chapter 36 geriatric emergencies
Causes of delirium in the older patient include all of the following, EXCEPT: A) alzheimer disease B) decreased cerebral perfusion C) low blood sugar level D) acute hypovolemia
A
Fractures of the pelvis in older patients often occur as the result of a combination of: A) osteoporosis and low energy trauma B) increased bone density and car crashes C) acetabular separation and severe falls D) arthritic joints and high energy trauma
A
Good general communication techniques with the elderly include: A) explaining procedures while you are performing them B) frequently asking the patient if he or she understands C) using medical terms to ensure patient understanding D) having at least two EMTs talk to the patient at a time
A
Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse. A) physical B) financial C) emotional D) psychological
A
Syncope in the older patient is: A. caused by an interruption of blood flow to the brain. B. generally of no concern unless the patient was injured. C. most commonly caused by a silent myocardial infarction. D. rarely life threatening but should be evaluated by a physician.
A
To minimize distractions and confusion when assessing an older patient, you should: A) dismiss the family members from the room or area B) perform a physical exam and then talk to the patient C) have only one EMT speak to the patient at a time D) elevate your voice and speak directly to the patient
A
blood levels of medications might rise in the elderly, sometimes to toxic levels. This is most likely to: A) renal insufficiency B) intentional overdose C) pancreatic failure D) splenic dysfunction
A
in contrast to younger patients, older patients are more prone to a decrease in blood pressure upon standing because: A) the body is less able to adapt the BP to rapid postural changes B) any change in position causes blood to be shunted to the brain C) their red blood cells are destroyed at a faster than normal rate D) the aging process results in an overall increase in blood volume
A
the EMT should suspect left sided heart failure in the geriatric patient who presents with: A) tachypnea and paroxysmal nocturnal dyspnea B) swelling of the lower extremities and weakness C) jugular venous distention and peripheral edema D) fever and a cough that produces green sputum
A
the reduction in brain weight and volume increases an older persons risk for: A) head trauma B) delirium C) stroke D) dementia
A
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) place the patient supine to see if the problem worsens D) give oxygen only if the patient has labored breathing
A
when documenting a case of suspected elder abuse, it is MOST important for the EMT to: A) avoid documenting any unsupported opinions B) theorize as to why the patient was abused C) document his or her perceptions of the event D) list the names of all of the suspected abusers
A
which of the following statements regarding a decreased level of consciousness in the elderly patient is correct? A) a decreased level of consciousness is not a normal part of the aging process B) most elderly patients have some deterioration in their level of consciousness C) a decreased level of consciousness is most often the result of chronic dementia D) the AVPU scale is an ineffective tool when assessing an elderly patients level of consciousness
A
An abdominal aortic aneurysm: Select one: 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.
B
Because of the complexity of the older patient and the vagueness of his or her complaint, you should: A) limit your physical examination to the area of pain or injury B) attempt to differentiate between chronic and acute problems C) perform a rapid assessment on all geriatric patients you treat D) rely exclusively on family members for the medical history
B
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) experienced a vasovagal response C) has a gastrointestinal hemorrhage D) has an abdominal aortic aneurysm
B
Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to: A) heart failure B) pneumonia C) osteoporosis D) ischemic stroke
B
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) observe for conditions that might make the residence unsafe C) begin his or her assessment after gathering any medication bottles D) immediately seek out a family member or other caregiver
B
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 injuries C) spinal cord tearing D) severe kyphosis
B
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) suspect severe pneumonia B) administer high flow oxygen C) position the patient supine D) apply a cold pack to his leg
B
a 73 year old female experienced a syncopal episode while watching TV. She is now conscious but diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should suspect: A) acute appendicitis B) an aortic aneurysm C) a strangulated bowel D) myocardial infarction
B
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 is normally alert. When you assess this patient, it is important to note that: A) because of her age and medical history, you should suspect Alzeimer disease B) the patient is experiencing delirious behavior, which suggests a new health problem C) her mental status is likely the result of hypoglycemia and you should give her sugar D) dementia typically presents as an acute onset of deterioration of cognitive function
B
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) pneumonia C) emphysema D) bronchitis
B
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) power of attorney B) advance directive C) physician directive D) statute of care
B
the purpose of the GEMS diamond is to: A) provide the EMT with a standard format for assessing elderly patients B) help EMS personnel remember what is different about elderly patients C) provide clues about an elderly patients problem by observing his or her home D) replace the typical ABC approach to patient care when caring for the elderly
B
the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is known as: A) delusion B) dementia C) paranoia D) delirium
B
when caring for an elderly patient who is hearing impaired, you should: A) remember that most hearing impaired can read lips B) recall that elderly patients have difficulty hearing high frequency sounds C) speak directly into his or her ears with an elevated tone D) request that he or she communicate with you by writing on paper
B
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) transport him or her to a hospital he or she is familiar with C) perform frequent detailed assessments to gain the patients trust D) allow at least two family members to accompany the patient
B
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. Because this patient is probably in shock, what is the MOST likely explanation for the absence of tachycardia? A) intrathoracic bleeding and cardiac compression B) deterioration of the cardiac conduction system C) the effects of her antihypertensive medication D) failure of the parasympathetic nervous system
C
Common causes of depression in the elderly include all of the following, EXCEPT: A) prescription medication use B) alcohol abuse and dependence C) an acute onset of dementia D) chronic medical conditions
C
Patients who have experienced even minor-appearing head injuries should be suspected of having a brain injury, especially if they: A) have minor abrasions to the head area B) do not have deformities to the skull C) are taking blood thinning medications D) have a history of alzheimer disease
C
When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it is MOST important to: A) contact each of the physicians whose name are on the medications B) ask the patient to explain what each medication is used for C) recall that the patient is at risk for negative medication interactions D) look up all of the medications before providing care to the patient
C
When faced with a situation in which an older patient with a terminal illness is in cardiac arrest, but written documentation regarding the patients wishes cannot be located, the EMT should: A) contact medical control for advice B) allow the patient to die in peace C) attempt to resuscitate the patient D) try to locate the documentation
C
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 patients abdomen is swollen B) the patient is prescribed an inhaler C) history of deep venous thrombosis D) frequent urinary tract infections
C
common causes of syncope in older patients include all of the following, EXCEPT: A) acute hypotension B) venous pooling C) vasoconstriction D) blood volume loss
C
in contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when: A) is it signed by 3 or more physicians B) the patient has a terminal illness C) the patient develops cardiac arrest D) the patient is in a healthcare setting
C
in contrast to delirium, dementia: A) often develops over a period of days B) is reversible with certain treatment C) is usually considered irreversible D) is the result of an acute condition
C
the leading cause of death in the geriatric patient is: A) hypertension B) arthritis C) heart disease D) altered mental status
C
the stooped posture of some older people, which gives them a humpback appearance, is called: A) scoliosis B) arthritis C) kyphosis D) miosis
C
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) factually document all findings C) accuse a caregiver of physical abuse D) review the patients activities of daily living
C
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) a subdural hematoma B) hypovolemic shock C) acute hyperglycemia D) a systemic infection
D
During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in: A) an increased risk of COPD B) baseline respiratory distress C) air trapping within the alveoli D) a decreased ability to cough
D
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
D
Many older victims of physical abuse may make false statements or lie about the origin of their injuries because: A) they are protective of the abuser B) most elderly patients have dementia C) they do not want to be bothersome D) they fear retribution from the abuser
D
an elderly patient might understate or minimize the symptoms of his or her illness because: A) the nervous system has deteriorated B) of decreased perception of pain C) of conditions such as dementia D) he or she fears hospitalization
D
osteoporosis is defined as: A) decreased bone marrow production B) increased flexibility of bone mass C) an abnormality near the growth plate D) a decrease in bone mass and density
D
the use of multiple prescription drugs by a single patient, causing the potential for negative effects such as overdosing or drug interaction, is called: A) drug dependency B) potentiation C) drug tolerance D) polypharmacy
D
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) ascertain about a history of atrial fibrillation D) determine the onset of the patients symptoms
D
which of the following is the MOST common mechanism of injury in older patients? A) abuse B) burns C) suicide D) falls
D
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 patients medications have not been filled in 2 months C) elderly patients present atypically and deserve your respect D) the patients residence is cold due to a malfunctioning heater
D