Test Questions

Delirium in the Elderly: Medications, Causes, and Treatment

Exam Questions

1. Which of the following medications is least likely to cause delirium?
    A. Atropine
    B. Prednisone
    C. Propofol
    D. Clonidine
2. A reciprocal relationship exists between dopamine and which other neurotransmitter?
    A. Cortisol
    B. Serotonin
    C. Acetylcholine
    D. GABA
3. A 79-year-old woman is hospitalized and requires postoperative pain medication. Which pain medication would be the least likely to cause delirium?
    A. Morphine
    B. Hydrocodone
    C. Meperidine
    D. Codeine
4. All of the following nonpharmacologic treatments of delirium have been found to be effective except:
    A. Isolation
    B. Calm environment
    C. Uninterrupted sleep-wake cycle
    D. Family support
5. What is the proposed mechanism by which diphenhydramine causes delirium?
    A. Gabanergic effects
    B. Serotonergic effects
    C. Dopaminergic effects
    D. Anticholinergic effects
6. A 90-year-old man develops delirium characterized by withdrawal. He is found to be lethargic but arousable. What treatment should you recommend?
    A. Haloperidol
    B. Lorazepam
    C. Risperidone
    D. No treatment
7. When should haloperidol be given to a patient undergoing hip surgery to prevent postoperative delirium?
    A. All patients should receive haloperidol before hip surgery
    B. Patients over the age of 70 should receive haloperidol before hip surgery
    C. No patients should receive haloperidol before hip surgery
    D. Only select patients should receive haloperidol before hip surgery
8. Delirium occurs in what percentage of hospitalized elderly?
    A. 10%
    B. 20%
    C. 30%
    D. 40%
9. Which dose of haloperidol was found to be associated with a greater incidence of adverse effects when compared to atypical antipsychotics?
    A. >4 mg
    B. >4.5 mg
    C. >5 mg
    D. >5.5 mg
10. All of the following are part of the criteria for identifying delirium in the elderly except:
    A. Lethargy
    B. Psychosis
    C. Halitosis
    D. Agitation
11. Compared with the IM and po route of haloperidol administration, the IV route may be associated with more ______ and less ______.
    A. QT prolongation, extrapyramidal symptoms (EPS)
    B. EPS, QT prolongation
    C. Neuroleptic malignant syndrome, EPS
    D. Parkinsonism, QT prolongation
12. Which of the following medications has the highest incidence of delirium?
    A. Prednisone
    B. Ciprofloxacin
    C. Ranitidine
    D. Risperidone
13. Which of the following atypical antipsychotics reportedly has the highest incidence of QT prolongation?
    A. Risperidone
    B. Olanzapine
    C. Quetiapine
    D. Ziprasidone
14. Which of the following atypical antipsychotics would not be appropriate for an elderly patient with swallowing problems?
    A. Risperidone
    B. Olanzapine
    C. Quetiapine
    D. Ziprasidone
15. What is the outcome when the dose of haloperidol is increased beyond 4.5 mg/day?
    A. Greater EPS
    B. Increased efficacy
    C. Decreased efficacy
    D. Neuroleptic malignant syndrome
16. An 85-year-old man is acutely agitated from delirium, and the doctor you are working with insists on using olanzapine, but asks you, the pharmacist, which dosage form would be the safest and most efficacious for this patient. You review the patient's chart and find that he has a history of active esophageal cancer and hypotension (last blood pressure reading 90/60 mm Hg). You suggest the following dosage form:
    A. Tablet
    B. IM injection
    C. Oral-disintegrating tablet
    D. Any of the above
17. Aripiprazole has a unique mechanism of action and has been suggested to restore which of the following in delirium?
    A. Attention
    B. Concentration
    C. Sleep-wake cycle
    D. All of the above are restored
18. Studies have shown consistently that patients with delirium have ______ levels of melatonin.
    A. Increased
    B. Decreased
    C. Increased or decreased
    D. Normal
19. In what cause of delirium are benzodiazepines considered first-line treatment?
    A. Alcohol withdrawal
    B. Infection
    C. Sedative withdrawal
    D. A and C
20. The Delirium Rating Scale is intended to ______ delirium.
    A. Diagnose
    B. Rate the severity of
    C. Predict the duration of
    D. All of the above

Evaluation Questions

21. Met objective 1:
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
    F. N/A for Pharmacy Technicians
22. Met objective 2:*
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
23. Met objective 3:
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
    F. N/A for Pharmacy Technicians
24. Met objective 4:*
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
25. Related to your practice needs:
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
26. Will help you improve patient care:
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
27. Avoided commercial bias:
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
28. How would you rate the overall quality of the material presented?
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
29. How would you rate the overall user friendliness of the program?
    A. Excellent
    B. Very Good
    C. Good
    D. Fair
    E. Poor
30. Comments on this program:
 
* Also applies to pharmacy technicians