Chapter 35 EMT

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

A. a decrease in bone mass and density.

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

A. 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. attempt to differentiate between chronic and acute problems. B. limit your physical examination to the area of pain or injury. C. rely exclusively on family members for the medical history. D. perform a rapid assessment on all geriatric patients you treat.

A. attempt to differentiate between chronic and acute problems.

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

A. dizziness or fainting upon standing.

General communication techniques with the elderly include: A. frequently asking the patient if he or she understands. B. having at least two EMTs talk to the patient at a time. C. using medical terms to ensure patient understanding. D. explaining procedures while you are performing them.

A. frequently asking the patient if he or she understands.

An elderly patient may understate or minimize the symptoms of his or her illness because: A. he or she fears hospitalization. B. the nervous system has deteriorated. C. of decreased perception of pain. D. of conditions such as dementia.

A. he or she fears hospitalization.

The leading cause of death in the geriatric patient is: A. heart disease. B. altered mental status. C. hypertension. D. arthritis.

A. heart disease.

When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it is MOST important to: A. recall that the patient is at risk for negative medication interactions. B. contact each of the physicians whose names are on the medications. C. ask the patient to explain what each of the medications is used for. D. look up all of the medications before providing care to the patient.

A. recall that the patient is at risk for negative medication interactions.

You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the patient conscious, lying in a recumbent position on the floor in her living room. In addition to providing the appropriate treatment, you should ask the patient if: A. she became dizzy or fainted before falling. B. she takes medications for Alzheimer disease. C. a family member regularly checks up on her. D. she attempted to catch herself before falling.

A. she became dizzy or fainted before falling.

In contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when: A. the patient develops cardiac arrest. B. the patient has a terminal illness. C. it is signed by three or more physicians. D. the patient is in a health care setting.

A. the patient develops cardiac arrest.

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

A. they fear retribution from the abuser.

Causes of delirium in the older patient include all of the following, EXCEPT: A. decreased cerebral perfusion. B. Alzheimer disease. C. acute hypovolemia. D. low blood sugar level.

B. Alzheimer disease.

Common causes of depression in the elderly include all of the following, EXCEPT: A. alcohol abuse and dependence. B. an acute onset of dementia. C. chronic medical conditions. D. prescription medication use.

B. an acute onset of dementia.

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

B. determine the onset of the patient's symptoms.

You are assessing a 70-year-old female who complains of intense thirst, frequent urination, and dizziness. She has a history of type 2 diabetes, heart disease, rheumatoid arthritis, and gout. Her blood glucose level is 450 mg/dL. She is conscious, but confused. Her blood pressure is 92/52 mm Hg, her pulse rate is 130 beats/min and weak, and her respirations are 22 breaths/min and shallow. This patient's clinical presentation is MOST consistent with: A. diabetic ketoacidosis. B. hyperosmolar hyperglycemic nonketotic coma (HHNC). C. acute renal failure with associated hyperglycemia. D. hyperglycemia with moderate dehydration.

B. hyperosmolar hyperglycemic nonketotic coma (HHNC).

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

B. is often the result of hypertension and atherosclerosis.

Blood levels of medications may rise in the elderly, sometimes to toxic levels. This is MOST likely due to: A. intentional overdose. B. renal insufficiency. C. splenic dysfunction. D. pancreatic failure.

B. renal insufficiency.

A 77-year-old female presents with an acute onset of altered mental status. Her son is present and advises that she has a history of hypertension, atrial fibrillation, type 2 diabetes, and glaucoma. He further advises that she takes numerous medications and that she is normally alert. When you assess this patient, it is important to note that: A. her mental status is likely the result of hypoglycemia and you should give her sugar. B. the patient is experiencing delirious behavior, which suggests a new health problem. C. dementia typically presents as an acute onset of deterioration of cognitive function. D. because of her age and medical history, you should suspect Alzheimer disease.

B. the patient is experiencing delirious behavior, which suggests a new health problem.

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

B. the usual chest pain is not present.

When explaining the need for a particular procedure to an elderly patient, you should: A. use the appropriate medical terminology. B. use plain language and simple terms. C. be complex so the patient fully understands. D. realize that he or she will not understand you.

B. use plain language and simple terms.

During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in: Select one: A. baseline respiratory distress. B. air-trapping within the alveoli. C. a decreased ability to cough. D. an increased risk of COPD.

C. a decreased ability to cough.

A specific legal document that directs relatives and caregivers regarding the medical treatment that may be given to patients who cannot speak for themselves is called a(n): A. physician directive. B. power of attorney. C. advance directive. D. statute of care.

C. advance directive.

Clouding of the lenses of the eyes is called: A. conjunctivitis. B. glaucoma. C. cataracts. D. retinitis.

C. cataracts.

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. obtain a complete list of the patient's medications. B. ask an attendant for the patient's medical records. C. determine the patient's baseline mental status. D. inquire about a history of Alzheimer disease.

C. 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 gently tap the patient, she does not respond. You should: A. 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. B. begin assisting her ventilations with a bag-mask device while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation. C. direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing. D. suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment.

C. direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing.

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

C. help EMS personnel remember what is different about elderly patients.

Fractures of the pelvis in older patients often occur as the result of a combination of: A. acetabular separation and severe falls. B. arthritic joints and high-energy trauma. C. osteoporosis and low-energy trauma. D. increased bone density and car crashes.

C. osteoporosis and low-energy trauma.

When caring for an elderly patient who is hearing-impaired, you should: A. request that he or she communicates with you by writing on paper. B. speak directly into his or her ear with an elevated tone. C. recall that elderly patients have difficulty hearing high-frequency sounds. D. remember that most hearing-impaired patients can read lips.

C. recall that elderly patients have difficulty hearing high-frequency sounds.

A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of 80/50 mm Hg and a heart rate of 74 beats/min that is weak. Her daughter, who was uninjured in the crash, tells you that her mother has a history of hypertension and takes beta-blockers. Considering the fact that this patient is probably in shock, what is the MOST likely explanation for the absence of tachycardia? A. intrathoracic bleeding and cardiac compression B. failure of the parasympathetic nervous system C. the effects of her antihypertensive medication D. deterioration of the cardiac conduction system

C. the effects of her antihypertensive medication

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

C. vasoconstriction.

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. 66-year-old active female with a history of hypertension D. 71-year-old male with recent surgery to a lower extremity

D. 71-year-old male with recent surgery to a lower extremity

Which of the following statements regarding suicide in the older patient is correct? A. Depression and hopeless feelings are often not predisposing factors. B. Most suicidal patients readily seek care and do not deny the problem. C. Older females have a higher rate of suicide than any other group. D. Older patients tend to use more lethal means than younger patients.

D. Older patients tend to use more lethal means than younger patients.

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 ischemic stroke. B. diabetic ketoacidosis. C. acute hyperglycemia. D. a subdural hematoma.

D. a subdural hematoma.

A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious, but is diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should be MOST suspicious for: A. myocardial infarction. B. acute appendicitis. C. a strangulated bowel. D. an aortic aneurysm.

D. an aortic aneurysm.

When assessing a 78-year-old female who complains of shortness of breath, the EMT should: A. give oxygen only if the patient has labored breathing. B. place the patient supine to see if the problem worsens. C. conclude that the patient is experiencing a heart attack. D. ask her how many pillows she uses when she sleeps.

D. ask her how many pillows she uses when she sleeps.

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

D. observe for conditions that may make the residence unsafe

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

D. outdated medications.

An older woman with osteoporosis presents with pain and deformity to her left hip after she shifted her weight onto her other foot. She has MOST likely experienced a(n): A. comminuted fracture. B. idiopathic fracture. C. compression fracture. D. pathologic fracture.

D. pathologic fracture.

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. emphysema. C. bronchitis. D. pneumonia.

D. pneumonia.

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

D. the injury may have been preceded by a medical condition.