Ch. 45 Questions AEMT
Which of the following statements regarding the elderly is TRUE? A. Cardiac output remains constant, but hypercholesterolemia and hypertension increase. B. A decrease in estrogen leads to increased cardiovascular disease in postmenopausal women. C. Osteoporosis can occur in both genders, but is especially common in men. D. There is a marked increase in obesity which is associated with the onset of type 1 diabetes.
A decrease in estrogen leads to increased cardiovascular disease in postmenopausal women.
Which of the following is NOT a risk factor for elder abuse? A. Female B. Immobility C. Age 70 D. Dementia
Age 70
Which of the following statements regarding treatment of an elderly patient is TRUE? A. Most external bleeding must be controlled by medications. B. Use caution when administering fluids except when the patient is hypovolemic. C. Changes in spinal alignment can made airway management challenging. D. Remove dentures to achieve a good seal between a ventilation mask and the face.
Changes in spinal alignment can made airway management challenging.
Which of the following BEST describes cataracts? A. Detachment of the retina B. Increased pressure in the anterior chamber of the eye C. Clouding of the lens of the eye D. Degeneration of the macula densa
Clouding of the lens of the eye
You are transporting a 69-year-old male who is dehydrated. You have started an IV and are administering a fluid bolus. The patient suddenly becomes short of breath and begins coughing. You hear coarse crackles bilaterally when you auscultate lung sounds. What should you immediately do? A. Discontinue the IV. B. Administer a beta2 agonist, such as albuterol. C. Decrease the IV fluid. D. Place the patient on a CPAP device.
Decrease the IV fluid.
Which of the following can increase the potential for organ injury in blunt trauma in the elderly? A. Decreased amount of adipose tissue. B. Decreased circulation to the organs. C. Decreased sensitivity to pain. D. Decreased bone density.
Decreased amount of adipose tissue.
Which of the following is the global, irreversible, progressive loss of cognitive function? A. Psychosis B. Epilepsy C. Dementia D. Delirium
Demetia
Which of the following is a factor associated with a person who abuses an elderly person? A. Adequate income B. Retired volunteers C. Females aged 35 to 50 years D. Financial and work difficulties
Financial and work difficulties
There is a high prevalence of urinary tract infection in patients with: A. Foley catheters. B. diarrhea. C. diabetes. D. urinary incontinence.
Foley catheters.
What is the difference between your treatment of an elderly patient you suspect of acute coronary syndrome without chest pain and your treatment of an elderly patient you suspect of ACS who has chest pain? A. For the patient with chest pain, start an IV. B. For the patient with chest pain, maintain an SpO2 of 95 percent or higher. C. For the patient without chest pain, administer oxygen if the SpO2 is less than 95 percent. D. For the patient without chest pain, contact medical direction for further orders concerning administration of nitroglycerin or aspirin.
For the patient without chest pain, contact medical direction for further orders concerning administration of nitroglycerin or aspirin.
Which of the following is NOT a normal physiologic change of the cardiovascular system in the elderly? A. Increased systemic vascular resistance B. Hypertension C. Dysrhythmias D. Hypotension
Hypotension
What is the consequence of changes in chest wall compliance in the elderly patient? A. Increased lung capacity B. Airway obstruction C. Enhanced diffusion D. Impaired ventilation
Impaired ventilation
You have been called to transport an 89-year-old female from a nursing home. The nursing staff states that the patient has become lethargic and slow to respond. Your assessment reveals that she is febrile, and when you move her to your stretcher, you find a deep ulcer over the ischial tuberosity. Which of the following BEST summarizes the appropriate response to this situation? A. An ulcer in this area is a result of abuse, and law enforcement should be contacted immediately. B. A decubitus ulcer is extremely uncommon in the elderly and is a clear sign of physical abuse. C. Decubitus ulcers are so common in the elderly that you would not expect the staff to report it. However, the patient is probably septic and needs to be treated and transported. D. It is concerning that the staff did not report the ulcer; the patient may be septic and needs an IV and supportive treatment in the prehospital setting.
It is concerning that the staff did not report the ulcer; the patient may be septic and needs an IV and supportive treatment in the prehospital setting.
Which of the following statements regarding physical assessment findings in elderly patients is FALSE? A. They may have difficulty staying warm. B. Pain perception increases in the elderly population. C. Crackles may be normal. D. They may exhibit a limited range of motion.
Pain perception increases in the elderly population.
You respond for an elderly female who has apparently taken the wrong medication. She tells you that she thought she took an aspirin for her headache, but instead she is feeling real tired. You check her medication and see that the aspirin looks like her sleeping pills. Which of the following likely lead to the problem? A. Presbycusis B. Presbyopia C. Proprioception D. Menopause
Presbyopia
Pressure sores associated with decreased mobility in the elderly are known as: A. kyphosis. B. spondylosis. C. decubitus ulcers. D. confabulation.
decubitus ulcers.
A sudden onset of altered mental status, often with changes in behavior, due to an underlying medical cause is known as: A. epilepsy. B. delirium. C. dementia. D. psychosis.
delirium.
Cognitive impairment of sudden onset and limited duration BEST defines: A. dementia. B. transient ischemic attack. C. Alzheimer's disease. D. delirium.
delirium.
Alzheimer's is the MOST recognizable form of ________ in the elderly. A. delirium B. dysarrthia C. bipolar disorder D. dementia
dementia
During your assessment of an elderly patient, if you have any doubt about the patient's mental status, then in the secondary assessment: A. perform a Mini-Mental State Exam. B. look for evidence of substance abuse. C. determine the patient's baseline condition. D. reassess the patient's ABCs.
perform a Mini-Mental State Exam.
A patient with kyphosis has fallen and is complaining of numbness in both arms. Regarding immobilization, you should: A. apply a cervical collar and transport in a semi-Fowler's position. B. place pillows in voids between the patient and stretcher. C. transport fully immobilized and in a prone position. D. disregard immobilization and transport using lights and sirens.
place pillows in voids between the patient and stretcher.
Pain that worsens with movement of the chest wall during inspiration is called ________ pain. A. pleuritic B. visceral C. somatic D. acute
pleuritic
The use of multiple medications is known as: A. noncompliance. B. polypharmacy. C. substance abuse. D. forgetfulness.
polypharmacy
You have been called for a 91-year-old woman who fell. Since your assessment reveals bruises to her body in various stages of healing and inconsistencies in information related to the fall from her family, you are suspicious of geriatric abuse. Your BEST action would be to: A. confront the family members regarding your suspicions. B. quietly transport and inform the emergency department physician. C. notify the Office of Elder Affairs prior to leaving the scene. D. have the EMS supervisor contact the patient's primary care physician.
quietly transport and inform the emergency department physician.
All of these statements concerning trauma in the elderly are correct EXCEPT: A. what appears to be a normal blood pressure may actually be low for an elderly person with preexisting hypertension. B. an early sign of hypoperfusion is altered mental status. C. the thicker skin of the elderly provides protection against burns. D. the ribs provide less protection, making thoracic organ injury more likely.
the thicker skin of the elderly provides protection against burns.
All of the following can lead to urinary retention EXCEPT: A. medications. B. neurological problems. C. enlarged prostate. D. urinary incontinence.
urinary incontinence.
When assessing a 70-year-old female patient, the best way to speak to the patient is to: A. use the patient's first name. B. use Ms. or Mrs. with her last name. C. direct questions to the patient's caregiver. D. immediately ask follow-up questions if the patient is slow to respond to the first question you ask.
use Ms. or Mrs. with her last name.
You are called for a motor vehicle collision involving two elderly women. You are concerned because you know that elderly patients are often prescribed blood thinner for cardiac problems. This can be a problem because? A. It increases their risk for pulmonary embolism. B. It leads to diminished liver and kidney function. C. It means they most likely have cardiac problems. D. .Impaired blood clotting can exacerbate blood loss.
.Impaired blood clotting can exacerbate blood loss.
An 88-year-old woman complains of generalized abdominal pain with a gradual onset and increasing intensity over the past nine hours. She is nauseated and vomited after she tried to drink some tea this morning. She has not had any oral intake since dinner last evening nearly 24 hours ago. She is awake but prefers to lie very still on her side with her legs drawn up. She is confused about the day and month but knows what year it is and recognizes her family members. Her skin is pale, warm, dry, and has poor turgor. The patient gives a history of heart failure and atrial fibrillation, for which she takes an ACE inhibitor and platelet aggregation inhibitor. She also recently had pneumonia and suffered a compression fracture of two thoracic vertebrae from forceful coughing. You hear slight crackles in the lower lung fields bilaterally on your initial auscultation of the lungs. Vital signs are heart rate, 112 beats per minute and irregular; blood pressure, 104/84 mmHg; respiratory rate, 24 breaths per minute with decreased tidal volume; and SpO2, 93 percent on room air. Which of the following is the BEST treatment plan for this patient? A. Sit the patient up in high Fowler's position, apply oxygen by nonrebreather mask, begin transport, and start an IV with a saline lock. B. Sit the patient up in high Fowler's position, apply oxygen by nasal cannula, begin transport, start two large-bore IVs, and infuse two 500-mL boluses of normal saline. C. Administer oxygen by nasal cannula, allow the patient to assume a position of comfort on the stretcher, start an IV of normal saline, and infuse fluids at a rate of 150 mL/hr. D. Allow the patient to assume a position of comfort, administer oxygen by nonrebreather mask, begin transport, and start an IV with a saline lock.
Administer oxygen by nasal cannula, allow the patient to assume a position of comfort on the stretcher, start an IV of normal saline, and infuse fluids at a rate of 150 mL/hr.
A 69-year-old man complains of a sudden onset of shortness of breath and weakness accompanied by pain in his chest while he was shopping. He describes the pain as a dull, heavy sensation, rated 5 on a scale of 1 to 10. He has a history of heart disease and had a heart attack 10 years ago. He also has high blood pressure and type 2 diabetes. He is pale and sweaty, and prefers to sit straight up. His lung sounds are clear and equal. He is obese, but his abdomen is soft and there are no areas of tenderness to palpation. Vital signs are heart rate, 64 beats per minute and regular; blood pressure, 142/92 mmHg; respiratory rate, 20 breaths per minute; and SpO2, 96 percent on room air. The patient has no known drug allergies and takes no medications other than his antihypertensive, although he cannot remember the name of it right now. Which treatment plan is BEST for this patient? A. Begin transport, perform a detailed head-to-toe assessment, give 325-mg aspirin chewed and swallowed, start an IV of normal saline at a keep-open rate, and give 0.4-mg nitroglycerin sublingually. B. Administer 325-mg aspirin chewed and swallowed, start an IV of normal saline at a keep-open rate, give 0.4-mg nitroglycerin sublingually while preparing for transport, and transport without further delay. C. Administer high-flow oxygen by nonrebreather mask, begin transport, administer 0.4-mg nitroglycerin sublingually and 162-mg aspirin chewed and swallowed, and start an IV with a saline lock. D. Administer oxygen by nasal cannula, begin transport, start an IV of normal saline at a keep-open rate, and administer 325-mg aspirin chewed and swallowed.
Administer 325-mg aspirin chewed and swallowed, start an IV of normal saline at a keep-open rate, give 0.4-mg nitroglycerin sublingually while preparing for transport, and transport without further delay.
When managing the airway of an elderly patient who is not breathing, what is NOT a consideration that must be made in regard to delivering proper ventilations? A. An irregular pulse is a common finding in elderly patients. B. Padding may be needed under the head due to kyphosis of the spine. C. Patients may have diminished gag reflexes. D. Elderly patients may have a loss of dentition or poorly fitting dentures.
An irregular pulse is a common finding in elderly patients.
Which of the following patients would be the MOST likely to be abused? A. A 62-year-old woman with decreased enjoyment of food B. An 82-year-old woman with Alzheimer's disease C. A 68-year-old man with asthma D. A 74-year-old man with hypertension
An 82-year-old woman with Alzheimer's disease
To BEST communicate with a geriatric patient who has diminished hearing, the AEMT should do which one of the following? A. Ask the family members about the patient's history. B. Be sure the patient has his hearing aid in place. C. Increase both the pitch and volume of your voice. D. Try to communicate using sign language.
Be sure the patient has his hearing aid in place.
A 78-year-old patient is complaining of "not feeling well." The patient's daughter is present. How should you obtain information about the patient's medical condition? A. Ask to speak directly to the patient's physician. B. Only speak to the patient's daughter. C. Encourage the patient to answer but incorporate the daughter if the patient is having difficulty. D. Speak directly to the patient unless the patient is slow to respond.
Encourage the patient to answer but incorporate the daughter if the patient is having difficulty.
Which of the following is a risk factor in elderly patients for environmental emergencies such as hyperthermia and hypothermia that involves trauma? A. Impaired thermoregulatory function B. Cognitive impairment C. Housing with inadequate climate control D. Extensive burns
Extensive burns
Which of the following is a characteristic of the elderly that is associated with a higher risk of suffering abuse? A. Having multiple stressors B. Being wealthy C. Living alone D. Having numerous medical problems
Having numerous medical problems
A patient has recently started a new medicine for hypertension that works by decreasing cardiac output. He also has a history of two myocardial infarctions, renal disease and hepatic disease. Two weeks later, he is very weak and is found to be borderline hypotensive and bradycardic. He is very thin and frail, but does have significant peripheral edema and mild inspiratory crackles. What pathophysiologic change to a geriatric patients is least likely contributing to this untoward blood pressure response? A. Increased total fluid volume B. Use of multiple medications C. Impaired renal and hepatic function D. Decreased fat stores
Increased total fluid volume
Which of the following is a factor that can increase drug-treatment compliance in the elderly? A. Making medications available without childproof packaging B. Minimizing the information provided about the drug C. Increasing the out-of-pocket costs to the elderly D. Prescribing long-term drug therapy
Making medications available without childproof packaging
You have been asked to deliver a talk about EMS and the geriatric population. Which one of the following points would you emphasize in your presentation? A. Many of the elderly have a combination of different diseases in various stages. B. Dementia is an inevitable part of the aging process. C. Assessment can be difficult since most persons older than 70 suffer from dementia. D. Geriatrics actually comprises a small number of EMS calls and transports.
Many of the elderly have a combination of different diseases in various stages.
On which of the following should you rely MOST heavily in determining the potential for shock in an elderly trauma patient? A. Heart rate B. Capillary refill C. Mechanism of injury D. Blood pressure
Mechanism of injury
Regarding the age-related physiologic changes of the elderly, which of the following listed below is FALSE? A. Fractures of the spine can occur from forceful coughing. B. Pain perception decreases. C. Menopause occurs in women in their late 50s. D. Urine production decreases.
Menopause occurs in women in their late 50s.
Which of the following statements about pneumonia in the elderly patient is FALSE? A. It may present without any fever. B. It may have a bacterial or viral cause. C. Pain may be referred to the shoulders. D. It may be community acquired or nosocomial.
Pain may be referred to the shoulders.
During the scene size-up for an emergency involving an older adult, which of the following would you NOT do? A. Assess the patient's degree of mobility. B. If the patient has a hearing aid but is not wearing it, offer to retrieve it for him. C. Remove poorly fitting dentures if they interfere with airway management. D. Notice any indications of chronic illness, such as the presence of oxygen tanks or tubing, nebulizers, a hospital bed, or other medical equipment.
Remove poorly fitting dentures if they interfere with airway management.
You are treating a 76-year-old female who is experiencing signs and symptoms of pneumonia. Despite several attempts to talk the patient into being transported to the hospital, she is still refusing transport. Which of the following is the LEAST likely reason she is refusing transport? A. She does not want to create an increasing financial burden upon herself. B. She is concerned for her spouse. C. She is suffering from acute dementia. D. She is afraid she will not be allowed to return home and live independently.
She is suffering from acute dementia.
When caring for an 84-year-old male at a residence, your partner is gathering information from the patient's adult daughter. Which of the following actions by the daughter would alert you to potential elder abuse? A. The daughter refuses to let you speak to the patient alone. B. The daughter appears very fatigued and overwhelmed. C. The daughter states that the patient's health has been quickly declining. D. The daughter hastily gives your partner information.
The daughter refuses to let you speak to the patient alone.
Which one of the following BEST describes the term "silent heart attack"? A. The patient had a single episode of chest pain followed by cardiac arrest. B. The chest pain was so intense the patient could not speak. C. The pain did not radiate into the arms, neck, or back. D. The patient had little to no chest pain or discomfort.
The patient had little to no chest pain or discomfort.
Which of the following is a characteristic of neglect of the elderly patient? A. The patient is bedridden with signs of multiple bruises in different stages of healing. B. The patient seems depressed. C. The patient is not being turned to help prevent decubitus ulcers from occurring. D. The patient is being restrained unnecessarily when the caretaker leaves the room.
The patient is not being turned to help prevent decubitus ulcers from occurring.
Your patient states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which of the following in the patient's history is of greatest concern? A. He had hip surgery two years ago. B. The patient states his left calf is tender and painful. C. The patient injured his wrist when he fell. D. The patient took nitroglycerin and now has a headache.
The patient states his left calf is tender and painful.
Which of the following statements regarding myocardial infarction in the elderly is TRUE? A. They are less likely than younger patients to present with classic symptoms. B. They usually complain of more severe symptoms. C. They are more likely to present with classic symptoms. D. They are less likely to have cardiac enzyme elevation.
They are less likely than younger patients to present with classic symptoms.
Which of the following statements regarding elderly patients is FALSE? A. They present with signs and symptoms of disease that should be attributed to their age unless proven otherwise. B. They may have problems with communication such as hearing impairment or poor dentition. C. They often have vague or multiple complaints that can make it difficult to identify the reason they need medical care. D. They may attribute symptoms to "old age" that actually indicate acute problems requiring treatment.
They present with signs and symptoms of disease that should be attributed to their age unless proven otherwise.
If it is not clear to you that the patient is oriented to person, place, and time, which assessment tool would be a more sensitive indication of the patient's mental status? A. The OPQRST mnemonic B. The AVPU mnemonic C. The Glasgow Coma Scale D. The Mini-Mental State Exam
The Mini-Mental State Exam
You are assessing the pupils of a 65-year-old male. When you shine the pin light into his eye, you note a gray clouding over the lens. You would document this assessment finding as: A. a chalazion. B. glaucoma. C. a cataract. D. conjunctivitis.
a cataract.
You are called for an elderly man with an apparent broken hip. The patient tells you that he has osteoporosis and type 2 diabetes. He denies falling and cannot remember any trauma. You should suspect: A. a pathological fracture. B. an associated spinal injury. C. decreased range of motion. D.
a pathological fracture.
The dysrhythmia commonly encountered as a result of the aging process is: A. idioventricular. B. sinus bradycardia. C. ventricular tachycardia. D. atrial fibrillation.
atrial fibrillation.
Each of the following patients is a high priority for treatment and transport EXCEPT: A. a 78-year-old male patient who presents with respiratory difficulty and requires an advanced airway adjunct. B. a 76-year-old female patient with a decreased level of responsiveness who presents with signs of dehydration and malnutrition. C. a 72-year-old female patient who is quiet and slow to respond to questions. D. a 74-year-old male patient who complains of chest pain.
a 72-year-old female patient who is quiet and slow to respond to questions.
A common condition appearing as cloudiness of the lens of the eye that affects the elderly and causes an impairment of vision is/are: A. cataracts. B. chemical conjunctivitis. C. astigmatism. D. blindness.
cataracts.
The cumulative effects of vascular disease and inflammatory processes can lead to: A. Alzheimer's disease. B. dementia. C. delirium. D. proprioception.
dementia.
An elderly patient with a flat or sad affect who gives slow, halting responses to questions should be suspected of: A. dementia. B. depression. C. hypoxia. D. infection.
depression.
A 75-year-old patient complains of severe, unilateral back pain at the level of T6. Inspection shows a vesicular rash along the T6 dermatome to the right of the midline. This is MOST consistent with: A. herpes zoster. B. eczema. C. pruritis. D. decubitus ulcer.
herpes zoster.
A shortened, externally-rotated lower extremity in an elderly patient is MOST associated with: A. hip fracture. B. anterior hip dislocation. C. fracture of the ischial tuberosity. D. posterior hip dislocation.
hip fracture.
Elderly patients with extensive burns are at increased risk for: A. hypoglycemia. B. hyperthermia. C. hypothermia. D. hyperglycemia.
hypothermia.
Patients with dementia often have reduced levels of melatonin which can lead to: A. decrease in calcium in the bones. B. impairment of the sleep-wake cycle. C. decreased absorption of medications. D. an increase in the inflammatory process.
impairment of the sleep-wake cycle.
You are interviewing an elderly patient about his eyesight. He tells you that he has good peripheral vision but diminished central vision. You should suspect: A. macular degeneration. B. confabulation. C. glaucoma. D. proprioception.
macular degeneration.
The MOST common mechanisms of trauma in the elderly are: A. falls and burns. B. motor vehicle collisions and abuse C. motor vehicle collisions and falls D. burns and abuse
motor vehicle collisions and falls
Which of the following is a contributing factor for the development of type 2 diabetes as a person ages? A. Obesity B. Presbyopia C. Immunocompromise D. Organ failure
obesity
An elderly man mistakenly presses the gas pedal instead of the brake causing him to crash into a convenience store. This scenario is commonly related to: A. Alzheimer's disease. B. proprioception. C. confabulation. D. dementia
proprioception.
The ability to sense the location, orientation, and movement of the body and its parts without visual input is known as: A. palliation. B. pronation. C. perception. D. proprioception.
proprioception.
You are called for an elderly man with what appears to be pleuritic chest pain. Further assessment shows he has pain in the lower leg with increased calf pain when he flexes his toes upwards. You should suspect: A. acute pulmonary edema. B. pulmonary embolism. C. aortic aneurysm. D. referred pain from appendicitis.
pulmonary embolism.
It is important to remember that emergencies experienced by elderly patients may NOT present with the normal signs and symptoms experienced by younger populations because: A. hyperreflexia is present in the elderly. B. sensations may be seriously diminished. C. the brain is unable to interpret signals. D. poor skin turgor diminishes pain sensations.
sensations may be seriously diminished.
You respond for a 66-year-old man complaining of severe pain on the back of his neck and right shoulder. You examine the area and see fluid filled blisters in a horizontal line across his shoulder. You should suspect: A. spondylosis. B. chicken pox. C. shingles. D. kyphosis.
shingles.
Decreased clearance of drugs that are metabolized by the liver may contribute to: A. increased risk of infection. B. impaired proprioception. C. constipation and bowel obstruction. D. signs and symptoms of drug overdose.
signs and symptoms of drug overdose.
Degeneration of the vertebrae and intervertebral disc caused by ________, can affect the neck and back, limiting mobility and increasing the risk for spine injury. A. arthritis B. osteoporosis C. pathological fractures D. spondylosis
spondylosis
Each of the following is a change in the respiratory system experienced by the elderly EXCEPT: A. swallowing is impaired. B. general decline causes a diminished level of gas exchange. C. the tendency for infection is increased. D. cough power is diminished
swallowing is impaired.
All of the following are common causes of seizures in the elderly EXCEPT: A. stroke. B. epilepsy. C. syncope. D. brain injury.
syncope
Which neurologic disorder is a common form of dementia in which there is a progressive loss of function including memory loss, confusion, and alterations in emotions and behavior? A. Status epilepticus B. Epilepsy C. Parkinson's disease D. Alzheimer's disease
Alzheimer's disease
Signs and symptoms of ________ include postural rigidity, tremors, and loss of facial expression. A. Alzheimer's disease B. Meniere disease C. Starling's disease D. Parkinson's disease
Parkinson's disease