Only asking the patient to list their medications from memory.
  • Correcting the patient every time they mispronounce a drug name.

Answer: A non-judgmental “brown bag review” and patient interview to get the most accurate possible list.

11. Which of the following is a common geriatric syndrome that can be caused or exacerbated by medications?

  • Increased bone density
  • Falls
  • Improved memory
  • Enhanced appetite

Answer: Falls

12. When a geriatric patient is accompanied by a caregiver, a sensitive pharmacist should:

  • Direct all questions only to the caregiver.
  • Direct all questions only to the patient, ignoring the caregiver.
  • Involve both the patient and the caregiver in the conversation, while respecting the patient’s autonomy.
  • Ask the caregiver to wait outside the counseling area.

Answer: Involve both the patient and the caregiver in the conversation, while respecting the patient’s autonomy.

13. The phrase “ageism” in healthcare refers to:

  • The specialization of caring for older adults.
  • The normal process of aging.
  • Discrimination or stereotyping against individuals based on their age.
  • A type of insurance plan for seniors.

Answer: Discrimination or stereotyping against individuals based on their age.

14. A sensitive pharmacist understands that medication non-adherence in an older adult is often due to:

  • A willful desire to be non-compliant.
  • Barriers such as cost, complex regimens, cognitive impairment, or side effects.
  • A lack of interest in their own health.
  • The patient trying to save money by skipping doses.

Answer: Barriers such as cost, complex regimens, cognitive impairment, or side effects.

15. A key wellness management activity for geriatric patients that pharmacists can promote is:

  • Encouraging a sedentary lifestyle.
  • Recommending a high-sodium diet.
  • Ensuring they are up-to-date on recommended immunizations, like influenza and pneumococcal.
  • Discouraging all social interaction.

Answer: Ensuring they are up-to-date on recommended immunizations, like influenza and pneumococcal.

16. Which of the following drug classes is a frequent cause of adverse drug events in the elderly and is included on the Beers Criteria?

  • Vitamins
  • Benzodiazepines
  • Proton pump inhibitors
  • Statins

Answer: Benzodiazepines

17. What is a sensitive way to assess a geriatric patient’s ability to manage their own medications?

  • Assume they are capable unless they state otherwise.
  • Ask, “Are you having trouble taking your pills?”
  • Ask open-ended questions like, “Can you tell me how you keep track of when to take your different medications?”
  • Test their memory by asking them to recite all their medication names.

Answer: Ask open-ended questions like, “Can you tell me how you keep track of when to take your different medications?”

18. A pharmacist who takes the time to put medications in a weekly pill organizer for an elderly patient is addressing which potential barrier to adherence?

  • Cost
  • Side effects
  • Regimen complexity or cognitive impairment.
  • A drug-drug interaction.

Answer: Regimen complexity or cognitive impairment.

19. The “de-prescribing” movement in geriatrics is a best practice that involves:

  • Prescribing medications for every symptom.
  • The systematic process of identifying and discontinuing medications when the harm outweighs the benefit.
  • Refusing to fill any new prescriptions for patients over 65.
  • Switching all brand-name drugs to generics.

Answer: The systematic process of identifying and discontinuing medications when the harm outweighs the benefit.

20. A sensitive communication strategy involves avoiding medical jargon. Instead of saying “hypertension,” a pharmacist could say:

  • “Essential hypertensive vascular disease”
  • “HTN”
  • “High blood pressure”
  • “Elevated systolic and diastolic readings”

Answer: “High blood pressure”

21. The “empathy project” mentioned in the Ambulatory Care syllabus is designed to help students:

  • Understand the daily challenges and perspectives of patients with chronic illness.
  • Practice their clinical calculation skills.
  • Learn how to bill for clinical services.
  • Memorize drug names.

Answer: Understand the daily challenges and perspectives of patients with chronic illness.

22. A patient-centered approach to geriatric care means:

  • The physician makes all decisions.
  • The pharmacist’s clinical recommendations are aligned with the individual patient’s goals and values.
  • The patient’s family makes all decisions.
  • The insurance company’s formulary dictates all care.

Answer: The pharmacist’s clinical recommendations are aligned with the individual patient’s goals and values.

23. Why is it important to allow more time for appointments with geriatric patients?

  • They may have multiple health issues to discuss.
  • They may have cognitive or sensory impairments that slow communication.
  • They may have more questions.
  • All of the above.

Answer: All of the above.

24. Which of the following is a physical sign of aging that could impact medication use?

  • Decreased dexterity, making it difficult to open child-resistant bottles.
  • Improved eyesight.
  • Thicker skin, which increases absorption of topical products.
  • Increased saliva production.

Answer: Decreased dexterity, making it difficult to open child-resistant bottles.

25. A pharmacist is counseling an elderly patient about a new anticoagulant. A key component of this counseling should be:

  • A detailed explanation of the clotting cascade.
  • Focusing on the signs and symptoms of bleeding and when to seek help.
  • The history of the drug’s development.
  • A list of all pharmacies that stock the medication.

Answer: Focusing on the signs and symptoms of bleeding and when to seek help.

26. The concept of “shared decision-making” is particularly important in geriatric care because:

  • It respects the patient’s autonomy and life experience.
  • It shifts all responsibility to the patient.
  • It is the fastest way to complete a consultation.
  • It is required by all state laws.

Answer: It respects the patient’s autonomy and life experience.

27. An older adult’s nutritional status is an important consideration because:

  • It is not relevant to medication therapy.
  • Poor nutrition can affect drug absorption and protein binding.
  • All older adults have excellent nutritional status.
  • It only matters if the patient is overweight.

Answer: Poor nutrition can affect drug absorption and protein binding.

28. A sensitive pharmacist recognizes that for many older adults, maintaining _______ is a primary goal of care.

  • A complex medication regimen.
  • Independence and quality of life.
  • A low body weight.
  • A busy work schedule.

Answer: Independence and quality of life.

29. When an older adult is experiencing delirium in the hospital, a sensitive first step is to:

  • Assume it is dementia and that it is irreversible.
  • Immediately request a high-dose antipsychotic.
  • Review their medication list for potential offending agents.
  • Place the patient in physical restraints.

Answer: Review their medication list for potential offending agents.

30. The “brown bag review” is an especially valuable practice in geriatrics due to the high prevalence of:

  • Polypharmacy and the use of multiple prescribers and pharmacies.
  • Acute, self-limiting illnesses.
  • Aversion to carrying bags.
  • Perfect medication adherence.

Answer: Polypharmacy and the use of multiple prescribers and pharmacies.

31. Instead of simply asking, “Do you have any questions?”, a more sensitive and effective approach is:

  • “I know this can be a lot of information. What questions do you have for me right now?”
  • “You don’t have any questions, do you?”
  • To not ask for questions at all.
  • To provide a phone number for the drug manufacturer.

Answer: “I know this can be a lot of information. What questions do you have for me right now?”

32. The increased volume of distribution for fat-soluble drugs in older adults can lead to:

  • A shorter half-life and less effect.
  • A longer half-life and prolonged drug effect.
  • No change in the drug’s pharmacokinetics.
  • Faster elimination of the drug.

Answer: A longer half-life and prolonged drug effect.

33. Which of the following is a common challenge that requires sensitivity when providing care to older adults?

  • Addressing end-of-life care preferences.
  • Discussing financial limitations.
  • Dealing with cognitive decline.
  • All of the above.

Answer: All of the above.

34. The primary goal of a Medication Therapy Management (MTM) session with a geriatric patient is often to:

  • Add more medications to their regimen.
  • Simplify the regimen and reduce the risk of adverse events.
  • Convince them to switch to all brand-name drugs.
  • Complete the process as quickly as possible.

Answer: Simplify the regimen and reduce the risk of adverse events.

35. A pharmacist demonstrates sensitivity by using person-first language. Which statement is the best example?

  • “The diabetic in room 204.”
  • “The patient in room 204 who has diabetes.”
  • “The non-compliant patient.”
  • “The dementia patient.”

Answer: “The patient in room 204 who has diabetes.”

36. For an older adult, the risk of orthostatic hypotension and falls is a major concern with which class of medications?

  • Antibiotics
  • Statins
  • Alpha-blockers used for BPH or hypertension
  • Proton pump inhibitors

Answer: Alpha-blockers used for BPH or hypertension

37. Geriatric wellness management includes screening for and promoting:

  • Social engagement.
  • Physical activity as tolerated.
  • Proper nutrition.
  • All of the above.

Answer: All of the above.

38. The use of a pillbox or adherence packaging is a sensitive intervention because it:

  • Acknowledges that complex regimens are difficult to manage and provides a practical tool for support.
  • Implies the patient is not intelligent.
  • Is only for patients with dementia.
  • Is the most expensive way to dispense medication.

Answer: Acknowledges that complex regimens are difficult to manage and provides a practical tool for support.

39. A pharmacist who speaks slowly, makes eye contact, and nods to show they are listening is practicing:

  • Inefficient communication.
  • Empathy and active listening.
  • A violation of professional boundaries.
  • A technique to intimidate the patient.

Answer: Empathy and active listening.

40. The risk of adverse effects from drugs that affect the Central Nervous System (CNS) is higher in older adults due to:

  • An increase in the integrity of the blood-brain barrier.
  • Increased neuronal sensitivity and changes in neurotransmitter systems.
  • The fact that older adults enjoy being sedated.
  • A decrease in CNS drug metabolism.

Answer: Increased neuronal sensitivity and changes in neurotransmitter systems.

41. When an older adult reports a new symptom, a sensitive clinician should first consider:

  • That it is an inevitable consequence of aging.
  • That it might be an adverse drug reaction.
  • That the patient is likely exaggerating.
  • That a new disease is the only possible cause.

Answer: That it might be an adverse drug reaction.

42. Which statement reflects a sensitive and collaborative approach to de-prescribing?

  • “You’re on too many pills. I’m stopping this one.”
  • “This medication is on the Beers List, so you can’t take it anymore.”
  • “Let’s talk about your medications. I’m wondering if this one is still providing a benefit that outweighs its risks for you.”
  • “Your insurance won’t pay for this drug after you turn 75.”

Answer: “Let’s talk about your medications. I’m wondering if this one is still providing a benefit that outweighs its risks for you.”

43. A key challenge in evaluating evidence for geriatric pharmacotherapy is that:

  • Older adults are often excluded from major clinical trials.
  • There are too many clinical trials conducted in older adults.
  • Evidence from younger adults can always be directly applied to geriatric patients.
  • Geriatric patients never experience adverse drug events.

Answer: Older adults are often excluded from major clinical trials.

44. A sensitive pharmacist is aware that an older adult’s “chief complaint” may not be:

  • Relevant to their medication regimen.
  • The only or most important health issue they are facing.
  • Truthful.
  • Worth documenting.

Answer: The only or most important health issue they are facing.

45. Which of the following is a normal physiological change of aging?

  • Dementia
  • A modest decline in short-term memory.
  • Depression
  • Chronic pain

Answer: A modest decline in short-term memory.

46. Recognizing and addressing social isolation in an older adult is an example of:

  • A holistic and sensitive approach to care.
  • Overstepping professional boundaries.
  • A diagnosis of depression.
  • A non-reimbursable activity.

Answer: A holistic and sensitive approach to care.

47. A pharmacist helping an older adult choose an OTC product for pain must be sensitive to:

  • Their concurrent disease states (e.g., CKD, HF).
  • Their other medications (e.g., anticoagulants).
  • The potential for anticholinergic effects from some products.
  • All of the above.

Answer: All of the above.

48. The ultimate goal of geriatric-sensitive pharmacy care is to:

  • Ensure the patient is on the fewest number of medications possible.
  • Maximize the patient’s quality of life and functional independence.
  • Extend the patient’s life at all costs.
  • Follow all clinical guidelines rigidly, regardless of the patient’s goals.

Answer: Maximize the patient’s quality of life and functional independence.

49. Providing patient education materials in a large font is a simple intervention that shows sensitivity to:

  • Age-related hearing loss.
  • Age-related changes in vision.
  • Cognitive decline.
  • Decreased dexterity.

Answer: Age-related changes in vision.

50. The “managing medications in clinically complex elders” reading emphasizes the need for:

  • A disease-centered approach.
  • A systematic and patient-centered approach to avoid the pitfalls of polypharmacy.
  • The use of more medications to treat all symptoms.
  • The pharmacist to make all decisions without patient input.

Answer: A systematic and patient-centered approach to avoid the pitfalls of polypharmacy.

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