Chapter 35 Geriatric Emergencies

An older person may have a decreased sense of __________________ and ____________ perception from the loss of end nerve fibers.

touch, pain

Neuropathy is a dysfunction of the central nervous system. True or False

False

Respiratory rates in a geriatric patient with chest pain tend to be lower. True or False

False

Anatomic changes that occur as a person ages predisposes geriatric patients to: A.) Airway obstruction B.) Fungal infections C.) Communicable diseases D.) Mental status changes

A.) Airway obstruction

Which of the following statements regarding geriatrics is FALSE? A.) Chronic mental status impairment is a normal process of aging B.) Multiple disease processes and complaints can make assessment complicated C.) Communication may be more complicated with an older adult D.) You should find and account for all patient medications

A.) Chronic mental status impairment is a normal process of aging

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.) Speak slowly and distinctly C.) Give the patient time to respond unless the condition appears urgent D.) Explain what you are doing before you do it

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

The "E" of the GEMS diamond stands for: A.) Environmental assessment B.) Events leading to the incident C.) Extrication of the patient D.) Emergency assessment

A.) Environmental assessment

_____________ and long-term exposure to loud noises are the main factors that contribute to hearing loss. A.) Heredity B.) Injury C.) Infection D.) Medications

A.) Heredity

Which of the following is NOT a factor that affects the development of osteoporosis? A.) Hypertension B.) Smoking C.) Level of activity D.) Alcohol consumption

A.) Hypertension

A drop in blood pressure with a change in position is referred to as: A.) Orthostatic hypotension B.) Metastatic hypotension C.) Malignant hypotension D.) Psychogenic hypotension

A.) Orthostatic hypotension

A patient with leg pain who complains of sudden shortness of breath, tachycardia, fever, chest pain, and a feeling of impending doom is likely experiencing a(n): A.) Pulmonary embolism B.) Pneumonia C.) Myocardial infarction D.) Aortic aneurysm

A.) Pulmonary embolism

Geriatric patient present as a special problem for caregivers because: A.) The classic presentation of disease is often altered B.) Geriatric patients tend not to understand their underlying conditions C.) Their medications are rather difficult to learn D.) The typical diseases of the geriatric population are uncommon

A.) The classic presentation of disease is often altered

All of the following are common specific gastrointestinal problems in older adults EXCEPT: A.) Ulcerative colitis B.) Diverticulitis C.) Peptic ulcer disease D.) Gallbladder disease

A.) Ulcerative colitis

Aneurysm

Abnormal blood-filled dilation of a blood vessel

______________ _____________ are specific legal papers that direct relatives and caregivers about what kinds of medical treatment may be given to patients who cannot speak for themselves.

Advanced directives

_______________ refers to stiffening of the blood vessel wall.

Arteriosclerosis

There is a lower mortality from penetrating trauma in older adults. True or False

False

The heart rate should be in the normal adult rage for a geriatric patient but can be altered by medications such as: A.) Insulin B.) Beta-blockers C.) Alpha-blockers D.) Aspirin

B.) Beta-blockers

Trauma is always isolated to a single issue when you are assessing and caring for a geriatric patient. True or False

False

Which of the following statements about changes to the gastrointestinal system is correct? A.) Gastric secretions are reduced as a person ages B.) Dental loss is not a normal result of the aging process C.) Blood flow to the liver is increased as a person ages D.) Gastric motility increases and results in an increase in gastric emptying

B.) Dental loss is not a normal result of the aging process

All of the following are common predisposing events that can lead to suicide in older adults EXCEPT: A.) Death of a loved one B.) Hallucinations C.) Alcohol abuse D.) Physical illness

B.) Hallucinations

Signs and symptoms of possible abuse include all of the following EXCEPT: A.) Chronic pain with no medical explanation B.) No history of repeated visits to the emergency department or clinic C.) Depression or lack of energy D.) Self-destructive behavior

B.) No history of repeated visits to the emergency department or clinic

All of the following are considered to be reasons for medication noncompliance EXCEPT: A.) Financial challenges B.) Patient disagrees with the diagnosis C.) Impaired cognitive ability D.) Inability to open pill bottles

B.) Patient disagrees with the diagnosis

______________ is the leading cause of death from infection in Americans older than 65 years. A.) Chronic bronchitis B.) Pneumonia C.) Endocarditis D.) Influenza

B.) Pneumonia

An 82-year-old woman has slurred speech, weakness on the left side of her body, visual disturbances, and a headache. This patient is likely to be suffering from a: A.) Myocardial infarction B.) Stroke C.) Diabetic emergency D.) Spinal cord emergency

B.) Stroke

Clues that might indicate elder abuse would include all of the following EXCEPT: A.) Bruises on the buttocks and lower back B.) Weight gain C.) Wounds in various stages of healing D.) Lack of hygiene

B.) Weight gain

____________________ ________________ may help determine if a loss of consciousness occurred before an accident.

Bystander information

Geriatric patients are at risk for _______________, an accumulation of fatty material in the arteries. A.) vasculitis B.) arteriosclerosis C.) artherosclerosis D.) vericose veins

C.) artherosclerosis

Which of the following is NOT one of the leading causes of death in the older population? A.) Heart disease B.) Diabetes C.) AIDS D.) Cancer

C.) AIDS

Changes to the kidney and genitourinary tract in older patients can cause all of the following EXCEPT: A.) Urinary incontinence B.) Urinary retention C.) An increased response to sodium deficiency D.) Enlargement of the prostate

C.) An increased response to sodium deficiency

A patient with an abdominal aortic aneurysm most commonly complains of abdominal pain that radiates to the: A.) Chest B.) Lower legs C.) Back D.) Shoulders

C.) Back

Older pedestrians struck by a vehicle commonly sustain injuries to the: A.) Chest B.) Abdomen C.) Extremities D.) Back

C.) Extremities

Which of the following is NOT a factor that predisposes an older patient to a serious head injury? A.) Long-term abuse of alcohol B.) Recurrent falls C.) Family history D.) Anticoagulant medication

C.) Family history

You are responding to the dementia unit at a nursing home for respiratory distress. When you arrive, you notice that the patient is experiencing mild dyspnea and has an altered mental stutus. What can you do to help determine if the patient's altered mental status is appropriate for her underlying dementia? A.) As long as the patient is alert and able to answer most questions there is no need to determine if this is normal behavior B.) Ask the patient's roommate if this is normal behavior for the patient C.) Find a staff member who can explain the patient's underlying mental status to you D.) Because the patient already has dementia, there is no need to investigate this further

C.) Find a staff member who can explain the patient's underlying mental status to you

Which of the following is NOT considered a common condition of older adults? A.) Hypertension B.) Asthma C.) Gastroenteritis D.) Arthritis

C.) Gastroenteritis

Which of the following is NOT a common stereotype regarding geriatrics? A.) Most older adults have dementia B.) Older adults are hard of hearing C.) Geriatric patients are likely to die on an EMS call D.) Older adults are immobile

C.) Geriatric patients are likely to die on an EMS call

All of the following are true of delirium EXCEPT: A.) It may have metabolic causes B.) The patient may be hypoglycemic C.) It develops slowly over a period of years D.) The memory remains mostly intact

C.) It develops slowly over a period of years

____________ is a progressive disease of the joints that destroys cartilage and leads to joint spurs and stiffness. A.) Osteoporosis B.) Osteosarcoma C.) Osteoarthritis D.) Osteoplegia

C.) Osteoarthritis

The most important piece of information to establish immediately when responding to a skilled nursing facility is determining: A.) When someone last saw the patient B.) Which nurse is overseeing patient care C.) What is wrong with the patient D.) How often this patient is transported to the hospital

C.) What is wrong with the patient

Cataract

Clouding of the lens of the eye

Stereotyping of older adults that often leads to discrimination is called: A.) Geritism B.) Geriographics C.) Oldism D.) Ageism

D.) Ageism

Geriatric patients are commonly found living in all of the following locations EXCEPT: A.) Their homes B.) Nursing homes C.) Skilled nursing home D.) Churches

D.) Churches

Because the brain tissue shrinks with age, older patients are more likely to sustain: A.) Basilar skull fractures B.) Depressed skull fractures C.) Open head injuries D.) Closed head injuries

D.) Closed head injuries

Older adults develop an inability to differentiate colors and have: A.) Increased sensitivity to light B.) Decreased eye movement C.) Decreased daytime vision D.) Decreased night vision

D.) Decreased night vision

The last meal is particularly important in a patient with: A.) Hypertension B.) Myocardial infarction C.) COPD D.) Diabetes

D.) Diabetes

Which of the following statements regarding dementia is FALSE? A.) Patients may have anxiety about going to the hospital B.) Some patients are confused and angry C.) There may be a decreased ability to communicate D.) Due to memory loss, they are able to adapt easily to changes in their daily routine

D.) Due to memory loss, they are able to adapt easily to changes in their daily routine

Which of the following is NOT considered a risk factor for geriatric patients to develop a pulmonary embolism? A.) Paralyzed extremities B.) Sedentary behavior C.) History of heart failure D.) Exercise

D.) Exercise

Burns in elder abuse typically do NOT result from which of the following? A.) Cigarettes B.) Matches C.) Hot liquids D.) Fireplaces

D.) Fireplaces

The alveoli in an older patient's lung tissue can become enlarged and less elastic, making it: A.) Easier to inhale air B.) Harder to inhale air C.) Easier to exhale air D.) Harder to exhale air

D.) Harder to exhale air

A patient experiencing weight gain, fatigue, cold intolerance, drier skin and hair, and a slower heart rate could be suffering from: A.) Hyperglycemia B.) Ketosis C.) Hyperthyroidism D.) Hypothyriodism

D.) Hypothyriodism

Which of the following statements regarding depression is TRUE? A.) Treatment typically involves medication because counseling usually does not work B.) Older adults in skilled nursing facilities are less likely to develop depression C.) It generally does not interfere with ability to function in older adults D.) It is diagnosed three times more commonly in women than in men

D.) It is diagnosed three times more commonly in women than in men

Older adults are more likely to experience burns because of all of the following EXCEPT: A.) Altered mental status B.) Inattention C.) Compromised neurologic status D.) Osteoporosis

D.) Osteoporosis

MRSA is NOT commonly found on which of the following? A.) Decubitus ulcers B.) Feeding tubes C.) Indwelling catheters D.) Patient's charts

D.) Patient's charts

In the presence of a DNR order, if the patient is still alive, you are obligated to provide all of the following supportive measures EXCEPT: A.) Oxygen delivery B.) Pain relief C.) Comfort D.) Resuscitation

D.) Resuscitation

The brain decreases in terms of ______________ and volume as a person ages. A.) length B.) width C.) size D.) weight

D.) weight

Loss of mechanisms to protect the upper airway include increased cough and gag reflexes. True or False

False

Dyspnea

Difficulty breathing

_________________ is a condition in which small pouches protrude from the colon.

Diverticulosis

Syncope

Fainting

Changes in the cardiovascular performance of a geriatric patient are the direct consequence of aging. True or False

False

Decreased liver function makes it easier for the liver to detoxify the blood. True or False

False

Hip fractures are less likely to occur when the patient has osteoporosis. True or False

False

Inflammation of the gallbladder will present with the left upper quadrant pain and fever. True or False

False

Ascites

Fluid in the abdomen

Kyphosis

Forward rounding of the back

Delirium

Inability to focus, think logically, or maintain attention

_________________ ______________ are facilities that serve patients who need 24-hour care; they are sometimes a step down from a hospital.

Nursing homes

______________ is a useful therapy for many geriatric problems, including vague complaints of weakness or dizziness.

Oxygen

______________ is an inflammation/infection of the lung from bacterial, viral, or fungal causes.

Pneumonia

_____________ is the gradual hearing loss that occurs as we age.

Presbycusis

________________ _____________ form when a patient is lying or sitting in the same position for a long time.

Pressure ulcers

Osteoporosis

Reduced bone mass leading to fractures after minimal trauma

Dementia

Slow onset of progressive disorientation

A general complaint of weakness and dizziness can be an indication of something more serious, such as a heart problem or pneumonia. True or False

True

A health care power of attorney is an advance directive that is exercised by a person who has been authorized by the patient to make medical decisions for the patient. True or False

True

Broken bones are common in the geriatric population and should be splinted in a manner appropriate to the injury. True or False

True

Glaucoma, macular degeneration, and retinal detachment can all cause vision problems in the geriatric patient. True or False

True

Irritation of the lining of the stomach or ulcers can cause forceful vomiting that tears the esophagus. True or False

True

Most geriatric suicides occur in people who have recently been diagnosed with depression. True or False

True

Most indoor hypothermia deaths involve geriatric patients. True or False

True

Multiple disease processes and multiple and/or vague complaints can make assessment complicated. True or False

True

Pneumonia and urinary tract infections are common in patients who are bedridden. True or False

True

Some older adults may not take all of their medications to save money. True or False

True

Taste can be diminished in an older patient due to a decrease in the number of taste buds. True or False

True

The "S" in the GEMS diamond stands for social assessment. True or False

True

The blood glucose level will be greater than 600 mg/dL in DKA. True or False

True

The heart hypertrophies with age, likely in response to the chronically increased afterload imposed by stiffened blood vessels. True or False

True

The treatment goal of a stroke is to salvage as much brain tissue as possible. True or False

True

Your first words to the patient and the attitude behind them can gtain or lose a patient's trust. True or False

True

Polypharmacy

Use of multiple medications

Dentures may cause a(n) _____________ _____________ in a patient with an altered level of consciousness.

airway obstruction

Severe blood loss can occur when a(n) _______________ bursts.

aneurysm

When assessing the abdomen, remember that geriatric patients have a _____________ ______________ __________________ and may not show signs of rigidity in abdominal trauma.

flaccid abdominal wall

As you get older, the brain shrinks, leading to higher risk of _______________ ____________ following a minimal mechanism of injury.

head injuries

Patients with ___________ will require padding in order to keep the patient supine.

kyphosis

With ________________ heart failure, fluid backs up into the lungs.

left-sided

Increased _____________ ______________, pulmonary secretions, and the inflammatory effects of infection all interfere with the ability of the alveoli to oxygenate the blood.

mucus production

Using the patient's ____________ shows respect and helps the patient to focus on your questions.

name

Hip fractures are more likely to occur when bones are weakened by _______________ or infection.

osteoporosis

In addition to hip fractures, elderly people with osteoporosis are at risk for _____________ fractures.

pelvic