Evidence-Based
Geriatric Nursing
Protocols for Best
Practice (6th
Edition): Universal
Mastery Test Bank
PART 0: THE TABLE OF CONTENTS
1. PART I: THE PREVIEW
2. PART II: THE ELITE TEST BANK
○ Tier 1: Foundational Syntax & Application (Questions 1–18)
○ Tier 2: Complex Application & Simulation (Questions 19–37)
○ Tier 3: Grandmaster Synthesis (Questions 38–55)
PART I: THE PREVIEW
Mastery of evidence-based geriatric protocols bridges the gap between theoretical knowledge
and the precise, high-stakes clinical decision-making required to preserve older adult function
and dignity. Execution of the principles embedded within this assessment translates directly to
elite clinical competence, reducing iatrogenic harm and optimizing care transitions globally.
● The 4Ms Framework: Always align care with What Matters, Medication, Mentation, and
Mobility to ensure age-friendly health systems.
● The AGS Beers Criteria®: Deprescribing is a primary intervention; inappropriate
medications directly precipitate delirium, falls, and functional decline.
● The STEADI Algorithm: Fall risk is a chronic, modifiable condition requiring systematic
screening (3 Key Questions), assessment, and multifactorial intervention.
● The HELP Protocol: Delirium is preventable; prioritize non-pharmacological interventions
such as orientation, early mobilization, and sleep enhancement over chemical restraints.
● Transitional Care Model (TCM): Continuity of care is paramount; uncoordinated
transitions are the leading cause of preventable readmissions and adverse events.
,Table 1: Critical Geriatric Diagnostic & Risk Frameworks
Framework / Tool Clinical Target Primary Mechanism of Elite Application
Action
AGREE II Guideline Evaluation Assesses Demands target
methodological rigour population
and transparency. (stakeholder)
involvement in protocol
design.
Katz ADL Functional Evaluates basic Identifies immediate
Independence survival tasks (bathing, need for physical
dressing). caregiving support to
prevent injury.
Lawton IADL Instrumental Evaluates complex Identifies early
Independence living tasks (finances, cognitive/functional
medication). decline requiring
systemic support.
Braden Scale Tissue Integrity Assesses sensory Triggers immediate
perception, moisture, mechanical offloading
activity, mobility. protocols (Q2 turns).
MCSI Caregiver Survival Quantifies strain on Predicts imminent
informal support transition failure and
networks. triggers social
interventions.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Utilizing the AGREE II framework to evaluate a new facility policy on fall prevention, which
action MUST be documented to satisfy the "Stakeholder Involvement" domain? A) Confirming
that the guideline was funded independently of pharmaceutical interests B) Demonstrating that
the protocol aligns specifically with the values and preferences of older adults C) Ensuring the
statistical methodology utilized to review the literature is explicitly detailed D) Calculating the
specific financial cost of implementing the protocol across all hospital units
● Answer: B (Demonstrating that the protocol aligns specifically with the values and
preferences of older adults)
● Distractor Analysis:
○ A is incorrect: Independence of funding belongs to the Editorial Independence
domain, not stakeholder involvement.
○ C is incorrect: Methodological transparency belongs to the Rigour of Development
domain.
○ D is incorrect: Cost calculation aligns with the Applicability domain.
The Mentor's Analysis: The AGREE II tool demands that end-users, including patients and
caregivers, are explicitly consulted during guideline formulation. When adopting new protocols,
the target population's preferences dictate the clinical relevance. Professional Intuition: A
scientifically pristine guideline is clinically useless if it violates the patient's core values.
, Q2: When differentiating between levels of functional decline, an older adult loses the ability to
manage their checkbook and prepare hot meals, but remains able to independently toilet and
feed themselves. Which tool FIRST identifies this specific tier of decline? A) The Katz Index of
Independence in Activities of Daily Living (ADL) B) The Lawton Instrumental Activities of Daily
Living (IADL) Scale C) The Braden Scale for Predicting Pressure Sore Risk D) The Montreal
Cognitive Assessment (MoCA)
● Answer: B (The Lawton Instrumental Activities of Daily Living (IADL) Scale)
● Distractor Analysis:
○ A is incorrect: The Katz ADL evaluates basic self-care tasks (toileting, feeding),
which the patient can still perform.
○ C is incorrect: The Braden scale assesses skin breakdown risk.
○ D is incorrect: While cognitive decline may cause the functional loss, the MoCA
measures cognition directly, not the functional task itself.
The Mentor's Analysis: Instrumental Activities of Daily Living (IADLs) involve complex tasks
requiring higher executive function (finances, cooking, medication management). The Lawton
scale identifies these early deficits, which often precede the loss of basic ADLs measured by the
Katz Index. Professional Intuition: Always differentiate between the inability to survive alone
(IADL) and the inability to survive at all (BADL).
Q3: According to the Centers for Disease Control and Prevention's STEADI algorithm, which
action is the FIRST mandatory step for a community-dwelling older adult presenting for an
annual wellness visit? A) Administer the Timed Up and Go (TUG) test to evaluate gait speed B)
Review the medication administration record for fall-risk-increasing drugs (FRIDs) C) Ask the
Three Key Questions regarding fall history, unsteadiness, and worry about falling D) Prescribe
prophylactic Vitamin D and calcium supplementation
● Answer: C (Ask the Three Key Questions regarding fall history, unsteadiness, and worry
about falling)
● Distractor Analysis:
○ A is incorrect: The TUG test is part of the assessment phase, initiated only if the
patient screens positive.
○ B is incorrect: Medication review is a crucial intervention, but follows a positive
screening and assessment.
○ D is incorrect: Blanket prescription without initial screening is not aligned with the
tiered STEADI methodology.
The Mentor's Analysis: The STEADI framework relies on a rigid progression: Screen, Assess,
Intervene. The universal initial screening requires asking three simple questions to identify
high-risk individuals before proceeding to physical assessments. Professional Intuition:
Screening is the gatekeeper of prevention; never assess what you have not yet screened.
Q4: Based on the updated 2023 AGS Beers Criteria, which medication class is unequivocally
linked to acute mentation changes, severe mobility impairment, and urinary retention in frail
older adults? A) Angiotensin-converting enzyme (ACE) inhibitors B) First-generation
antihistamines C) Proton pump inhibitors (PPIs) D) Thiazide diuretics
● Answer: B (First-generation antihistamines)
● Distractor Analysis:
○ A is incorrect: ACE inhibitors carry risks (hypotension), but do not primarily cause
acute mentation changes or retention.
○ C is incorrect: PPIs are associated with bone loss and C. difficile over long-term
use, but lack immediate central nervous system toxicity.
○ D is incorrect: Thiazides cause electrolyte imbalances, not profound central nervous
Geriatric Nursing
Protocols for Best
Practice (6th
Edition): Universal
Mastery Test Bank
PART 0: THE TABLE OF CONTENTS
1. PART I: THE PREVIEW
2. PART II: THE ELITE TEST BANK
○ Tier 1: Foundational Syntax & Application (Questions 1–18)
○ Tier 2: Complex Application & Simulation (Questions 19–37)
○ Tier 3: Grandmaster Synthesis (Questions 38–55)
PART I: THE PREVIEW
Mastery of evidence-based geriatric protocols bridges the gap between theoretical knowledge
and the precise, high-stakes clinical decision-making required to preserve older adult function
and dignity. Execution of the principles embedded within this assessment translates directly to
elite clinical competence, reducing iatrogenic harm and optimizing care transitions globally.
● The 4Ms Framework: Always align care with What Matters, Medication, Mentation, and
Mobility to ensure age-friendly health systems.
● The AGS Beers Criteria®: Deprescribing is a primary intervention; inappropriate
medications directly precipitate delirium, falls, and functional decline.
● The STEADI Algorithm: Fall risk is a chronic, modifiable condition requiring systematic
screening (3 Key Questions), assessment, and multifactorial intervention.
● The HELP Protocol: Delirium is preventable; prioritize non-pharmacological interventions
such as orientation, early mobilization, and sleep enhancement over chemical restraints.
● Transitional Care Model (TCM): Continuity of care is paramount; uncoordinated
transitions are the leading cause of preventable readmissions and adverse events.
,Table 1: Critical Geriatric Diagnostic & Risk Frameworks
Framework / Tool Clinical Target Primary Mechanism of Elite Application
Action
AGREE II Guideline Evaluation Assesses Demands target
methodological rigour population
and transparency. (stakeholder)
involvement in protocol
design.
Katz ADL Functional Evaluates basic Identifies immediate
Independence survival tasks (bathing, need for physical
dressing). caregiving support to
prevent injury.
Lawton IADL Instrumental Evaluates complex Identifies early
Independence living tasks (finances, cognitive/functional
medication). decline requiring
systemic support.
Braden Scale Tissue Integrity Assesses sensory Triggers immediate
perception, moisture, mechanical offloading
activity, mobility. protocols (Q2 turns).
MCSI Caregiver Survival Quantifies strain on Predicts imminent
informal support transition failure and
networks. triggers social
interventions.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Utilizing the AGREE II framework to evaluate a new facility policy on fall prevention, which
action MUST be documented to satisfy the "Stakeholder Involvement" domain? A) Confirming
that the guideline was funded independently of pharmaceutical interests B) Demonstrating that
the protocol aligns specifically with the values and preferences of older adults C) Ensuring the
statistical methodology utilized to review the literature is explicitly detailed D) Calculating the
specific financial cost of implementing the protocol across all hospital units
● Answer: B (Demonstrating that the protocol aligns specifically with the values and
preferences of older adults)
● Distractor Analysis:
○ A is incorrect: Independence of funding belongs to the Editorial Independence
domain, not stakeholder involvement.
○ C is incorrect: Methodological transparency belongs to the Rigour of Development
domain.
○ D is incorrect: Cost calculation aligns with the Applicability domain.
The Mentor's Analysis: The AGREE II tool demands that end-users, including patients and
caregivers, are explicitly consulted during guideline formulation. When adopting new protocols,
the target population's preferences dictate the clinical relevance. Professional Intuition: A
scientifically pristine guideline is clinically useless if it violates the patient's core values.
, Q2: When differentiating between levels of functional decline, an older adult loses the ability to
manage their checkbook and prepare hot meals, but remains able to independently toilet and
feed themselves. Which tool FIRST identifies this specific tier of decline? A) The Katz Index of
Independence in Activities of Daily Living (ADL) B) The Lawton Instrumental Activities of Daily
Living (IADL) Scale C) The Braden Scale for Predicting Pressure Sore Risk D) The Montreal
Cognitive Assessment (MoCA)
● Answer: B (The Lawton Instrumental Activities of Daily Living (IADL) Scale)
● Distractor Analysis:
○ A is incorrect: The Katz ADL evaluates basic self-care tasks (toileting, feeding),
which the patient can still perform.
○ C is incorrect: The Braden scale assesses skin breakdown risk.
○ D is incorrect: While cognitive decline may cause the functional loss, the MoCA
measures cognition directly, not the functional task itself.
The Mentor's Analysis: Instrumental Activities of Daily Living (IADLs) involve complex tasks
requiring higher executive function (finances, cooking, medication management). The Lawton
scale identifies these early deficits, which often precede the loss of basic ADLs measured by the
Katz Index. Professional Intuition: Always differentiate between the inability to survive alone
(IADL) and the inability to survive at all (BADL).
Q3: According to the Centers for Disease Control and Prevention's STEADI algorithm, which
action is the FIRST mandatory step for a community-dwelling older adult presenting for an
annual wellness visit? A) Administer the Timed Up and Go (TUG) test to evaluate gait speed B)
Review the medication administration record for fall-risk-increasing drugs (FRIDs) C) Ask the
Three Key Questions regarding fall history, unsteadiness, and worry about falling D) Prescribe
prophylactic Vitamin D and calcium supplementation
● Answer: C (Ask the Three Key Questions regarding fall history, unsteadiness, and worry
about falling)
● Distractor Analysis:
○ A is incorrect: The TUG test is part of the assessment phase, initiated only if the
patient screens positive.
○ B is incorrect: Medication review is a crucial intervention, but follows a positive
screening and assessment.
○ D is incorrect: Blanket prescription without initial screening is not aligned with the
tiered STEADI methodology.
The Mentor's Analysis: The STEADI framework relies on a rigid progression: Screen, Assess,
Intervene. The universal initial screening requires asking three simple questions to identify
high-risk individuals before proceeding to physical assessments. Professional Intuition:
Screening is the gatekeeper of prevention; never assess what you have not yet screened.
Q4: Based on the updated 2023 AGS Beers Criteria, which medication class is unequivocally
linked to acute mentation changes, severe mobility impairment, and urinary retention in frail
older adults? A) Angiotensin-converting enzyme (ACE) inhibitors B) First-generation
antihistamines C) Proton pump inhibitors (PPIs) D) Thiazide diuretics
● Answer: B (First-generation antihistamines)
● Distractor Analysis:
○ A is incorrect: ACE inhibitors carry risks (hypotension), but do not primarily cause
acute mentation changes or retention.
○ C is incorrect: PPIs are associated with bone loss and C. difficile over long-term
use, but lack immediate central nervous system toxicity.
○ D is incorrect: Thiazides cause electrolyte imbalances, not profound central nervous
