Chapter 33 Geriatric Emergencies

An abdominal aortic aneurysm: A. causes dull pain that often radiates to the shoulders. B. is usually not repairable, even if discovered early. C. is often the result of hypertension and atherosclerosis. D. can sometimes be palpated as a mass in the groin area.

The correct answer is: is often the result of hypertension and atherosclerosis.

Findings during the social assessment of an older patient include all of the following, EXCEPT: A. outdated medications. B. delays in obtaining meals. C. daily activity assistance. D. interaction with others.

The correct answer is: outdated medications.

Which of the following patients is at highest risk for a pulmonary embolism? A. 59-year-old male who is recovering from pneumonia B. 78-year-old female who takes blood thinning medications C. 71-year-old male with recent surgery to a lower extremity D. 66-year-old active female with a history of hypertension

The correct answer is: 71-year-old male with recent surgery to a lower extremity

Which of the following statements regarding a decreased level of consciousness in the elderly patient is correct? A. A decreased level of consciousness is most often the result of chronic dementia. B. Most elderly patients have some deterioration in their level of consciousness. C. A decreased level of consciousness is not a normal part of the aging process. D. The AVPU scale is an ineffective tool when assessing an elderly patient's level of consciousness.

The correct answer is: A decreased level of consciousness is not a normal part of the aging process.

Which of the following statements regarding the aging process is correct? A. The older a person gets, the slower the decline in the function of vital organs, such as the kidneys and liver. B. Aging is a linear process; the rate at which a person loses functions does not increase with age. C. Human growth and development peaks in the late 40s or early 50s, at which point the aging process sets in. D. Because he or she is younger and healthier, a 35-year-old person ages slower than a 75-year-old person.

The correct answer is: Aging is a linear process; the rate at which a person loses functions does not increase with age.

Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown? A. Victims of elder abuse are hesitant to report it. B. It has been largely hidden from society. C. The definitions of abuse and neglect vary. D. Human resource agencies fail to investigate.

The correct answer is: Human resource agencies fail to investigate.

Which of the following observations or statements represents the "E" in the GEMS diamond? A. Elderly patients present atypically and deserve your respect. B. The patient's residence is cold due to a malfunctioning heater. C. A patient is assisted with his or her activities of daily living. D. The patient's medications have not been filled in 2 months.

The correct answer is: The patient's residence is cold due to a malfunctioning heater.

Osteoporosis is MOST accurately defined as: A. a decrease in bone mass and density. B. decreased bone marrow production. C. an abnormality near the growth plate. D. increased flexibility of bone mass.

The correct answer is: a decrease in bone mass and density.

You receive a call for a sick person. When you arrive, you find the patient, a 75-year-old male, lying unresponsive in his bed. His respirations are slow and irregular and his pulse is slow and weak. His daughter tells you that he fell the day before, but refused to allow her to call 9-1-1. His past medical history is significant for hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis. His medications include blood thinners and vitamins. You should be MOST suspicious that this patient is experiencing: A. acute hyperglycemia. B. acute ischemic stroke. C. diabetic ketoacidosis. D. a subdural hematoma.

The correct answer is: a subdural hematoma.

When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do all of the following, EXCEPT: A. ask the patient how the bruises occurred. B. accuse a caregiver of physical abuse. C. review the patient's activities of daily living. D. factually document all findings.

The correct answer is: accuse a caregiver of physical abuse.

Because of the complexity of the older patient and the vagueness of his or her complaint, you should: A. rely exclusively on family members for the medical history. B. perform a rapid assessment on all geriatric patients you treat. C. attempt to differentiate between chronic and acute problems. D. limit your physical examination to the area of pain or injury.

The correct answer is: attempt to differentiate between chronic and acute problems.

When faced with a situation in which an older patient with a terminal illness is in cardiac arrest, but written documentation regarding the patient's wishes cannot be located, the EMT should: A. try to locate the documentation. B. attempt to resuscitate the patient. C. contact medical control for advice. D. allow the patient to die in peace.

The correct answer is: attempt to resuscitate the patient.

Syncope in the older patient is: A. generally of no concern unless the patient was injured. B. most commonly caused by a silent myocardial infarction. C. rarely life threatening but should be evaluated by a physician. D. caused by an interruption of blood flow to the brain.

The correct answer is: caused by an interruption of blood flow to the brain.

With age, the spine stiffens as a result of shrinkage of the intervertebral disc spaces, and the vertebrae become brittle. This increases the risk of: A. distracting injuries. B. compression fractures. C. severe kyphosis. D. spinal cord tearing.

The correct answer is: compression fractures.

When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, it is MOST important to: A. determine the onset of the patient's symptoms. B. ascertain about a history of atrial fibrillation. C. determine if the patient has risk factors for a stroke. D. administer 324 mg of aspirin as soon as possible.

The correct answer is: determine the onset of the patient's symptoms.

You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The patient is clearly confused and asks you if you are her husband. As your partner administers oxygen to the patient, you should: A. inquire about a history of Alzheimer disease. B. ask an attendant for the patient's medical records. C. obtain a complete list of the patient's medications. D. determine the patient's baseline mental status.

The correct answer is: determine the patient's baseline mental status.

Upon arriving at the residence of an elderly female who apparently fainted, you find the patient lying supine on her living room floor. She is not moving and her eyes are closed. A neighbor tells you that she found the patient this way, but did not move her. When you talk to the patient, she does not respond. You should: A. direct your partner to manually stabilize her head while you open her airway and ensure that her oropharynx is clear of secretions or blood. B. suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment. C. open her airway with the head tilt-chin lift maneuver, insert an oral or nasal airway, and assess her blood glucose level to rule out hypoglycemia. D. begin assisting her ventilations with a bag-mask device while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation.

The correct answer is: direct your partner to manually stabilize her head while you open her airway and ensure that her oropharynx is clear of secretions or blood.

An older patient with significant dehydration would MOST likely present with: A. dizziness or fainting upon standing. B. an increase in blood pressure upon standing. C. a drop in heart rate upon standing. D. weakness to one side of the body.

The correct answer is: dizziness or fainting upon standing.

A 10% to 20% reduction in brain weight and volume would MOST likely increase an older person's risk for: A. dementia. B. stroke. C. delirium. D. head trauma.

The correct answer is: head trauma.

The purpose of the GEMS diamond is to: A. provide the EMT with a standard format for assessing elderly patients. B. provide clues about an elderly patient's problem by observing his or her home. C. replace the typical ABC approach to patient care when caring for the elderly. D. help EMS personnel remember what is different about elderly patients.

The correct answer is: help EMS personnel remember what is different about elderly patients.

In contrast to delirium, dementia: A. is reversible with certain treatment. B. is usually considered irreversible. C. is the result of an acute condition. D. often develops over a period of days.

The correct answer is: is usually considered irreversible.

Talking about an elderly patient in front of him or her to other members of the family: A. may cause the patient to think that he or she has no say in making decisions. B. will anger the patient and result in his or her refusal to accept care or transport. C. is usually beneficial because the patient's cognitive skills are typically impaired. D. often causes the patient to become paranoid and untrusting of your help.

The correct answer is: may cause the patient to think that he or she has no say in making decisions.

Upon entering the residence of a geriatric patient with a medical or trauma complaint, the EMT should: A. begin his or her assessment after gathering any medication bottles. B. observe for conditions that may make the residence unsafe. C. talk to the patient after performing his or her primary assessment. D. immediately seek out a family member or other caregiver.

The correct answer is: observe for conditions that may make the residence unsafe.

A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for: A. heart failure. B. bronchitis. C. emphysema. D. pneumonia.

The correct answer is: pneumonia.

Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to: A. pneumonia. B. osteoporosis. C. heart failure. D. ischemic stroke.

The correct answer is: pneumonia.

The EMT should suspect left-sided heart failure in the geriatric patient who presents with: A. jugular venous distention and peripheral edema. B. fever and a cough that produces green sputum. C. tachypnea and paroxysmal nocturnal dyspnea. D. swelling of the lower extremities and weakness.

The correct answer is: tachypnea and paroxysmal nocturnal dyspnea.

When caring for a geriatric patient with a traumatic injury, it is important to consider that: A. the injury may have been preceded by a medical condition. B. geriatric patients typically present with classic signs of shock. C. decreased bone density often results in incomplete fractures. D. geriatric patients usually present with little to no pain.

The correct answer is: the injury may have been preceded by a medical condition.

A "silent" heart attack occurs when: A. the usual chest pain is not present. B. sweating is the only presentation. C. the patient minimizes the chest pain. D. a sudden dysrhythmia causes death.

The correct answer is: the usual chest pain is not present.

Many older victims of physical abuse may make false statements or lie about the origin of their injuries because: A. they do not want to be bothersome. B. most elderly patients have dementia. C. they fear retribution from the abuser. D. they are protective of the abuser.

The correct answer is: they fear retribution from the abuser.

Common causes of syncope in older patients include all of the following, EXCEPT: A. vasoconstriction. B. blood volume loss. C. acute hypotension. D. venous pooling.

The correct answer is: vasoconstriction.