Chapter 35

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

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

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

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EMTS are dispatched to a residence for an 80-year-old woman who is ill. The patient's daughter states that her mother almost fainted after going to the bathroom, and that her pulse was very slow. The patient's pulse rate is 80 beats/min and irregular and she is conscious and alert. The EMTs should suspect that the patient: A. took too much of her medication. B. has an abdominal aortic aneurysm. C. experienced a vasovagal response. D. has a gastrointestinal hemorrhage.

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Motor nerve neuropathy is characterized by: A. numbness, tingling, and severe muscle pain. B. loss of balance, muscle weakness, and spasms. C. constipation, low blood pressure, and bradycardia. D. loss of bladder control and sensitivity to touch.

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When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it is MOST important to: A. look up all of the medications before providing care to the patient. 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. recall that the patient is at risk for negative medication interactions.

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When assessing a 78-year-old female who complains of shortness of breath, the EMT should: A. determine the position in which the patient normally sleeps. B. conclude that the patient is experiencing a heart attack. C. give oxygen only if the patient has labored breathing. D. place the patient supine to see if the problem worsens.

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

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

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

Which of the following is generally NOT acceptable when interviewing an older patient? A. Do not initiate eye contact, because many geriatric patients might find this disrespectful. B. Explain what you are doing before you do it. C. Speak slowly and distinctly. D. Give the patient time to respond unless the condition appears urgent.

Do not initiate eye contact, because many geriatric patients might find this disrespectful.

Which of the following is the MOST common mechanism of injury in older patients? A. Burns B. Suicide C. Abuse D. Falls

Falls

A 75-year-old woman complains of shortness of breath. Which of the following findings should alert the EMT to the possibility of a pulmonary embolism? A. The patient is prescribed an inhaler. B. History of deep venous thrombosis C. Frequent urinary tract infections D. The patient's abdomen is swollen.

History of deep venous thrombosis

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. Failure of the parasympathetic nervous system B. Deterioration of the cardiac conduction system C. The effects of her antihypertensive medication D. Intrathoracic bleeding and cardiac compression

The effects of her antihypertensive medication

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

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

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

a decreased ability to cough

An 84-year-old male fell a week ago and has been bedridden since then. Today, he presents with an altered mental status. His skin is pale and cold and his respirations are rapid and shallow. The EMT should suspect: A. acute hyperglycemia. B. a systemic infection. C. hypovolemic shock. D. a subdural hematoma,

a systemic infection

A 70-year-old man complains of a sudden onset of difficulty breathing. He has dried blood on his lips and is very anxious. His left leg is red, swollen, and painful. The EMT should: A. position the patient supine. B. apply a cold pack to his leg. C. suspect severe pneumonia. D. administer high-flow oxygen.

administer high-flow oxygen.

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. physician directive. C. advance directive. D. statute of care.

advance directive.

Patients who have experienced even minor-appearing head injuries should be suspected of having a brain injury, especially if they: A. have a history of Alzheimer disease. B. have minor abrasions to the head area. C. do not have deformities to the skull. D. are taking blood-thinning medications.

are taking blood-thinning medications.

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. rely exclusively on family members for the medical history. C. perform a rapid assessment on all geriatric patients you treat. D. limit your physical examination to the area of pain or injury.

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. allow the patient to die in peace. B. try to locate the documentation. C. attempt to resuscitate the patient. D. contact medical control for advice.

attempt to resuscitate the patient.

When documenting a case of suspected elder abuse, it is MOST important for the EMT to: A. theorize as to why the patient was abused. B. list the names of all of the suspected abusers. C. avoid documenting any unsupported opinions. D. document his or her perceptions of the event.

avoid documenting any unsupported opinions.

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

cataracts

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.

compression fractures.

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

dementia

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

determine the onset of the patient's symptoms.

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

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

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

he or she fears hospitalization.

The reduction in brain weight and volume increases an older person's risk for: A. dementia. B. head trauma. C. stroke. D. delirium.

head trauma

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

heart disease

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 reads "high." 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. acute renal failure with associated hyperglycemia. B. hyperglycemia with moderate dehydration. C. hyperosmolar hyperglycemic nonketotic syndrome. D. diabetic ketoacidosis.

hyperosmolar hyperglycemic nonketotic syndrome.

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

is often the result of hypertension and atherosclerosis.

The stooped posture of some older people, which gives them a humpback appearance, is called: A. scoliosis. B. miosis. C. arthritis. D. kyphosis.

kyphosis

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

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. talk to the patient after performing his or her primary assessment. C. immediately seek out a family member or other caregiver. D. observe for conditions that may make the residence unsafe.

observe for conditions that may make the residence unsafe.

A drop in blood pressure with a change in position is referred to as: A. psychogenic hypotension. B. metastatic hypotension. C. orthostatic hypotension. D. malignant hypotension.

orthostatic hypotension

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

osteoporosis and low-energy trauma

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

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. compression fracture. B. idiopathic fracture. C. comminuted fracture. D. pathologic fracture.

pathologic fracture

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

physical

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

place blankets behind the patient's head.

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

pneumonia

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

renal insufficiency

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

tachypnea and paroxysmal nocturnal dyspnea.

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

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

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. because of her age and medical history, you should suspect Alzheimer disease. C. the patient is experiencing delirious behavior, which suggests a new health problem. D. dementia typically presents as an acute onset of deterioration of cognitive function.

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.

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 are protective of the abuser. D. they fear retribution from the abuser.

they fear retribution from the abuser.

When transporting a stable older patient to the hospital, the MOST effective way to reduce his or her anxiety is to: A. avoid the use of a long backboard, even if trauma is suspected. B. allow at least two family members to accompany the patient. C. transport him or her to a hospital that he or she is familiar with. D. perform frequent detailed assessments to gain the patient's trust.

transport him or her to a hospital that he or she is familiar with.

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

use plain language and simple terms.