Gerontological Nursing Certification Examination cheat sheet

Comprehensive geriatric assessment (CGA) is multidimensional: medical, functional, cognitive, psychological, social, and environmental, with an individualized care plan.

Atypical disease presentation in older adults includes delirium, falls, incontinence, weight loss, and functional decline instead of classic symptoms (e.g., no fever or chest pain).

Screening for hearing and vision impairment is part of routine assessment; uncorrected sensory loss is linked to delirium, falls, and social isolation.

Frailty phenotype (Fried) uses five criteria: unintentional weight loss, exhaustion, low grip strength, slow gait speed, low physical activity; 3 or more = frail.

The Clinical Frailty Scale (1-9) is a judgment-based tool; scores of 5-6 indicate mild-moderate frailty and 7-9 severe frailty to very severe.

Advance care planning and identification of a health care proxy belong in the initial assessment, not only at end of life.

Nutrition screening tools (e.g., MNA-SF) identify risk of malnutrition; unintentional weight loss of 5% or more in 1 month warrants evaluation.

Depression and cognitive impairment frequently coexist; screening for both is required because depression can mimic or worsen dementia.

Primary prevention targets risk factors before disease; secondary prevention is early detection (screening); tertiary prevention limits disability from established disease.

USPSTF colorectal cancer screening for average-risk adults continues to age 75; for ages 76-85, individualize based on health status and prior screening.

Bone density screening (DXA) is recommended for women 65 and older and for younger postmenopausal women at increased risk.

Influenza vaccination annually; pneumococcal and shingles vaccination per current ACIP schedule; zoster recombinant vaccine for adults 50 and older.

Exercise recommendations: at least 150 minutes/week moderate-intensity aerobic activity plus muscle-strengthening on 2 or more days/week, with balance training for fall prevention.

Tobacco cessation and alcohol screening (e.g., AUDIT-C) are core prevention activities; brief intervention is effective at any age.

Screening for cognitive impairment is recommended when symptoms are reported or observed; universal screening of asymptomatic adults is not established.

Health promotion includes social engagement, advance directives, and driving and home safety review as part of routine preventive visits.

Multimorbidity requires prioritizing goals of care over single-disease guideline targets; strict disease-specific targets may cause harm in frail patients.

Type 2 diabetes in frail older adults: less stringent HbA1c targets (e.g., 8.0-8.5%) are appropriate when hypoglycemia risk or limited life expectancy is present.

Hypertension in older adults: treat to individualized targets; orthostatic hypotension should be assessed before intensifying therapy.

Heart failure with reduced ejection fraction benefits from guideline-directed therapy, but dose escalation must be balanced against renal function and hypotension.

COPD management emphasizes inhaler technique, vaccination, and pulmonary rehabilitation; oxygen therapy is for documented hypoxemia.

Chronic kidney disease requires dose adjustment of renally cleared medications; eGFR is used to guide dosing.

Pain in older adults is often undertreated; start low and go slow with analgesics and consider nonpharmacologic modalities first for chronic pain.

Care for multimorbidity includes self-management support, caregiver involvement, and coordination across specialists to reduce treatment burden.

Polypharmacy is commonly defined as use of 5 or more medications; it increases risk of adverse drug events, falls, and hospitalization.

The Beers Criteria and STOPP/START tools identify potentially inappropriate medications (PIMs) in older adults; anticholinergics, benzodiazepines, and long-acting sulfonylureas are common examples.

Anticholinergic burden (e.g., diphenhydramine, oxybutynin) is linked to cognitive decline, delirium, urinary retention, and falls.

Start low and go slow: initiate new medications at reduced doses and titrate based on response and tolerance.

The prescribing cascade occurs when a side effect is treated with another drug rather than adjusting the offending medication.

Medication reconciliation at every transition of care reduces discrepancies and adverse events.

Renal and hepatic function decline alters drug clearance; use Cockcroft-Gault creatinine clearance for many renally dosed drugs.

Deprescribing is a planned, supervised process of reducing or stopping medications when harms outweigh benefits; it requires monitoring for withdrawal and symptom recurrence.

ADLs include bathing, dressing, toileting, transferring, continence, and feeding; IADLs include managing finances, medications, shopping, and transportation.

The Timed Up and Go (TUG) test: 12 or more seconds suggests increased fall risk; 10 seconds is often used as a screening cutoff.

Gait speed of less than 0.8 m/s indicates increased vulnerability and predicts adverse outcomes.

A fall is defined as an unplanned descent to the floor; any fall in an older adult warrants multifactorial risk assessment.

Multifactorial fall risk assessment includes medications, vision, orthostatic blood pressure, gait and balance, footwear, and home hazards.

Strong evidence supports exercise (balance, strength, and gait training) as a core fall-prevention intervention.

Vitamin D supplementation is considered in those with deficiency; routine high-dose supplementation is not recommended for fall prevention alone.

Early mobilization and minimizing restraints and tethers reduce functional decline and delirium in hospitalized older adults.

Delirium is acute, fluctuating inattention and altered awareness; it is a medical emergency and often the first sign of illness in older adults.

Dementia is chronic, progressive cognitive decline affecting function; Alzheimer disease is the most common cause, followed by vascular dementia.

The Confusion Assessment Method (CAM) diagnoses delirium by acute onset/fluctuation plus inattention, with either disorganized thinking or altered consciousness.

Delirium prevention (e.g., HELP program) targets sleep, orientation, mobility, hydration, nutrition, and sensory aids.

Depression screening uses the PHQ-2/PHQ-9 or Geriatric Depression Scale; somatic symptoms may be attributed to medical illness.

Late-life depression is associated with increased suicide risk, especially in older men; ask directly about suicidal ideation.

Antipsychotics for behavioral symptoms of dementia carry increased mortality risk and should be used at the lowest dose for the shortest time.

Nonpharmacologic management of behavioral symptoms includes routine, environmental modification, caregiver education, and addressing unmet needs.

Palliative care focuses on symptom relief and quality of life at any stage of serious illness; hospice requires a prognosis of 6 months or less if disease runs its usual course.

Pain management follows the WHO analgesic ladder; opioids are appropriate for moderate-severe pain, with bowel regimens to prevent constipation.

Dyspnea management includes opioids, oxygen for hypoxemia, positioning, and fan-directed airflow; opioids do not hasten death at appropriate doses.

Terminal secretions ('death rattle') are managed with anticholinergics and repositioning; it is generally not distressing to the patient.

Advance directives include living wills and durable power of attorney for health care; POLST/MOLST translates preferences into actionable orders.

The five stages of grief (Kübler-Ross) are not linear or prescriptive; grief responses vary widely among patients and families.

Hospice interdisciplinary team includes physician, nurse, social worker, chaplain, aide, and volunteer; bereavement support continues after death.

Withdrawal of life-sustaining treatment is ethically and legally equivalent to withholding it when consistent with patient wishes.

Transitions of care are vulnerable points; medication reconciliation and a written discharge summary reduce adverse events.

The teach-back method verifies patient and caregiver understanding of discharge instructions.

A follow-up appointment within 7 days of discharge is associated with lower readmission rates for high-risk patients.

Transitional care models (e.g., Care Transitions Intervention, Naylor Transitional Care Model) use advanced practice nurses to bridge settings.

Readmission risk factors include polypharmacy, functional impairment, social isolation, and lack of caregiver support.

Interdisciplinary team communication (SBAR: Situation, Background, Assessment, Recommendation) improves handoff safety.

Home health and community resources should be arranged before discharge, not after, to prevent gaps in care.

Care coordination includes identifying the patient's goals and preferences and sharing them across settings.

Autonomy is the primary ethical principle in geriatric care; decision-making capacity is task-specific and assessed, not assumed.

Capacity requires understanding, appreciation, reasoning, and expression of a choice; it differs from clinical competence, which is a legal determination.

Informed consent requires disclosure of risks, benefits, alternatives, and the patient's voluntary agreement.

Confidentiality may be breached only when required by law (e.g., reportable abuse, imminent harm) or with patient permission.

Elder mistreatment includes physical, emotional, sexual, financial abuse, neglect, and self-neglect; reporting is mandated in most jurisdictions.

Patient safety strategies include medication reconciliation, fall precautions, pressure injury prevention, and hand hygiene.

Advocacy includes addressing health literacy, language barriers, and access to care for vulnerable older adults.

Ethical conflicts (e.g., family disagreement with patient wishes) are resolved by identifying the patient's expressed values and using ethics consultation when needed.