Geriatrics Questions

1. A 90 year old woman living in a nursing home because of moderate dementia and lack of family caregiver has been frequently restrained in her bed and chair because of intermittent agitation and wandering behavior.  One evening, after being unrestrained as part of the facility’s “restraint reduction” policy, she fell while on her way to the bathroom, prompting the facility to re-examine the use of restraints and their relation to patients’ risk of falls.

Which of the following statements concerning restraints and their relationship to falls is most consistent with what is known?

a.Restraints are not able to prevent falls.

b. Bedrails have been shown to be an effective alternative to physical restraints.

c. Restraint use can increase risk of falls by producing muscle weakness and deconditioning.

d.  estraints are an acceptable method for managing wandering behavior.

e. Restraint reduction is not associated with increased risk of falls.

2.  An 80 year old woman was hospitalized after sustaining a hip fracture.  Her hospital course has been complicated by the development of a nosocomial pneumonia and the new onset of seizure activity on day 4 of hospitalization.  Current medications include:  theophylline 300 mg twice daily; albuterol; beclomethasone and ipratropium inhalers; diltiazem 180mg daily; fluoxetine 20 mg daily; imipenim 500 mg IV every 8 hours and meperidine 75 mg IM every 6 hours since surgery.  Her serum creatinine is 2.1 mg/dl.

Which medication is the most likely cause of her new seizure activity?

a. theophylline

b)      meperidine

c)      imipenim

d)      fluoxetine

3. In an 82 year old man admitted to an acute medical unit with UTI and fever, which of the following is most suggestive of the diagnosis of delirium?

a)      Inability to stay focused on questions.

b)      Worsening of behavior at night.

c)      Angry outbursts and claims the staff are trying to harm him

d)      Mini-mental State Examination score of 18/30