Chapter 33
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 patient's level of consciousness.
A) A decreased level of consciousness is not a normal part of the aging process.
Which of the following would you MOST likely encounter during your assessment of an uninjured elderly patient's neck and back? A) Severe kyphosis B) Point tenderness C) Spinal instability D) Vertebral deformity
A) Severe kyphosis
Hip fractures in the elderly commonly involve injury to all of the following structures, EXCEPT the: A) acetabulum. B) femoral neck. C) femoral head. D) proximal femur.
A) acetabulum.
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) an aortic aneurysm. B) acute appendicitis. C) a strangulated bowel. D) myocardial infarction.
A) an aortic aneurysm.
When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, it is MOST important to: A) determine the onset of the patient's symptoms. B) ascertain about a history of atrial fibrillation. C) administer 324 mg of aspirin as soon as possible. D) determine if the patient has risk factors for a stroke.
A) determine the onset of the patient's symptoms.
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) determine the patient's baseline mental status. B) inquire about a history of Alzheimer disease. C) obtain a complete list of the patient's medications. D) ask an attendant for the patient's medical records.
A) determine the patient's baseline mental status.
The leading cause of trauma, death, and disability in the elderly is: A) falls. B) burns. C) abuse. D) suicide.
A) falls.
The purpose of the GEMS diamond is to: A) help EMS personnel remember what is different about elderly patients. B) provide the EMT with a standard format for assessing elderly patients. C) replace the typical ABC approach to patient care when caring for the elderly. D) provide clues about an elderly patient's problem by observing his or her home.
A) help EMS personnel remember what is different about elderly patients.
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.
The stooped posture of some older people, which gives them a humpback appearance, is called: A) kyphosis. B) arthritis. C) scoliosis. D) miosis.
A) kyphosis.
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) arthritic joints and high-energy trauma. D) acetabular separation and severe falls.
A) osteoporosis and low-energy trauma.
Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to: A) pneumonia. B) osteoporosis. C) heart failure. D) ischemic stroke.
A) pneumonia.
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) ask the patient to explain what each of the medications is used for. C) look up all of the medications before providing care to the patient. D) contact each of the physicians whose names are on the medications.
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 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.
Common signs and symptoms of an infection in the elderly patient include all of the following, EXCEPT: A) slow, weak pulse B) cough or chills. C) hot, flushed skin. D) burning with urination.
A) slow, weak pulse
Which of the following statements regarding the aging process is correct?
Aging is a linear process; the rate at which a person loses functions does not increase with age.
When taking an elderly patient's blood pressure in a supine position, a drop in the systolic blood pressure of more than ___ mm Hg when he or she sits or stands up suggests dehydration. A) 5 B) 10 C) 15 D) 20
B) 10
Causes of delirium in the older patient include all of the following, EXCEPT: A) acute hypovolemia. B) Alzheimer disease. C) low blood sugar level. D) decreased cerebral perfusion.
B) Alzheimer disease.
Which of the following statements regarding altered mental status in the elderly is MOST correct? A) Acute psychotic episodes are the most common causes of altered mental status. B) Alzheimer's disease patients should not experience an acute mental status change. C) Most causes of altered mental status in the elderly population are not reversible. D) Altered mental status secondary to hyperglycemia can be reversed by the EMT-B.
B) Alzheimer's disease patients should not experience an acute mental status change.
Which of the following observations or statements represents the "E" in the GEMS diamond? A) Elderly patients present atypically and deserve your respect. B) The patient's residence is cold due to a malfunctioning heater. 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.
B) The patient's residence is cold due to a malfunctioning heater.
When assessing an older patient 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 patient how the bruises occurred. D) review the patient's activities of daily living.
B) accuse a caregiver of physical abuse.
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) are taking blood-thinning medications. C) do not have deformities to the skull. D) have a history of Alzheimer's disease.
B) are taking blood-thinning medications.
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) try to locate the documentation. B) attempt to resuscitate the patient. C) allow the patient to die in peace. D) contact medical control for advice.
B) attempt to resuscitate the patient.
An older patient with significant dehydration would MOST likely present with: A) an increase in blood pressure upon standing. B) dizziness or fainting upon standing. C) weakness to one side of the body. D) a drop in heart rate upon standing.
B) dizziness or fainting upon standing.
The MOST effective way to monitor an elderly patient's level of consciousness is to: A) assess his or her response to pain. B) frequently converse with him or her. C) assess the pupils on a frequent basis. D) remind him or her of the time and date.
B) frequently converse with him or her.
To minimize distractions and confusion when assessing an elderly patient, you should: A) dismiss the family members from the room or area. B) have only one EMT-B speak to the patient at a time. C) elevate your voice and speak directly to the patient. D) perform a physical exam and then talk to the patient.
B) have only one EMT-B speak to the patient at a time
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) may cause the patient to think that he or she has no say in making decisions. C) will anger the patient and result in his or her refusal to accept care or transport. D) is usually beneficial because the patient's cognitive skills are typically impaired.
B) 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) immediately seek out a family member or other caregiver. B) observe for conditions that may make the residence unsafe. C) begin his or her assessment after gathering any medication bottles. D) talk to the patient after performing his or her primary assessment.
B) observe for conditions that may make the residence unsafe.
When immobilizing a patient with a kyphotic spine to a long backboard, the EMT-B would MOST likely have to: A) force the head into a neutral alignment. B) place blankets behind the patient's head. C) secure the patient's head before the torso. D) use a scoop stretcher instead of a log roll.
B) place blankets behind the patient's head.
The EMT should suspect left-sided heart failure in the geriatric patient who presents with: A) fever and a cough that produces green sputum. B) tachypnea and paroxysmal nocturnal dyspnea. C) jugular venous distention and peripheral edema. D) swelling of the lower extremities and weakness.
B) tachypnea and paroxysmal nocturnal dyspnea.
A "silent" heart attack occurs when: A) sweating is the only presentation. B) the usual chest pain is not present. C) a sudden dysrhythmia causes death. D) the patient minimizes the chest pain.
B) the usual chest pain is not present.
When transporting a stable elderly patient to the hospital, the MOST effective way to reduce his or her anxiety is to: A) allow at least two family members to accompany the patient. B) transport him or her to a hospital that he or she is familiar with. C) avoid the use of a long backboard, even if trauma is suspected. D) perform frequent detailed assessments to gain the patient's trust.
B) transport him or her to a hospital that he or she is familiar with.
The MOST effective way to gain an elderly patient's trust and confidence is to: A) perform a detailed physical exam, regardless of the problem. B) treat the patient with respect and explain what you are doing. C) frequently reassure him or her that everything will be alright. D) address the patient by his or her first name to reduce anxiety.
B) treat the patient with respect and explain what you are doing.
Common causes of syncope in older patients include all of the following, EXCEPT: A) venous pooling. B) vasoconstriction. C) acute hypotension. D) blood volume loss.
B) vasoconstriction.
Osteoporosis is MOST accurately defined as: A) increased flexibility of bone mass. B) decreased bone marrow production. C) a decrease in bone mass and density. D) an abnormality near the growth plate.
C) a decrease in bone mass and density.
Which of the following patients is at highest risk for a pulmonary embolism? A) 59-year-old male who is recovering from pneumonia B) 66-year-old active female with a history of hypertension C) 71-year-old male with recent surgery to a lower extremity D) 78-year-old female who takes blood thinning medications
C) 71-year-old male with recent surgery to a lower extremity
When assessing a 78-year-old female who complains of shortness of breath, the EMT-B should: A) give oxygen only if the patient has labored breathing. B) conclude that the patient is experiencing a heart attack. C) ask her how many pillows she uses when she sleeps. D) place the patient supine to see if the problem worsens.
C) ask her how many pillows she uses when she sleeps.
Because of the complexity of the geriatric patient and the vagueness of his or her complaint, you should: A) limit your physical examination to the area of pain or injury. B) rely exclusively on family members for the medical history. C) attempt to differentiate between chronic and acute problems. D) perform a rapid assessment on all geriatric patients you treat.
C) attempt to differentiate between chronic and acute problems.
To obtain an accurate medical history when assessing an elderly patient, the EMT-B must: A) ask detailed questions about his or her history. B) always obtain medical history data from the family. C) be patient and have effective communication skills. D) contact the patient's physician to obtain information.
C) be patient and have effective communication skills.
The MOST common type of spinal injury seen in the elderly population, which may occur from relatively minor trauma, is a: A) burst fracture. B) distraction injury. C) compression fracture. D) vertebral dislocation.
C) compression fracture.
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) 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-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.
Motor nerve neuropathy is characterized by: A) numbness, tingling, and severe muscle pain. B) loss of bladder control and sensitivity to touch. C) loss of balance, muscle weakness, and spasms. D) constipation, low blood pressure, and bradycardia.
C) loss of balance, muscle weakness, and spasms.
Findings during the social assessment of an older patient include all of the following, EXCEPT: A) interaction with others. B) daily activity assistance. C) outdated medications. D) delays in obtaining meals.
C) outdated medications.
When determining whether to perform a focused physical exam or a rapid trauma assessment on an injured elderly patient, you should: A) routinely perform a focused exam to minimize time at the scene. B) perform a detailed physical exam prior to initiating any treatment. C) recall that it will take less of an MOI to cause significant injuries. D) focus your assessment just on the area(s) of pain or obvious injury.
C) recall that it will take less of an MOI to cause significant injuries.
In contrast to younger patients, older patients are more prone to a decrease in blood pressure upon standing because: A) their red blood cells are destroyed at a faster than normal rate. B) the aging process results in an overall increase in blood volume. C) the baroreceptors have become less sensitive to blood pressure. D) any change in position causes blood to be shunted to the brain.
C) the baroreceptors have become less sensitive to blood pressure.
When caring for a geriatric patient with a traumatic injury, it is important to consider that: A) geriatric patients 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 patients typically present with classic signs of shock.
C) the injury may have been preceded by a medical condition.
Which of the following is the BEST example of a question to ask an elderly patient with chest pain? A) "Does the pain radiate to your arm?" B) "Is the pain sharp, dull, or stabbing?" C) "Does it feel like a pressure sensation?" D) "Can you describe how the pain feels?"
D) "Can you describe how the pain feels?"
Which of the following statements regarding communications with the elderly is correct? A) The majority of elderly patients are hearing or visually impaired. B) Attempt to calm the elderly patient by using his or her first name. C) Explain the justification for a procedure after it has been completed. D) Older patients have difficulty understanding when they are stressed.
D) Older patients have difficulty understanding when they are stressed.
Which of the following statements regarding an elderly patient's vital signs is MOST correct? A) Systolic blood pressure typically decreases by 1 mm Hg per year. B) The patient's pupils usually become more briskly reactive with age. C) Most patients over 65 years of age normally have an irregular pulse. D) Some drugs may prevent the heart rate from increasing when needed.
D) Some drugs may prevent the heart rate from increasing when needed.
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) document his or her perceptions of the event. C) list the names of all of the suspected abusers. D) avoid documenting any unsupported opinions.
D) avoid documenting any unsupported opinions.
The chief component of connective tissues and bones that deteriorates as people age is called: A) fibrin. B) elastin. C) sebum. D) collagen.
D) collagen.
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) severe kyphosis. B) distracting injuries. C) spinal cord tearing. D) compression fractures.
D) compression fractures.
The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is known as: A) delirium. B) delusion. C) paranoia. D) dementia.
D) dementia.
An elderly patient may 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) he or she fears hospitalization.
A 10% to 20% reduction in brain weight and volume would MOST likely increase an older person's risk for: A) stroke. B) delirium. C) dementia. D) head trauma.
D) head trauma.
The leading cause of death in the geriatric patient is: A) hypertension. B) altered mental status. C) arthritis. D) heart disease.
D) heart disease.
A geriatric patient's chief complaint: A) is typically grossly obvious to the EMT-B. B) is usually related to a single disease process. C) usually presents with fairly classic symptoms. D) may be an exacerbation of a chronic problem.
D) may be an exacerbation of a chronic problem.
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) bronchitis. C) emphysema. D) pneumonia.
D) pneumonia.
When caring for an elderly patient who is hearing-impaired, you should: A) speak directly into his or her ear with an elevated tone. B) remember that most hearing-impaired patients can read lips. C) request that he or she communicates with you by writing on paper. D) recall that elderly patients have difficulty hearing high-frequency sounds.
D) recall that elderly patients have difficulty hearing high-frequency sounds.
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) they do not want to be bothersome. C) most elderly patients have dementia. D) they fear retribution from the abuser.
D) they fear retribution from the abuser.
Relatively minor hyperextension injuries to the spine can result in central cord syndrome, a dysfunction characterized by: A) permanent absence of sensory and motor functions to one side of the body. B) absent or weak sensory function more pronounced in the lower extremities. C) temporarily disabled sensory and motor functions in the lower extremities. D) weak or absent motor function more pronounced in the upper extremities.
D) weak or absent motor function more pronounced in the upper extremities.
Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown?
Human resource agencies fail to investigate
Which of the following statements regarding suicide in the older patient is correct?
Older patients tend to use more lethal means than younger patients.
During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in:
a decreased ability to cough
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 subdural hematoma
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 an:
advance directive
Clouding of the lenses of the eyes is called:
cataracts
Syncope in the older patient is:
caused by an interruption of blood flow to the brain
What is the MOST common mechanism of injury in older patients?
falls
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:
hyperosmolar hyperglycemic nonketotic coma (HHNC).
An abdominal aortic aneurysm:
is often the result of hypertension and atherosclerosis.
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:
pathologic fracture
Poor maintenance of home, poor personal care, and dietary neglect are all possible indications of ____________ elder abuse.
physical
When performing your secondary assessment on an older patient who has been injured, it is important to:
recall that it will take a less severe mechanism of injury to cause significant injuries
In contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when:
the patient develops cardiac arrest
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:
the patient is experiencing delirious behavior, which suggests a new health problem
When explaining the need for a particular procedure to an elderly patient, you should:
use plain language and simple terms