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ACSW practice questions

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Question 1Gerontology

Which demographic trend most directly shapes the demand for gerontological social work services in industrialized nations?

  1. Steady decline in the number of people aged 85 and older
  2. Rapid population aging driven by declining fertility and rising life expectancy Correct answer.
  3. Reduction in the proportion of women in the older population
  4. Decreasing rates of chronic illness among older adults

Explanation

Population aging results from sustained low fertility combined with longer life expectancy, which increases both the number and proportion of older adults needing services. This structural shift is the primary driver of demand for gerontological practice.

Question 2Gerontology

A social worker uses the term 'young-old' in a case conference. Which age range does this term conventionally describe?

  1. 85 years and older
  2. 65 to 74 years Correct answer.
  3. 55 to 64 years
  4. 75 to 84 years

Explanation

Gerontology commonly divides later life into young-old (roughly 65 to 74), middle-old (75 to 84), and oldest-old (85 and over). The young-old category is generally associated with relatively better health and independence.

Question 3Gerontology

Which biological theory of aging proposes that aging results from the cumulative damage of random molecular errors over time?

  1. Disengagement theory
  2. Stochastic error theory Correct answer.
  3. Programmed aging theory
  4. Activity theory

Explanation

Stochastic theories treat aging as the result of random, cumulative damage such as DNA errors and oxidative stress. Programmed theories, by contrast, propose genetically timed senescence.

Question 4Gerontology

A 78-year-old client reports that since retirement she has replaced her work role with volunteer leadership at a community garden and feels satisfied. Which psychosocial theory best explains her adjustment?

  1. Continuity theory
  2. Disengagement theory
  3. Role exit theory
  4. Activity theory Correct answer.

Explanation

Activity theory holds that successful aging depends on maintaining activity and substituting new roles for lost ones such as employment. Her volunteer leadership is a direct role replacement that supports well-being.

Question 5Gerontology

According to Erikson's psychosocial theory, the central developmental task of later adulthood is:

  1. Ego integrity versus despair Correct answer.
  2. Identity versus role confusion
  3. Intimacy versus isolation
  4. Generativity versus stagnation

Explanation

Erikson's final stage is ego integrity versus despair, in which older adults review their lives and seek acceptance of their choices and limitations. The other stages listed occur earlier in the lifespan.

Question 6Gerontology

Which statement best describes the concept of ageism?

  1. A clinical diagnosis of cognitive decline in later life
  2. A legal standard for determining retirement eligibility
  3. The biological process of cellular senescence
  4. Prejudice and discrimination based on a person's age Correct answer.

Explanation

Ageism refers to stereotyping, prejudice, and discrimination directed at people because of their age. It operates at individual, institutional, and cultural levels and can affect access to services and employment.

Question 7Gerontology

A hospital social worker notices that staff routinely speak to an alert 80-year-old patient in a loud, simplified 'sing-song' voice. This behavior is best described as:

  1. Sundowning
  2. Aphasia
  3. Confabulation
  4. Elderspeak Correct answer.

Explanation

Elderspeak is a patronizing speech style using simplified grammar, elevated pitch, and terms of endearment, often applied regardless of the person's competence. It can communicate lowered expectations and reduce the older adult's sense of autonomy.

Question 8Gerontology

Which physiological change associated with normal aging most affects the absorption of medications?

  1. Increased gastric acid secretion
  2. Increased renal clearance
  3. Increased hepatic blood flow
  4. Decreased gastric motility and blood flow Correct answer.

Explanation

Normal aging reduces gastrointestinal motility and splanchnic blood flow, which can alter drug absorption. Hepatic blood flow and renal clearance generally decline rather than increase with age.

Question 9Gerontology

An older adult's total body water decreases with age. What pharmacokinetic consequence should a prescriber anticipate for a water-soluble drug?

  1. Reduced protein binding with no effect on concentration
  2. A larger volume of distribution and lower serum concentration
  3. A smaller volume of distribution and higher serum concentration Correct answer.
  4. No change in distribution but faster elimination

Explanation

Because total body water declines with age, water-soluble drugs distribute into a smaller volume, raising serum concentration for a given dose. This is one reason dosing adjustments are often needed in older adults.

Question 10Gerontology

Which set of findings is most characteristic of delirium rather than dementia?

  1. Insidious onset with stable, gradual decline over years
  2. Acute onset with fluctuating attention and altered consciousness Correct answer.
  3. Progressive memory loss with preserved attention
  4. Slow decline in executive function with intact arousal

Explanation

Delirium is distinguished by acute onset, fluctuating course, inattention, and altered level of consciousness, often due to a medical cause. Dementia typically has an insidious, progressive course with attention relatively preserved until late stages.

Question 11Gerontology

A social worker assesses decision-making capacity in a client with mild cognitive impairment. Which element is central to a capacity determination?

  1. The client's ability to understand relevant information and appreciate consequences Correct answer.
  2. The client's chronological age
  3. The family's preference for the treatment plan
  4. The client's score on a screening instrument alone

Explanation

Decision-making capacity is functional and rests on abilities such as understanding relevant information, appreciating the situation and consequences, reasoning, and expressing a choice. A test score alone cannot determine capacity.

Question 12Gerontology

Which screening instrument is specifically designed to detect depressive symptoms in older adults and avoids reliance on somatic items?

  1. Katz Index of Independence
  2. Mini-Cog
  3. Mini-Mental State Examination
  4. Geriatric Depression Scale Correct answer.

Explanation

The Geriatric Depression Scale was developed for older adults and uses a yes/no format that deemphasizes somatic symptoms common in later life. The other instruments assess cognition or functional independence.

Question 13Gerontology

An older client can dress, bathe, and use the toilet independently but cannot manage finances or arrange transportation. These limitations fall primarily under which domain?

  1. Instrumental activities of daily living Correct answer.
  2. Activities of daily living
  3. Basic mobility measures
  4. Cognitive screening

Explanation

Instrumental activities of daily living include complex tasks such as managing money, shopping, transportation, and medication management. Basic self-care tasks like bathing and toileting are activities of daily living.

Question 14Gerontology

Which finding on a home safety review poses the greatest fall risk for an older adult with peripheral neuropathy?

  1. Grab bars installed in the shower
  2. Loose throw rugs and poor lighting along the hallway Correct answer.
  3. A bedside commode within reach
  4. A raised toilet seat in the bathroom

Explanation

Loose rugs and poor lighting compound the balance and proprioceptive deficits of peripheral neuropathy, substantially raising fall risk. The other items are environmental modifications that reduce risk.

Question 15Gerontology

Which statement accurately reflects the concept of elder mistreatment in social work practice?

  1. It includes physical, emotional, sexual, financial, and neglectful forms Correct answer.
  2. It refers only to physical assaults by strangers
  3. It is rare and seldom involves family caregivers
  4. It can be ruled out when the older adult does not report it

Explanation

Elder mistreatment encompasses physical, emotional, sexual, and financial abuse as well as neglect and self-neglect. Perpetrators are frequently family members or trusted others, and underreporting is common due to fear or dependence.

Question 16Gerontology

A social worker suspects financial exploitation of a client with early dementia by a nephew who recently gained access to her accounts. What is the most appropriate initial action?

  1. Wait until the client requests help before acting
  2. Advise the client to close all accounts without further assessment
  3. Confront the nephew directly and demand repayment
  4. Document findings and follow mandated reporting and protective service procedures Correct answer.

Explanation

Suspected financial exploitation of a vulnerable adult triggers documentation and adherence to mandated reporting and adult protective service protocols. Direct confrontation or unilateral financial advice can escalate risk and overstep the worker's role.

Question 17Gerontology

Which policy framework in the United States prohibits discrimination in employment on the basis of age for workers 40 and older?

  1. The Family and Medical Leave Act
  2. The Age Discrimination in Employment Act Correct answer.
  3. The Americans with Disabilities Act
  4. The Older Americans Act

Explanation

The Age Discrimination in Employment Act protects workers aged 40 and older from age-based discrimination in hiring, promotion, and termination. The Older Americans Act funds services rather than prohibiting employment discrimination.

Question 18Gerontology

What is the primary purpose of the Older Americans Act's network of Area Agencies on Aging?

  1. To adjudicate guardianship petitions
  2. To plan and coordinate community-based services for older adults Correct answer.
  3. To license nursing home administrators
  4. To set Medicare reimbursement rates

Explanation

Area Agencies on Aging plan, coordinate, and fund community-based services such as meals, transportation, and in-home support under the Older Americans Act. They do not license administrators, decide guardianship, or set Medicare rates.

Question 19Gerontology

Which Medicare component primarily covers skilled nursing facility care following a hospital stay and hospice care?

  1. Part C
  2. Part B
  3. Part D
  4. Part A Correct answer.

Explanation

Medicare Part A covers inpatient hospital care, skilled nursing facility care after a qualifying stay, and hospice. Part B covers outpatient and physician services, Part C is Medicare Advantage, and Part D covers prescription drugs.

Question 20Gerontology

An older adult with limited income needs help paying Medicare premiums and cost-sharing. Which program should the social worker explore?

  1. Medicare Savings Programs Correct answer.
  2. The Low-Income Home Energy Assistance Program
  3. The Supplemental Nutrition Assistance Program
  4. Supplemental Security Income

Explanation

Medicare Savings Programs help eligible low-income beneficiaries with premiums and, depending on the program, deductibles and coinsurance. The other programs address income support, energy costs, or food rather than Medicare cost-sharing.

Question 21Gerontology

Which arrangement best exemplifies a guardianship as opposed to a power of attorney?

  1. A court appoints a surrogate decision-maker after finding the person incapacitated Correct answer.
  2. A person voluntarily names an agent to act if they later lose capacity
  3. A family member informally manages a relative's finances
  4. A physician signs a do-not-resuscitate order

Explanation

Guardianship is a court-ordered arrangement in which a surrogate is appointed after a legal finding of incapacity. A power of attorney is a voluntary document executed while the person has capacity.

Question 22Gerontology

A social worker helps an older client complete an advance directive. Which document allows the client to name a person to make health care decisions if the client loses capacity?

  1. Durable power of attorney for health care Correct answer.
  2. Physician orders for life-sustaining treatment
  3. Living will
  4. Last will and testament

Explanation

A durable power of attorney for health care designates a health care agent to make decisions if the person loses capacity. A living will instead states treatment preferences without naming an agent.

Question 23Gerontology

Which practice best reflects cultural humility when working with an older client from a collectivist cultural background?

  1. Applying the worker's own family norms as the standard
  2. Exploring the client's values and involving chosen family in decisions Correct answer.
  3. Assuming the client wants independent decision-making
  4. Avoiding discussion of cultural preferences to remain neutral

Explanation

Cultural humility involves eliciting the client's values and preferences and respecting how decisions are made within the client's family and community. Imposing the worker's norms or avoiding the topic undermines culturally responsive practice.

Question 24Gerontology

A nursing home resident with mild dementia is socially isolated and shows declining mood. Which intervention is best supported for reducing isolation in long-term care?

  1. Increasing television time in the resident's room
  2. Scheduling all activities in large auditoriums to maximize attendance
  3. Restricting visitors to reduce overstimulation
  4. Structured small-group activities matched to the resident's interests and abilities Correct answer.

Explanation

Structured, interest-matched small-group activities are associated with improved engagement and mood for residents with dementia. Large, unstructured settings and passive media tend to increase isolation rather than reduce it.

Question 25Gerontology

A caregiver reports significant strain while caring for a spouse with advanced dementia. Which intervention is most consistent with a caregiver support framework?

  1. Recommending immediate nursing home placement without discussion
  2. Advising the caregiver to reduce all outside contact
  3. Telling the caregiver that strain is an expected part of duty
  4. Respite care combined with psychoeducation and support groups Correct answer.

Explanation

Caregiver support frameworks combine respite, education, and peer support to reduce burden and sustain the caregiver's capacity. Isolating the caregiver or dismissing strain can worsen outcomes.

Question 26Gerontology

Which theory of aging proposes that successful aging depends on maintaining social activity and roles as people age?

  1. Continuity theory
  2. Programmed aging theory
  3. Activity theory Correct answer.
  4. Disengagement theory

Explanation

Activity theory holds that well-being in later life is supported by remaining socially engaged and replacing lost roles. Disengagement theory argues the opposite, that mutual withdrawal between society and the older person is normal. Continuity theory emphasizes maintaining longstanding habits and identity rather than activity level per se.

Question 27Gerontology

A social worker meets an 82-year-old client who reports low mood, poor appetite, and frequent napping. The client denies feeling sad and says, 'I'm just tired and my stomach bothers me.' Which principle should guide the worker's next step?

  1. Screen for depression because older adults often present with somatic and fatigue symptoms rather than stated sadness. Correct answer.
  2. Assume the symptoms are normal aging and monitor without further action.
  3. Rely on the client's denial of sadness to rule out depression.
  4. Refer immediately for dementia evaluation because appetite loss suggests cognitive decline.

Explanation

Depression in later life frequently presents with somatic complaints, fatigue, and appetite change rather than explicit sadness, so a formal screen is warranted. Normalizing symptoms as aging or accepting denial can leave treatable depression unaddressed. Appetite loss alone is not a specific marker of dementia.

Question 28Gerontology

A social worker is planning a discharge for an older adult who lives alone and has moderate mobility limitations. Which approach best reflects the person-environment competence model?

  1. Match environmental supports such as grab bars and home-delivered services to the person's specific functional abilities. Correct answer.
  2. Focus solely on the client's motivation to adapt without altering the home environment.
  3. Delay planning until the client's mobility declines further and needs become clearer.
  4. Recommend relocation to a nursing home because of the mobility limitation alone.

Explanation

The person-environment competence model holds that well-being depends on the fit between an individual's capacities and the demands of the environment. Interventions therefore aim to modify environmental demands, such as adding supports and services, to match the person's abilities. Relocation or inaction based on a single limitation ignores this fit.

Question 29Gerontology

During a home visit, a social worker notices an older client has lost weight and appears unkempt, and the client's adult child answers all questions for the client. Which combination of findings should most prompt a structured assessment for mistreatment?

  1. Weight loss, unkempt appearance, and the child's control of communication together. Correct answer.
  2. Weight loss and unkempt appearance alone.
  3. The adult child answering questions alone.
  4. The client's older age alone.

Explanation

Elder mistreatment assessment is indicated when multiple converging indicators appear, such as unexplained weight loss, poor hygiene, and a caregiver who dominates communication or isolates the client. No single sign is definitive, so clustering indicators strengthens the case for a structured screen. Age alone is not an indicator.

Question 30Hospice and Palliative Care

Under Medicare hospice regulations, what is the standard certification period for the first hospice benefit period?

  1. Two 90-day periods followed by unlimited 60-day periods
  2. Two 90-day periods
  3. One 90-day period Correct answer.
  4. An unlimited number of 60-day periods

Explanation

The Medicare hospice benefit begins with two 90-day periods, after which the patient may elect an unlimited number of 60-day periods. The first period alone is 90 days. Recertification requirements differ between these periods.

Question 31Hospice and Palliative Care

Which prognostic indicator most strongly suggests a hospice-eligible trajectory in a patient with advanced heart failure?

  1. Refractory symptoms despite optimized therapy Correct answer.
  2. Occasional palpitations on exertion
  3. Ejection fraction of 45% with stable symptoms
  4. NYHA class II symptoms controlled with diuretics

Explanation

Hospice eligibility in advanced heart failure generally requires disabling symptoms at rest or with minimal exertion despite optimal medical therapy, often with recurrent hospitalizations. A low ejection fraction alone is insufficient without clinical correlation.

Question 32Hospice and Palliative Care

A patient with terminal cancer reports severe pain that is currently well controlled on a stable long-acting opioid regimen. Which prescribing approach is most appropriate?

  1. Discontinue the long-acting opioid to avoid tolerance
  2. Prescribe a short-acting opioid only for rescue doses
  3. Rotate to a different opioid immediately
  4. Continue the long-acting opioid with a short-acting rescue dose available Correct answer.

Explanation

For persistent cancer pain, scheduled long-acting analgesia with an as-needed short-acting agent for breakthrough pain is the standard approach. Stable control should be maintained rather than destabilized.

Question 33Hospice and Palliative Care

Which medication is the first-line treatment for opioid-induced constipation in a hospice patient who is not responding to stimulant laxatives alone?

  1. Docusate
  2. Methylnaltrexone Correct answer.
  3. Ondansetron
  4. Loperamide

Explanation

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist indicated for opioid-induced constipation refractory to laxatives. It does not reverse central analgesia.

Question 34Hospice and Palliative Care

Which finding best distinguishes delirium from dementia in a dying patient?

  1. Preserved orientation to time
  2. Stable cognitive deficits
  3. Acute onset with fluctuating attention Correct answer.
  4. Insidious onset over years

Explanation

Delirium is characterized by acute onset, fluctuating course, and inattention. Dementia typically has an insidious, progressive course without acute fluctuation.

Question 35Hospice and Palliative Care

A terminally ill patient has audible gurgling respirations from pooled secretions. Which intervention is most appropriate initially?

  1. Anticholinergic medication such as glycopyrrolate Correct answer.
  2. Suctioning every hour
  3. Aggressive intravenous hydration
  4. Chest physiotherapy

Explanation

Death rattle arises from secretions the patient cannot clear; anticholinergics reduce secretion production and are first-line. Suctioning is distressing and often ineffective.

Question 36Hospice and Palliative Care

Which statement about advance directives is most accurate?

  1. A POLST form is identical to a living will
  2. Advance directives are legally binding in all clinical circumstances
  3. A durable power of attorney for health care takes effect only after incapacity Correct answer.
  4. A living will appoints a surrogate decision-maker

Explanation

A health care power of attorney designates a surrogate and generally becomes operative when the patient loses decision-making capacity. Living wills record treatment preferences rather than appointing an agent.

Question 37Hospice and Palliative Care

What is the primary goal of palliative sedation at the end of life?

  1. To hasten death for a suffering patient
  2. To relieve refractory symptoms when other measures fail Correct answer.
  3. To treat existential distress with psychotherapy alone
  4. To provide routine sedation for all dying patients

Explanation

Palliative sedation is intended to relieve intolerable, refractory symptoms in the imminently dying. It is proportionate to symptom relief and is not intended to hasten death.

Question 38Hospice and Palliative Care

A patient with advanced COPD asks about hospice. Which clinical feature most supports a prognosis of six months or less?

  1. Occasional use of a rescue inhaler
  2. Stable oxygen saturation on room air
  3. Dyspnea at rest with recurrent exacerbations despite maximal therapy Correct answer.
  4. FEV1 of 60% predicted

Explanation

Hospice eligibility in COPD typically requires disabling dyspnea at rest, recurrent exacerbations, or cor pulmonale despite optimal therapy. Spirometry alone is not sufficient.

Question 39Hospice and Palliative Care

Which is the most appropriate first-line treatment for nausea in a hospice patient with a bowel obstruction?

  1. Metoclopramide
  2. Haloperidol or olanzapine Correct answer.
  3. Loperamide
  4. Erythromycin

Explanation

In bowel obstruction, prokinetics can worsen cramping, so dopamine antagonists or atypical antipsychotics are preferred for nausea. These agents also help with associated agitation.

Question 40Hospice and Palliative Care

Which symptom is most commonly undertreated in dying patients according to palliative care literature?

  1. Pruritus
  2. Pain
  3. Hiccups
  4. Dyspnea Correct answer.

Explanation

Dyspnea is highly prevalent at the end of life and frequently undertreated relative to pain. Opioids are the mainstay for relief.

Question 41Hospice and Palliative Care

A family asks whether morphine will hasten their dying father's death. What is the most accurate response?

  1. Morphine always hastens death when used near the end of life
  2. Only high-dose morphine affects survival
  3. Morphine should be withheld to avoid respiratory depression
  4. Opioids at appropriate doses for dyspnea do not shorten survival Correct answer.

Explanation

Evidence indicates that appropriately titrated opioids for pain or dyspnea do not shorten survival and may improve comfort. The doctrine of double effect addresses intent when sedation or respiratory depression is a foreseeable risk.

Question 42Hospice and Palliative Care

Which interdisciplinary team member is primarily responsible for assessing spiritual needs and providing chaplaincy support in hospice?

  1. Bereavement counselor
  2. Chaplain Correct answer.
  3. Registered nurse
  4. Social worker

Explanation

The hospice chaplain addresses spiritual and existential concerns as part of the interdisciplinary team. Social workers focus on psychosocial and practical needs.

Question 43Hospice and Palliative Care

A hospice patient's caregiver reports feeling overwhelmed and exhausted. Which action best reflects the hospice social worker's role?

  1. Discharge the patient from hospice
  2. Assess caregiver burden and coordinate respite and support resources Correct answer.
  3. Recommend immediate nursing home placement
  4. Prescribe an antidepressant

Explanation

Caregiver assessment and linkage to respite care, counseling, and community resources are core social work functions. Placement decisions require shared decision-making, not unilateral recommendation.

Question 44Hospice and Palliative Care

Which finding is most consistent with impending death in the last days of life?

  1. Improved appetite
  2. Mottling of extremities and decreased oral intake Correct answer.
  3. Increased urine output
  4. Increased alertness and orientation

Explanation

Peripheral mottling, cool extremities, decreasing urine output, and reduced intake are common signs of active dying. Families should be prepared for these changes.

Question 45Hospice and Palliative Care

Which opioid is preferred for a hospice patient with significant renal impairment and moderate cancer pain?

  1. Hydromorphone
  2. Codeine
  3. Morphine
  4. Fentanyl Correct answer.

Explanation

Fentanyl has no active renally cleared metabolites and is generally preferred in renal failure. Morphine and codeine accumulate active metabolites that can cause toxicity.

Question 46Hospice and Palliative Care

Which statement about the Medicare hospice benefit is correct?

  1. Patients may revoke hospice and later re-elect it Correct answer.
  2. Room and board are covered for home hospice
  3. Curative treatment is always covered alongside hospice
  4. Hospice requires a do-not-resuscitate order

Explanation

Patients may revoke the hospice benefit at any time and may re-elect it if eligibility criteria are met. Curative treatment for the terminal diagnosis is not covered while on hospice.

Question 47Hospice and Palliative Care

A patient with advanced dementia is no longer eating and the family requests a feeding tube. Which response best reflects current evidence?

  1. Feeding tubes prolong survival in advanced dementia
  2. Feeding tubes reliably prevent aspiration pneumonia
  3. Tube feeding does not improve survival or comfort and may cause harm Correct answer.
  4. Artificial nutrition is required by hospice regulations

Explanation

Evidence shows that feeding tubes in advanced dementia do not improve survival or quality of life and may increase aspiration and restraint use. Comfort-focused hand feeding is preferred.

Question 48Hospice and Palliative Care

Which medication is used for terminal secretions and also has antiemetic properties?

  1. Glycopyrrolate
  2. Hyoscyamine
  3. Atropine
  4. Scopolamine Correct answer.

Explanation

Scopolamine is an anticholinergic used for death rattle that also has antiemetic effects, particularly for motion-related nausea. Glycopyrrolate and hyoscyamine are less sedating and lack prominent antiemetic utility.

Question 49Hospice and Palliative Care

Which intervention best addresses dyspnea in a hospice patient with advanced lung cancer when opioids are already optimized?

  1. A fan directing cool air to the face Correct answer.
  2. Increasing fluid intake
  3. Nebulized saline
  4. High-flow oxygen regardless of saturation

Explanation

Cool airflow to the face can reduce dyspnea through trigeminal stimulation independent of oxygenation. Oxygen is beneficial mainly in hypoxemic patients.

Question 50Hospice and Palliative Care

What is the primary purpose of a bereavement risk assessment in hospice?

  1. To identify family members needing additional support Correct answer.
  2. To determine the patient's prognosis
  3. To decide whether to admit the patient
  4. To bill Medicare for grief counseling

Explanation

Bereavement risk assessment identifies survivors at elevated risk for complicated grief so that targeted support can be provided. Medicare requires bereavement services for at least one year after death.