2024 Summer GAPNA Newsletter Volume 43 Number 2

Gerontological Specialists Certification Prep: Practice Questions

Prepare for the Gerontological Specialists Certification (GS-C) exam with these 5 practice questions.

Test Result Normal Range
Hemoglobin 10.1 g/dL 12.1 - 20.0 g/dL
Hematocrit 40.4% 37 - 47%
MCV 80 fL 78 - 98 fL
MCH 30 pg 27 - 31 pg
Serum Iron 33.8 42 - 135 mcg/dL
Transferrin Saturation 15.0% 15% - 50%
Serum Ferritin 152.1 40 - 160 ng/mL
Total Iron Binding 219 mcg/dL 250 - 350 mcg/dL

Question 1

A 79-year-old female and recent widow presents to the primary care clinic with vague symptoms of fatigue and decreased energy. Her laboratory findings are shown above. The APRN would correctly diagnose the patient as having

  1. pernicious anemia
  2. anemia of chronic disease.
  3. folic acid deficiency anemia.
  4. iron deficiency anemia.

B

Blueprint Area: II. Performs appropriate screening, diagnostic testing, treatment, and planning of care for the complex older adult.

Rationale: Anemia of chronic disease is a normocytic, normochromic, chronic anemia due to chronic infections (e.g., tuberculosis), chronic inflammation (e.g., rheumatoid arthritis, neoplastic disease), as well as other chronic illnesses (e.g., liver disease, diabetes mellitus). Laboratory findings include low serum iron despite normal iron stores. The anemia is usually mild, progressive, and asymptomatic.

Question 2

Which of the following oral antidiabetic agents is most likely to cause a patient to fall?

  1. Sitagliptin (Januvia).
  2. Pioglitazone (Actos).
  3. Glyburide (DiaBeta).
  4. Acarbose (Precose).

C

Blueprint Area: III. Prescribes medications, including consideration of risks and benefits of pharmacotherapy for complex older adults.

Rationale: Glyburide is an insulin stimulator that can cause severe hypoglycemia, which causes weakness and dizziness that can lead to patient falls. Additionally, glyburide appears on Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Pioglitazone, an insulin sensitizer, has minimal hypoglycemic effects but may cause or exacerbate heart failure. Sitagliptin inhibits the enzyme GPP-4 and causes minimal hypoglycemia. Acarbose, an alpha-glucosidase inhibitor, causes flatulence and abdominal distension but minimal hypoglycemia.

Question 3

Measurement of resident outcomes in an accredited long-term care facility has shown less than excellent results. In response to the negative report, which of the following occurrences would be most beneficial for the facility?

  1. The evaluation report provides the catalyst to motivate the administration to institute change.
  2. The residents are empowered to expect improved staff performance.
  3. The administration discharges several problematic patients.
  4. The findings in the evaluation precipitate the resignation of poorly performing staff.

A

Blueprint Area: VII. Uses a systems-based approach to anticipate and deploy resources to optimize outcomes for older adult populations.

Rationale: Measurement of outcomes is an important way to demonstrate quality of care in long-term care facilities. A finding of less than excellent outcomes may provide the tension within the facility needed for important changes to occur.

Question 4

Which of the following types of medication is associated with urinary retention and overflow incontinence in men who have benign prostatic hyperplasia?

  1. Probiotics
  2. Proton-pump inhibitors
  3. Cardiac glycosides
  4. Decongestants

D

Blueprint Area: III. Prescribes medications, including consideration of risks and benefits of pharmacotherapy for complex older adults.

Rationale: Oral decongestants are α1-adrenergic agonists (sympathomimetic) drugs that increase alpha-adrenergic tone in the prostatic urethra and bladder neck, resulting in constriction and bladder outlet obstruction. This leads to urinary retention and overflow incontinence.

 

Question 5

When measuring quality in an institution, which of the following is considered a process measure?

  1. Use of an electronic medical record (EMR) system by providers in the healthcare organization.
  2. Proportion of patients with myocardial infarction (MI) who were prescribed beta blockers.
  3. Percentage of post-hospitalization readmissions for heart failure.
  4. Rate of hospital-acquired pressure ulcer injuries.

B

Blueprint Area: VII. Uses a systems-based approach to anticipate and deploy resources to optimize outcomes for older adult populations.

Rationale: According to the Agency for Healthcare Research and Quality (AHRQ), process measures indicate what a provider does to maintain or improve health for a particular population, which often reflect generally accepted guidelines for clinical practice. This would include prescribing beta blockers for persons who had MIs. Structural measures provide information about the healthcare provider’s capacity, systems, and processes to provide high-quality care, such as the use of an EMR system. Outcome measures reflect the impact of healthcare services on the patients’ health, such as the percent of post-hospitalization readmissions for heart failure or the rate of hospital- acquired infections or pressure ulcer injuries.

 

Want to practice more? Click here for 8 more practice questions.