Chapter 35 Geriatric Emergencies

Which of the following observations or statements represents the "E" in the GEMS diamond? A. The patient's residence is cold due to a malfunctioning heater. B. Elderly patients present atypically and deserve your respect. 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.

A. The patient's residence is cold due to a malfunctioning heater.

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

A. an aortic aneurysm

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

A. caused by an interruption of blood flow to the brain.

The purpose of the GEMS diamond is to: A. help EMS personnel remember what is different about elderly pt's. B. provide the EMT with a standard format for assessing elderly pt. C. replace the typical ABC approach to pt care when caring for the elderly.

A. help EMS personnel remember what is different about elderly pt's.

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

A. is usually considered irreversible.

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

A. older pt's tend to use more lethal means than younger pt's.

When immobilizing a patient with a kyphotic spine to a long backboard, the EMT would MOST likely have to: A. place blankets behind the patient's head. B. secure the patient's head before the torso. C. force the head into a neutral alignment. D. use a scoop stretcher instead of a log roll.

A. place blankets behind the patient's head.

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

A. she became dizzy or fainted before falling.

Which of the following statements regarding the aging process is correct? A. the process of aging is gradual, & the rate at which a person loses functions does not increase with age. B. because he/she is younger & healthier, a 35-year-old person ages slower than a 75-years-old person. C. human growth & developmental peaks in the late 40s or early 50s, at which point the aging process sets in.

A. the process of aging is gradual, & the rate at which a person loses functions does not increase with age.

A 71-year-old man with a history of hypertension and vascular disease presents with tearing abdominal pain. His blood pressure is 80/60 mm Hg, his heart rate is 120 beats/min, and his respirations are 28 breaths/min. Your assessment reveals that his abdomen is rigid and distended. Considering his medical history and vital signs, you should be MOST suspicious for a(n): A.aortic aneurysm. B.hemorrhagic stroke. C.acute myocardial infarction. D.infarction of the large intestine.

Answer: A Rationale: Arteriosclerosis is a vascular disease in which the arteries thicken, harden, and calcify. This places the patient at risk for stroke, heart disease, bowel infarction, and hypertension, among other conditions. Hypertension and vascular disease are significant risk factors for an aneurysm—a weakening in the wall of an artery. The patient's vital signs; abdominal pain; and rigid, distended abdomen should make you highly suspicious for a leaking abdominal aortic aneurysm.

A condition that clouds the lens of the eye is called: A.cataract. B.nystagmus. C.astigmatism. D.glaucoma.

Answer: A Rationale: As people get older, cataracts, or clouding of the lens of the eye, may interfere with vision. Glaucoma is a condition caused by increased intraocular pressure (IOP). Nystagmus is characterized by involuntary movement of the eyes. Astigmatism is an optical defect that causes blurred vision due to the inability of the eye to focus an object into a sharp, focused image on the retina.

Polypharmacy is a term used to describe a patient who takes: A. multiple medications. B. other people's medications. C. a medication more than once a day. D. medication only when he or she feels the need to.

Answer: A Rationale: Polypharmacy is a term used to describe a patient who takes multiple medications every day. The more medications a patient takes, the greater the risk of a negative drug interaction.

Which of the following conditions makes the elderly patient prone to fractures from even minor trauma? A.Hypertension B.Osteoporosis C.Arteriosclerosis D.Rheumatoid arthritis

Answer: B Rationale: Osteoporosis, a decrease in bone density that causes the bones to become brittle, makes elderly patients prone to fractures, even from minor trauma. It is especially common in postmenopausal women.

According to the GEMS diamond, a person's activities of daily living are evaluated during the: A. SAMPLE history. B. social assessment. C. medical assessment. D. environmental assessment.

Answer: B Rationale: The GEMS diamond was created to help you remember what is unique to older people. During the social assessment (the "S" in the GEMS diamond), the patient's activities of daily living (eg, eating, dressing, bathing, toileting) are evaluated. Are these activities being provided? If so, by whom? Are there delays in obtaining food, medication, or other necessary items?

Which of the following is a physiologic change that occurs during the process of aging? A.Increased elasticity of the alveoli B.A gradual decrease in blood pressure C.A decline in kidney function D.10% to 15% increase in brain weight

Answer: C Rationale: As a person gets older, certain anatomic and physiologic changes occur. The alveoli in the lungs become less elastic, even though their overall size increases. Blood pressure gradually increases secondary to the process of arteriosclerosis (hardening of the arteries). A decline in kidney function occurs because of a decrease in the number of nephrons. By the age of 85 years, a 10% reduction in brain weight occurs, which causes an increased risk of head trauma.

The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is called: A.senility. B.delirium. C.dementia. D.delusion.

Answer: C Rationale: Dementia is defined as the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function. Alzheimer disease is an example of dementia. In contrast to dementia, delirium is an acutely altered mental status, such as that caused by hypoglycemia.

You are called to a neatly kept residence for an 80-year-old woman who lives by herself. She burned her hand on the stove and experienced a full-thickness burn. When treating this patient, it is important to note that: A.there is a high likelihood that she has been abused. B.isolated full-thickness burns to the hand are not critical burns. C.this patient should probably be placed in an assisted-living center. D.slowing of reflexes causes a delayed pain reaction in older people.

Answer: D Rationale: In older patients, the sense of touch decreases due to a loss of the end-nerve fibers. This loss, in conjunction with slowing of the peripheral nervous system, causes a delayed reaction to pain. In this particular scenario, there is no indication that the patient has been abused. Partial- and full-thickness burns to the hands, feet, face, and genitalia are considered critical burns, regardless of the patient's age.

Inflicted bruises are commonly found in all of the following areas, EXCEPT: A.the buttocks. B.the lower back. C.the inner thighs. D.the forearms.

Answer: D Rationale: Inflicted bruises are typically found on the buttocks and lower back, genitalia and inner thighs, cheek or earlobe, upper lip and inside the mouth, and neck. Bruises to these areas should increase your index of suspicion for abuse.

The LEAST common cause of death in patients over 65 years of age is: A. stroke. B. diabetes. C. heart attack. D. drug overdose.

Answer: D Rationale: The leading causes of death in patients over 65 years of age are heart disease, diabetes, stroke, cancer, pulmonary diseases, and trauma. Drug overdose—intentional or unintentional—is not a leading cause of death in this age group.

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

B. a subdural hematoma.

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

B. accuse a caregiver of physical abuse.

As a person ages, the heart may enlarge as a result of: A. widespread vascular dilation. B. chronically increased afterload. C. an overall decrease in blood volume. D. decreased blood return to the heart.

B. chronically increased afterload.

To minimize distractions and confusion when assessing an older patient, you should: A. perform a physical exam and then talk to the patient. B. have only one EMT speak to the patient at a time. C. elevate your voice and speak directly to the patient. D. dismiss the family members from the room or area.

B. have only one EMT speak to the patient at a time.

The use of multiple prescription drugs by a single pt, causing the potential for negative effects such as overdosing or drug interaction, is called: A. potentiation B. polypharmacy C. drug tolerance D. drug dependency

B. polypharmacy

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because: A. the aging process results in an overall increase in blood volume. B. the body is less able to adapt the BP to rapid postural changes. C. any change in position causes blood to be shunted to the brain. D. their red blood cells are destroyed at a faster than normal rate.

B. the body is less able to adapt the BP to rapid postural changes.

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

B. the pt develops cardiac arrest.

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

C. a decrease in bone mass & density.

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. power of attorney. B. statute of care. C. advance directive. D. physician directive.

C. advance directive.

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

C. cataracts.

Upon arrival at the residence of an elderly female who apparently fainted, you find the pt lying supine on her living room floor. She is not moving & her eyes are closed. A neighbor tells you that she found the pt this way but did not move her. When you gently tap the pt, She does not respond. You should: A. suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment. B. 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. C. direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing. D. begin assisting her ventilations with a bag-valve mask 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.

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

C. frequently asking the pt if he or she understands.

Which of the following statements is NOT a reason why the exact extent & prevalence of elder abuse is unknown? A. it has been largely hidden from society. B. the definition of abuse & neglect vary. C. human resources agencies fail to investigate. D. victims of elder abuse are hesitant to report it.

C. human resources agencies fail to investigate.

When performing your secondary assessment on an older pt who has been injured, it is important to: A. routinely perform a focused exam to minimize time at the scene B. perform an in-depth physical exam prior to initiating any treatment. C. recall that it will take a less severe mechanism of injury to cause significant injuries. D. focus your assessment just on the area(s) of pain or obvious injury.

C. recall that it will take a less severe mechanism of injury to cause significant injuries.

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

C. renal insufficiency.

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

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

Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse. A. psychological B. emotional C. financial D. physical

D. physical

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

D. pneumonia

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

D. 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. swelling of the lower extremities and weakness. D. tachypnea and paroxysmal nocturnal dyspnea.

D. tachypnea and paroxysmal nocturnal dyspnea.

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

determine the pt's baseline mental status.