Top Tips for Mastering the OIIQ-RN March 2025 Exam Geriatric Section

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Top Tips for Mastering the OIIQ-RN March 2025 Exam Geriatrics Section

Top Tips for Mastering the OIIQ-RN March 2025 Exam Geriatric Section

What is the most common cause of dementia?	Alzheimer’s disease.
What is the primary pathophysiological change in Alzheimer’s disease?	Beta-amyloid plaques and neurofibrillary tangles cause neuronal damage and brain atrophy.
What are common causes of reversible dementia?	Vitamin B12 deficiency, hypothyroidism, depression, and medication side effects.
What is vascular dementia, and how does it differ from Alzheimer’s disease?	Vascular dementia is caused by reduced blood flow to the brain (stroke-related), whereas Alzheimer’s is a progressive neurodegenerative disorder.
What is Lewy body dementia?	Dementia associated with Parkinson’s disease, characterized by fluctuating cognition and visual hallucinations.
What is an early sign of Alzheimer’s disease?	Short-term memory loss.
What are middle-stage symptoms of Alzheimer’s?	Disorientation, difficulty with language, mood changes, and wandering.
What is a late-stage symptom of dementia?	Loss of motor skills, incontinence, inability to communicate.
How does dementia differ from delirium?	Dementia is a gradual decline, while delirium is an acute and reversible condition.
What imaging studies are used to diagnose dementia?	MRI and CT scan to rule out other causes like stroke or tumors.
What cognitive test is commonly used to assess dementia?	Mini-Mental State Examination (MMSE).
What score on the MMSE indicates cognitive impairment?	Less than 24 out of 30.
What is the priority intervention for a patient with moderate-stage dementia who wanders?	Ensure a safe environment with door alarms and ID bracelets.
What technique is recommended when communicating with a dementia patient?	Use simple words, maintain eye contact, and speak slowly.
How should a nurse manage agitation in a dementia patient?	Redirect the patient with a calm voice and avoid arguing.
What is the best way to provide instructions to a dementia patient?	Give one-step directions and use visual cues.
What are first-line medications for Alzheimer’s disease?	Cholinesterase inhibitors like donepezil (Aricept) and rivastigmine (Exelon).
What is the mechanism of action of cholinesterase inhibitors?	They prevent the breakdown of acetylcholine, improving memory and cognition.
What NMDA receptor antagonist is used in moderate to severe Alzheimer’s?	Memantine (Namenda).
What common side effects occur with cholinesterase inhibitors?	Nausea, diarrhea, dizziness.
What is the best approach for a dementia patient experiencing hallucinations?	Acknowledge their feelings and provide reassurance without reinforcing the hallucination.
Which non-pharmacologic intervention helps reduce sundowning?	Maintain a consistent bedtime routine and reduce evening stimulation.
Why should benzodiazepines be avoided in dementia patients?	They increase fall risk and worsen confusion.
What is the best way to encourage eating in dementia patients?	Serve finger foods, minimize distractions, and provide familiar meals.
Why are dementia patients at risk for dehydration?	They may forget to drink or not recognize thirst.
What dietary modification can help prevent choking in advanced dementia?	Pureed foods and thickened liquids.
What should caregivers do when a dementia patient becomes aggressive?	Stay calm, do not argue, and redirect attention.
How can caregivers prevent caregiver burnout?	Encourage support groups, respite care, and self-care.
What legal document is important for dementia patients to complete early?	Advance directives (living will, power of attorney).
What is the focus of care in end-stage dementia?	Comfort care, pain management, and ensuring dignity.
What is the main cause of death in advanced dementia?	Aspiration pneumonia due to swallowing difficulties.
Should tube feeding be initiated in advanced dementia?	No, evidence shows it does not improve quality of life or survival.
What is delirium?	An acute, reversible condition characterized by confusion, inattention, and altered consciousness.
How does delirium differ from dementia?	Delirium is sudden and reversible, while dementia is gradual and progressive.
What is the most common cause of delirium in hospitalized older adults?	Infections (e.g., UTI, pneumonia), electrolyte imbalances, or medication side effects.
What are the three types of delirium?	Hyperactive (agitation, hallucinations), hypoactive (lethargy, withdrawal), and mixed.
Which patients are at highest risk for developing delirium?	Older adults, ICU patients, those with multiple comorbidities, polypharmacy, or sensory impairments.
Why are elderly patients at higher risk for delirium?	Decreased physiological reserves, polypharmacy, and underlying cognitive impairment.
How does hospitalization increase the risk of delirium?	Sleep deprivation, unfamiliar environment, sensory overload, or deprivation.
Causes of Delirium	D - Drugs (opioids, anticholinergics, sedatives) E - Electrolyte imbalances (hyponatremia, dehydration) L - Lack of sleep I - Infection (UTI, pneumonia, sepsis) R - Reduced sensory input (vision/hearing loss) I - Intracranial issues (stroke, head injury) U - Urinary retention/fecal impaction M - Myocardial infarction or metabolic disorders
What is the most common infection that causes delirium in older adults?	Urinary tract infection (UTI).
Which medications commonly contribute to delirium?	Benzodiazepines, anticholinergics, opioids, corticosteroids.
How does dehydration contribute to delirium?	Causes electrolyte imbalances and decreased cerebral perfusion.
What is a key feature of delirium that distinguishes it from dementia?	Fluctuating levels of consciousness.
What are common signs of hyperactive delirium?	Agitation, hallucinations, restlessness.
What are common signs of hypoactive delirium?	Lethargy, confusion, decreased responsiveness.
Why is hypoactive delirium often missed?	Patients appear withdrawn and are mistakenly thought to be depressed or fatigued.
What screening tool is commonly used for delirium?	Confusion Assessment Method (CAM).
What are the four criteria of the CAM test for delirium?	Acute onset and fluctuating course Inattention Disorganized thinking Altered level of consciousness
What lab tests help identify the cause of delirium?	CBC, electrolytes, urinalysis, liver/kidney function tests, and oxygen levels.
What is the priority intervention for a patient with delirium?	Identify and treat the underlying cause.
How should the nurse provide orientation for a delirious patient?	Use clocks, calendars, reorient frequently, and provide familiar objects.
What is the best environment for managing delirium?	Quiet, well-lit room with minimal stimulation.
Why should physical restraints be avoided in delirium?	Restraints increase agitation and risk of injury.
What is an appropriate nursing intervention for a patient with hypoactive delirium?	Encourage mobility, hydration, and frequent interactions.
What is the first-line treatment for delirium?	Non-pharmacologic interventions (reorientation, hydration, treating infection).
Which medication may be used for severe agitation in delirium?	Haloperidol (Haldol), but only if non-pharmacologic measures fail.
Why should benzodiazepines be avoided in delirium?	They can worsen confusion and increase fall risk.
Which medication is preferred for delirium caused by alcohol withdrawal?	Benzodiazepines (e.g., lorazepam, diazepam).
What interventions help prevent delirium in hospitalized patients?	Encourage mobility, promote sleep, ensure hydration, minimize sedation.
How can nurses reduce nighttime confusion in hospitalized patients?	Provide a consistent routine, avoid unnecessary nighttime disturbances.
Why should anticholinergic medications be avoided in older adults?	They increase confusion and fall risk.
Why are delirious patients at high risk for falls?	Impaired cognition, restlessness, and decreased balance.
What safety measures can prevent falls in delirious patients?	Bed alarms, frequent monitoring, clear pathways, and proper lighting.
What are common behavioral symptoms of dementia?	Agitation, aggression, wandering, hallucinations, delusions, paranoia, and apathy.
What is the term for increased confusion and agitation in dementia patients during the evening?	Sundowning syndrome.
What is a common cause of aggressive behavior in dementia patients?	Pain, frustration, hunger, or unmet needs.
What environmental factors can trigger agitation in dementia patients?	Loud noises, unfamiliar surroundings, overstimulation, or changes in routine.
How can an unmet need cause behavioral disturbances in dementia?	Hunger, thirst, pain, or toileting needs may lead to restlessness or aggression.
Why do dementia patients develop paranoia or delusions?	Memory loss and confusion cause misinterpretation of reality.
What is the first-line intervention for an agitated dementia patient?	Identify the trigger and use calm, reassuring communication.
What should the nurse avoid when dealing with an agitated dementia patient?	Arguing, reasoning, or forcing the patient to comply.
What non-pharmacologic methods help calm an aggressive dementia patient?	Music therapy, redirection, validation therapy, and reducing stimuli.
What is validation therapy?	Acknowledging the patient’s emotions and redirecting the conversation instead of correcting them.
What is the priority intervention for a dementia patient who wanders?	Ensure a safe environment with secured exits and identification bracelets.
How can the nurse reduce wandering behavior?	Engage the patient in structured activities and provide a calm environment.
What should caregivers do if a dementia patient frequently wanders?	Use door alarms, install safety locks, and provide supervision.
What should the nurse do when a dementia patient reports seeing people who are not there?	Acknowledge their feelings and provide reassurance, but do not argue.
What is the best way to respond to a dementia patient experiencing paranoia?	Avoid confrontation and create a calm, reassuring environment.
What environmental modifications can reduce hallucinations in dementia patients?	Ensure adequate lighting and remove reflective surfaces.
What is sundowning syndrome?	Increased confusion, agitation, and restlessness in the late afternoon and evening.
What interventions help manage sundowning?	Maintain a consistent bedtime routine, provide soothing activities, and reduce evening stimulation.
Why should naps be minimized for dementia patients with sundowning?	Too much daytime sleep can disrupt the sleep-wake cycle.
What is the first-line treatment for behavioral symptoms in dementia?	Non-pharmacologic interventions (redirection, routine, calm communication).
Which medication class is sometimes used for severe agitation in dementia patients?	Atypical antipsychotics (e.g., risperidone, olanzapine) but only when necessary.
What antidepressant is commonly used in dementia patients with depression?	Selective serotonin reuptake inhibitors (SSRIs) like sertraline.
How can caregivers effectively communicate with a dementia patient?	Use simple words, short sentences, and a calm voice.
What should caregivers do when a dementia patient becomes aggressive?	Stay calm, do not argue, and redirect attention.
What feeding modifications can help a dementia patient who refuses to eat?	Provide finger foods, minimize distractions, and serve familiar meals.
What should caregivers do if a dementia patient forgets to drink fluids?	Offer fluids frequently and use cups with straws or adaptive lids.
What is the primary pathophysiology of Parkinson’s disease?	Loss of dopamine-producing neurons in the substantia nigra of the brain.
What neurotransmitter imbalance occurs in Parkinson’s disease?	Decreased dopamine and increased acetylcholine.
What is the cause of Parkinson’s disease?	The exact cause is unknown, but it is linked to genetic and environmental factors.
What is the peak age for Parkinson’s disease onset?	60 years and older.
Mnemonic: TRAP	T - Tremor (resting tremor, "pill-rolling") R - Rigidity (muscle stiffness, "cogwheel rigidity") A - Akinesia/Bradykinesia (slow movements, difficulty initiating movement) P - Postural instability (risk of falls, shuffling gait)
What is the first symptom usually noticed in Parkinson’s disease?	Resting tremor (pill-rolling).
What is bradykinesia?	Slow movements and difficulty initiating voluntary movements.
What gait abnormality is common in Parkinson’s disease?	Shuffling, festinating gait.
What is cogwheel rigidity?	Muscle stiffness with jerky movements.
What non-motor symptoms are common in Parkinson’s?	Depression, constipation, sleep disturbances, orthostatic hypotension.
Why do Parkinson’s patients experience orthostatic hypotension?	Autonomic nervous system dysfunction.
What speech problems occur in Parkinson’s disease?	Soft, monotone voice (hypophonia).
What is the leading cause of death in Parkinson’s patients?	Aspiration pneumonia due to dysphagia.
Why are Parkinson’s patients at high risk for falls?	Postural instability and shuffling gait.
How does Parkinson’s affect bowel function?	Causes constipation due to slowed peristalsis.
What is the primary medication used to treat Parkinson’s?	Levodopa-carbidopa (Sinemet).
How does levodopa work?	Levodopa converts to dopamine in the brain.
Why is carbidopa added to levodopa?	Prevents peripheral breakdown of levodopa, allowing more to reach the brain.
What are common side effects of levodopa?	Dyskinesia (involuntary movements), nausea, hypotension.
What should patients avoid when taking levodopa?	High-protein meals, which reduce drug absorption.
What is a major side effect of dopamine agonists? (Pramipexole, Ropinirole)	Sudden sleep attacks and impulse control issues.
What food should be avoided when taking MAO-B inhibitors? (Selegiline, Rasagiline)	Tyramine-rich foods (aged cheese, wine) to prevent hypertensive crisis.
What type of diet is recommended for Parkinson’s patients?	High-fiber diet to prevent constipation, small frequent meals.
What should the nurse encourage to prevent aspiration in Parkinson’s patients?	Sit upright when eating, use thickened liquids if needed.
How can Parkinson’s patients improve mobility?	Use assistive devices, practice slow and deliberate movements.
What technique helps patients with freezing episodes?	Step over an imaginary line or object to initiate movement.
What surgical option is available for severe Parkinson’s symptoms?	Deep brain stimulation (DBS).
How does deep brain stimulation work?	Electrodes implanted in the brain deliver electrical impulses to reduce tremors.
What symptoms does DBS help with?	Tremors and rigidity, but not cognitive decline.
What mental health disorder is common in Parkinson’s patients?	Depression and anxiety.
Why do Parkinson’s patients experience social withdrawal?	Speech difficulties and embarrassment about motor symptoms.
What support resources are beneficial for Parkinson’s patients?	Support groups, speech therapy, physical therapy.
What are the main types of elder abuse?	Physical, emotional (psychological), financial, sexual, neglect, and abandonment.
Which type of elder abuse involves withholding basic needs?	Neglect.
What is an example of financial abuse?	A caregiver misusing an elderly person's funds or coercing them into changing a will.
What is the most common type of elder abuse?	Neglect.
Which elderly individuals are at the highest risk for abuse?	Those with dementia, disabilities, social isolation, or financial dependence on caregivers.
What caregiver factors increase the risk of elder abuse?	Caregiver stress, financial burden, mental illness, and substance abuse.
Which living situation increases the risk of elder abuse?	Being dependent on a family member or living in a poorly regulated facility.
What are physical signs of elder abuse?	Unexplained bruises, burns, fractures, or pressure ulcers.
What behavioral signs suggest emotional abuse?	Fearfulness, withdrawal, depression, or agitation when a caregiver is present.
What are signs of financial exploitation?	Unpaid bills, missing valuables, sudden changes in bank accounts, or forged signatures.
How might an abused elderly person behave when questioned?	They may seem fearful, provide vague answers, or hesitate to speak in front of their caregiver.
What should the nurse do if elder abuse is suspected?	Report it to Adult Protective Services (APS) immediately.
Is a nurse legally required to report suspected elder abuse?	Yes, nurses are mandatory reporters.
What is the priority nursing intervention if elder abuse is suspected?	Ensure the patient’s safety and report findings to the appropriate authorities.
Can a nurse report elder abuse without proof?	Yes, the nurse only needs a reasonable suspicion, not proof.
What is an appropriate question to ask when screening for elder abuse?	“Do you feel safe at home?”
Which screening tool is commonly used for elder abuse?	Elder Abuse Suspicion Index (EASI).
How should a nurse interview a suspected elder abuse victim?	Privately, away from the suspected abuser.
What should the nurse document when assessing for elder abuse?	Objective descriptions of injuries, patient statements in quotes, and observations of interactions.
What is a key strategy to prevent elder abuse?	Providing caregiver support and respite care.
How can healthcare providers help prevent elder financial abuse?	Educate older adults about recognizing scams and fraud.
What is a community resource that can help prevent elder abuse?	Adult Protective Services (APS) or senior advocacy programs.
What legal document can help protect elderly individuals from financial abuse?	Power of attorney (POA) with a trusted individual.
What signs may indicate abuse in a nursing home?	Sudden weight loss, dehydration, pressure ulcers, or fear of staff.
What is an ombudsman’s role in elder care?	An ombudsman advocates for residents in long-term care facilities.
What should a nurse do if abuse is suspected in a nursing home?	Report it to facility administrators
What is a sign of medication abuse in a nursing home?	Excessive sedation or chemical restraints used inappropriately.
Can a nurse be sued for reporting suspected elder abuse?	No, mandatory reporters are legally protected.
What should be included in an elder abuse report?	Objective observations, injuries, statements from the patient, and interactions with caregivers.
How does elder abuse affect mental health?	Increased risk of depression, anxiety, PTSD, and suicidal thoughts.
What support services should be offered to an elder abuse victim?	Counseling, support groups, legal aid, and social work services.
What is the primary goal of palliative care?	To improve quality of life by managing symptoms in patients with serious illnesses.
How does palliative care differ from hospice care?	Palliative care can be provided alongside curative treatments, whereas hospice care is for end-of-life patients who are no longer receiving curative treatments.
What is the best communication approach for a palliative care discussion?	Use open-ended questions, active listening, and allow the patient to express feelings.
How should the nurse respond when a palliative care patient asks, “Am I dying?”	Acknowledge their feelings, provide honest yet compassionate information, and ask about their concerns.
What are common psychosocial concerns in palliative care patients?	Fear of pain, loss of independence, financial burden, and spiritual distress.
What is the first-line medication for moderate to severe pain in palliative care?	Opioids (e.g., morphine, hydromorphone).
What is a common side effect of opioid use, and how is it managed?	Constipation—managed with stool softeners and increased fluids.
How should breakthrough pain be treated in a palliative care patient on opioids?	Provide short-acting opioids as needed in addition to long-acting pain control.
What medication is commonly used to relieve dyspnea in palliative care?	Morphine, which decreases the sensation of air hunger.
What non-pharmacologic interventions can help with dyspnea?	Fan near the face, repositioning, pursed-lip breathing, and supplemental oxygen if hypoxic.
What medications are commonly used for nausea in palliative care?	Ondansetron (Zofran), metoclopramide (Reglan), and prochlorperazine.
What non-pharmacologic methods help with nausea?	Small, frequent meals, avoiding strong smells, and cool fluids.
What is the first-line medication for anxiety in palliative care?	Benzodiazepines (e.g., lorazepam).
What non-pharmacologic interventions help reduce anxiety?	Calm environment, music therapy, deep breathing exercises.
What are signs of impending death?	Decreased appetite, mottled skin, irregular breathing (Cheyne-Stokes respirations), and decreased urine output.
What is the priority nursing intervention for a dying patient with noisy, "death rattle" respirations?	Provide anticholinergics (e.g., atropine drops, scopolamine patch) and reposition the patient.
Should artificial hydration be provided to a dying patient who is not eating or drinking?	No, artificial hydration does not improve comfort and may cause fluid overload.
What is the role of hospice care?	Providing comfort-focused care when life expectancy is ≤6 months.
What legal document outlines a patient’s end-of-life wishes?	Advance directive (includes living will and durable power of attorney for healthcare).
What is the role of a healthcare proxy?	A designated person who makes medical decisions if the patient is unable to do so.
What is the difference between a DNR and a DNI order?	DNR (Do Not Resuscitate): No CPR or defibrillation. DNI (Do Not Intubate): No mechanical ventilation, but other resuscitation may be provided.
Can a nurse override a DNR order in an emergency?	No, the DNR order must be followed.
How should a nurse address a patient’s spiritual distress in palliative care?	Encourage open discussions and offer pastoral or chaplain support.
What cultural beliefs may impact end-of-life care decisions?	Some cultures may prefer family decision-making or may oppose withdrawal of life support.
How should a nurse respond if a patient’s family refuses palliative care due to cultural beliefs?	Respect their views and provide education on comfort measures.
What is anticipatory grief?	Grief that occurs before a patient’s death as family members prepare for the loss.
How can nurses support grieving family members?	Provide emotional support, allow time for goodbyes, and offer bereavement resources.
What is the priority intervention if a family member is distressed about a loved one’s death?	Encourage them to talk about their feelings and provide a quiet space for mourning.