Geriatric Emergencies (Multiple Choice)
Which of the following questions should you ask if you suspect a patient may have congestive heart failure? -"In what position do you normally sleep?" -"How many pillows do you sleep on?" -"How many hours of sleep do you get each night?" -"Do you take any medication to help you sleep at night?"
"How many pillows do you sleep on?"
Which of the following is a physiologic change that occurs during the process of aging? -Increased elasticity of the alveoli -A gradual decrease in blood pressure -A decline in kidney function -10% to 15% increase in brain weight
A decline in kidney function
Osteoporosis is defined as: -Increased flexibility of bone mass -Decreased bone marrow production -A decrease in bone mass and density -An abnormality near the growth plate
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: -Acute hyperglycemia -A subdural hematoma -Acute ischemic stroke -Diabetic ketoacidosis
A subdural hematoma
You are working on a geriatric patient who reports severe abdominal pain radiating through her back and flank. She also reports discomfort in her right leg and your assessment reveals a diminished pulse in the extremity. What should you suspect? -Pulmonary embolism -Abdominal aortic aneurysm -Venous stasis -Peptic ulcer disease
Abdominal aortic aneurysm
When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do all of the following, EXCEPT: -Factually document all findings -Accuse a caregiver of physical abuse -Ask the patient how the bruises occurred -Review the patient's activities of daily living.
Accuse a caregiver of physical abuse
Which of the following would be part of the "S" component of the GEMS diamond? -Polypharmacy -Normal changes of aging -Hazardous living conditions -Activities of daily living
Activities of daily living
Which of the following is a non-preventable factor in stroke? -Obesity -Atrial fibrillation -Age -Hypertension
Age
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 suspect: -An aortic aneurysm -Acute appendicitis -A strangulated bowel -Myocardial infarction
An aortic aneurysm
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): -Aortic aneurysm -Hemorrhagic stroke -Acute myocardial infarction -Infarction of the large intestine
Aortic aneurysm
A condition that clouds the lens of the eye is called: -Cataract -Nystagmus -Astigmatism -Glaucoma
Cataract
Syncope in the older patient is: -Caused by an interruption of blood flow to the brain -Generally of no concern unless the patient was injured -Most commonly caused by a silent myocardial infarction -Rarely life threatening but should be evaluated by a physician
Caused by an interruption of blood flow to the brain
As a person ages, the heart may enlarge as a result of: -Widespread vascular dilation -Chronically increased afterload -An overall decrease in blood volume -Decreased blood return to the heart
Chronically increased afterload
In arteriosclerosis, overproduction of abnormal collagen and decreased quantities of elastin lead to what? -Decreased coronary artery perfusion -Narrowing pulse pressure -Hypotension -Increased coronary artery perfusion
Decreased coronary artery perfusion
Venous stasis in an older patient creates problems such as superficial phlebitis and ________. -Deep venous thrombosis -Aneurysm -Ascites -Hemoptysis
Deep venous thrombosis
The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is called: -Senility -Delirium -Dementia -Delusion
Dementia
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. You should: -Determine the patient's baseline mental status -Inquire about a history of Alzheimer's disease -Obtain a complete list of the patient's medications -Ask an attendant for the patient's medical records
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: -Suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment -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 -Direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing -Begin assisting her ventilations with a bag-valve mask while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation
Direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing
The LEAST common cause of death in patients over 65 years of age is: -Stroke -Diabetes -Heart attack -Drug overdose
Drug overdose
True or False A geriatric patient with cholecystitis generally presents with left lower quadrant pain and fever.
False
True or False Delirium is the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function.
False
True or False Function of the small and large bowel changes significantly as a consequence of aging.
False
True or False The respiratory rate in an older patient is faster than that of a younger adult.
False
True or False You should remove the patient's dentures when assessing the airway.
False
On auscultation of a patient's lungs, you hear crackles. These lung sounds are caused by air passing through what? -Fluid in the alveoli -Thick secretions in the airways -Constricted airways -Inflamed airways
Fluid in the alveoli
Good general communication techniques with the elderly include: -Using medical terms to ensure patient understanding -Explaining procedures while you are performing them -Frequently asking the patient if he or she understands -Having at least two EMTs talk to the patient at a time.
Frequently asking the patient if he or she understands
The purpose of the GEMS diamond is to: -Help EMS personnel remember what is different about elderly patients -Provide the EMT with a standard format for assessing elderly patients -Replace the typical ABC approach to patient care when caring for the elderly -Provide clues about an elderly patient's problem by observing his or her home
Help EMS personnel remember what is different about elderly patients
Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown? -It has been largely hidden from society -The definitions of abuse and neglect vary -Human resource agencies fail to investigate -Victims of elder abuse are hesitant to report it
Human resource agencies fail to investigate
In contrast to delirium, dementia: -Is usually considered irreversible -Is the result of an acute condition -Is reversible with certain treatment -Often develops over a period of days
Is usually considered irreversible
Which interview technique should you use when addressing a geriatric patient? -Listen carefully to the answers the patient provides -Speak loudly and slowly -Refer to the patient by his first name -Have both you and your partner ask questions
Listen carefully to the answers the patient provides
Which of the following is true regarding delirium? -It is a result of an irreversible metabolic disorder -Memory remains intact -It is rare in older hospitalized patients -It has a slow onset of progressive disorientation
Memory remains intact
Polypharmacy is a term used to describe a patient who takes: -Multiple medications -Other people's medications -A medication more than once a day -Medication only when he or she feels the need to
Multiple medications
Which of the following statements regarding suicide in the older patient is correct? -Older patients tend to use more lethal means than younger patients -Older females have a higher rate of suicide than any other group -Depression and hopeless feelings are often not predisposing factors -Most suicidal patients readily seek care and do not deny the problem.
Older patients tend to use more lethal means than younger patients
Which of the following conditions makes the elderly patient prone to fractures from even minor trauma? -Hypertension -Osteoporosis -Arteriosclerosis -Rheumatoid arthritis
Osteoporosis
You are assessing an 80-year-old patient who explains that he was awakened by a sudden feeling of suffocation and respiratory distress. What are his symptoms a characteristic of? -Exertional dyspnea -Intermittent sleep apnea -Orthopnea -Paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea
A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for: -Heart failure -Bronchitis -Emphysema -Pneumonia
Pneumonia
The use of multiple prescription drugs by a single patient, causing the potential for negative effects such as overdosing or drug interaction, is called: -Potentiation -Polypharmacy -Drug tolerance -Drug dependency
Polypharmacy
When caring for an elderly patient who is hearing impaired, you should: -Speak directly into his or her ear with an elevated tone -Request that he or she communicates with you by writing on paper -Recall that elderly patients often have difficulty hearing high-frequency sounds -Remember that most hearing-impaired patients can read lips
Recall that elderly patients often have difficulty hearing high-frequency sounds
When performing your secondary assessment on an older patient who has been injured, it is important to: -Routinely perform a focused exam to minimize time at the scene -Perform an in-depth physical exam prior to initiating any treatment -Recall that it will take a less severe mechanism of injury to cause significant injuries -Focus your assessment just on the area(s) of pain or obvious injury
Recall that it will take a less severe mechanism of injury to cause significant injuries
Although more typically seen in children, ________ can also cause serious illness in older people, especially those with lung disease or weakened immune systems. -Methicillin-resistant Staphylococcus aureus (MRSA) -Clostridium difficile -Vancomycin-resistant enterococci (VRE) -Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV)
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: -She became dizzy or fainted before falling -She attempted to catch herself before falling -A family member regularly checks up on her -She takes medications for Alzheimer disease
She became dizzy or fainted before falling
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: -There is a high likelihood that she has been abused -Isolated full-thickness burns to the hand are not critical burns -This patient should probably be placed in an assisted-living center -Slowing of reflexes causes a delayed pain reaction in older people
Slowing of reflexes causes a delayed pain reaction in older people
According to the GEMS diamond, a person's activities of daily living are evaluated during the: -SAMPLE history -Social assessment -Medical assessment -Environmental assessment
Social assessment
The EMT should suspect left-sided heart failure in the geriatric patient who presents with: -Fever and a cough that produces green sputum -Swelling of the lower extremities and weakness -Tachypnea & paroxysmal nocturnal dyspnea -Jugular venous distention & peripheral edema
Tachypnea & paroxysmal nocturnal dyspnea
Inflicted bruises are commonly found in all of the following areas, EXCEPT: -The buttocks -The lower back -The inner thighs -The forearms
The forearms
When caring for a geriatric patient with a traumatic injury, it is important to consider that: -Geriatric patients usually present with little to no pain -Decreased bone density often results in incomplete fractures -The injury may have been preceded by a medical condition -Geriatric patients typically present with classic signs of shock.
The injury may have been preceded by a medical condition
In contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when: -The patient has a terminal illness -The patient develops cardiac arrest -The patient is in a health care setting -It is signed by three or more physicians
The patient develops cardiac arrest
Which of the following statements regarding the aging process is correct? -The process of aging is gradual, and the rate at which a person loses functions does not increase with age -Because he or she is younger and healthier, a 35-year-old person ages slower than a 75-year-old person -Human growth and development peaks in the late 40s or early 50s, at which point the aging process sets in -The older a person gets, the slower the decline in the function of vital organs, such as the kidneys and liver.
The process of aging is gradual, and the rate at which a person loses functions does not increase with age
True or False Autonomic nerve neuropathy affects involuntary functions such as blood pressure and heart rate, constipation, and bladder and sexual dysfunction.
True
True or False Forcing an older patient who is short of breath into a supine position may result in respiratory distress or failure.
True
True or False Nearly half of fatal falls in geriatric patients result in traumatic brain injury.
True
Which of the following groups are most likely to commit suicide? -White males older than 85 years -African American women older than 65 years -Teenage girls (any ethnicity) -College-educated males aged 45-65 years
White males older than 85 years