EMT - Chapter 35: Geriatric Emergencies

Which of the following questions should you ask if you suspect a patient may have congestive heart failure? "How many hours of sleep do you get each night?" "In what position do you normally sleep?" "How many pillows do you sleep on?" "Do you take any medication to help you sleep at night?"

"How many pillows do you sleep on?" The need to sleep on several pillows suggests early congestive heart failure.

urinary tract infection (UTI)

A bacterial infection that affects the urinary tract.

Methicillin-resistant Staphylococcus aureus (MRSA)

A bacterium that causes infections in different parts of the body and is often resistant to commonly used antibiotics; can be found on the skin, in surgical wounds, in the bloodstream, lungs, and urinary tract.

vancomycin-resistant enterococci (VRE)

A bacterium that is normally present in the human intestines and the female reproductive tract, but which can cause infection and which is resistant to the antibiotic vancomycin.

pulmonary embolism

A condition that causes a sudden blockage of the pulmonary artery by a venous clot.

Arteriosclerosis

A disease that causes the arteries to thicken, harden, and calcify.

syncope

A fainting spell or transient loss of consciousness often caused by an interruption of blood flow to the brain.

kyphosis

A forward curling of the back caused by an abnormal increase in the curvature of the spine.

Osteoporosis

A generalized bone disease, commonly associated with postmenopausal women, in which there is a reduction in the amount of bone mass leading to fractures after minimal trauma in either sex.

neuropathy

A group of conditions in which the nerves leaving the spinal cord are damaged, resulting in distortion of signals to or from the brain.

respiratory syncytial virus (RSV)

A highly contagious virus that causes an infection of the upper and lower respiratory system.

Abdominal aortic aneurysm (AAA)

A rapidly fatal condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge.

delirium

A sudden change in mental status marked by the inability to focus, think logically, and maintain attention; this condition is generally acute and reversible.

jugular vein distention

A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or tension pneumothorax.

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 statements regarding the aging process is correct? A. Aging is a linear process; the rate at which a person loses functions does not increase with age. B. Because he or she is younger and healthier, a 35-year-old person ages slower than a 75-year-old person. C. Human growth and development peaks in the late 40s or early 50s, at which point the aging process sets in. D. The older a person gets, the slower the decline in the function of vital organs, such as the kidneys and liver.

A. Aging is a linear process; the rate at which a person loses functions does not increase with age.

Which of the following statements regarding suicide in the older patient is correct? A. Older patients tend to use more lethal means than younger patients. B. Older females have a higher rate of suicide than any other group. C. Depression and hopeless feelings are often not predisposing factors. D. Most suicidal patients readily seek care and do not deny the problem.

A. 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. a decreased ability to cough. B. baseline respiratory distress. C. an increased risk of COPD. D. air-trapping within the alveoli.

A. a decreased ability to cough.

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.

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

A. cataracts.

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. caused by an interruption of blood flow to the brain.

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.

Which of the following is the MOST common mechanism of injury in older patients? A. falls B. burns C. abuse D. suicide

A. falls

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

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

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.

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

A. is often the result of hypertension and atherosclerosis.

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.

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

A. pathologic fracture.

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. physical

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.

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because: Select one: 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. the aging process results in an overall increase in blood volume. D. their red blood cells are destroyed at a faster than normal rate.

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

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

A. use plain language and simple terms.

Which of the following would be part of the "S" component of the GEMS diamond? Activities of daily living Hazardous living conditions Normal changes of aging Polypharmacy

Activities of daily living The "S" in the GEMS diamond stands for "social assessment." Activities of daily living would fall under this category.

Which of the following is a nonpreventable factor in stroke? Age Atrial fibrillation Hypertension Obesity

Age is a nonpreventable factor in stroke.

Aneurysm

An abnormal enlargement of a part of an artery, resulting from weakening of the arterial wall

Peptic Ulcer Disease

An abrasion of the stomach or small intestine.

presbycusis

An age-related condition of the ear that produces progressive bilateral hearing loss that is most noted at higher frequencies.

elder abuse

Any action on the part of an older person's family member, caregiver, or other associated person that takes advantage of the older person's person, property, or emotional state.

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 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.

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. acute hyperglycemia. B. a subdural hematoma. C. acute ischemic stroke. D. diabetic ketoacidosis.

B. a subdural hematoma.

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.

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

B. an acute onset of dementia. Chapter 35, page 1299, Behavioral Emergencies

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 disease.

B. are taking blood-thinning medications.

Because of the complexity of the older patient and the vagueness of his or her complaint, you should: Select one: A. rely exclusively on family members for the medical history. B. attempt to differentiate between chronic and acute problems. C. limit your physical examination to the area of pain or injury. D. perform a rapid assessment on all geriatric patients you treat.

B. attempt to differentiate between chronic and acute problems. Chapter 35, page 1301, Special Considerations in Assessing a Geriatric Medical Patient

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.

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

B. cataracts.

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.

To minimize distractions and confusion when assessing an older patient, you should: A. dismiss the family members from the room or area. B. have only one EMT 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 speak to the patient at a time.

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

B. 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. 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 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.

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

B. pneumonia. Chapter 35, page 1285, Common Complaints and the Leading Causes of Death in Older People

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. potentiation. B. polypharmacy. C. drug tolerance. D. drug dependency.

B. polypharmacy.

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

B. renal insufficiency.

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

B. renal insufficiency.

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.

The EMT should suspect left-sided heart failure in the geriatric patient who presents with: Select one: 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. Chapter 35, pages 1288-1289, Changes in the Cardiovascular System

In contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when: A. the patient has a terminal illness. B. the patient develops cardiac arrest. C. the patient is in a health care setting. D. it is signed by three or more physicians.

B. 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: A. because of her age and medical history, you should suspect Alzheimer 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. the patient is experiencing delirious behavior, which suggests a new health problem.

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: Select one: A. because of her age and medical history, you should suspect Alzheimer 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. the patient is experiencing delirious behavior, which suggests a new health problem.

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 older 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.

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.

melena

Black, foul-smelling, tarry stool containing digested blood.

Which of the following statements are true about hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? It causes ketosis. Blood glucose levels are typically 600 mg/dL or higher. It presents with Kussmaul respirations. The signs and symptoms of HHNS and DKA often overlap.

Blood glucose levels are typically 600 mg/dL or higher. The signs and symptoms of HHNS and DKA often overlap. Correct. In HHNS, blood glucose levels are typically 600 mg/dL or higher and the signs and symptoms of HHNS and DKA often overlap.

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

Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown? A. It has been largely hidden from society. B. The definitions of abuse and neglect vary. C. Human resource agencies fail to investigate. D. Victims of elder abuse are hesitant to report it.

C. Human resource agencies fail to investigate.

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

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

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.

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): Select one: A. statute of care. B. physician directive. C. advance directive. D. power of attorney.

C. advance directive.

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

C. an acute onset of dementia.

When assessing a 78-year-old female who complains of shortness of breath, the EMT 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 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. 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.

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.

General communication techniques with the elderly include: A. using medical terms to ensure patient understanding. B. explaining procedures while you are performing them. C. frequently asking the patient if he or she understands. D. having at least two EMTs talk to the patient at a time.

C. frequently asking the patient if he or she understands.

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: A. diabetic ketoacidosis. B. hyperglycemia with moderate dehydration. C. hyperosmolar hyperglycemic nonketotic coma (HHNC). D. acute renal failure with associated hyperglycemia.

C. hyperosmolar hyperglycemic nonketotic coma (HHNC).

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: Select one: A. acute renal failure with associated hyperglycemia. B. hyperglycemia with moderate dehydration. C. hyperosmolar hyperglycemic nonketotic syndrome. D. diabetic ketoacidosis.

C. 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.

C. is often the result of hypertension and atherosclerosis.

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.

Talking about an elderly patient in front of him or her to other members of the family: Select one: A. is usually beneficial because the patient's cognitive skills are typically impaired. 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. often causes the patient to become paranoid and untrusting of your help.

C. may cause the patient to think that he or she has no say in making decisions.

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.

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

C. physical

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

C. place blankets behind the patient's head.

When performing your secondary assessment on an older patient who has been injured, it is important to: A. routinely perform a focused exam to minimize time at the scene. B. perform an in-depth physical exam prior to initiating any treatment. C. recall that it will take a less severe mechanism of injury to cause significant injuries. D. focus your assessment just on the area(s) of pain or obvious injury.

C. recall that it will take a less severe mechanism of injury 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.

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. deterioration of the cardiac conduction system B. intrathoracic bleeding and cardiac compression C. the effects of her antihypertensive medication D. failure of the parasympathetic nervous system

C. the effects of her antihypertensive medication

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.

cataracts

Clouding of the lens of the eye or its surrounding transparent membranes.

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.

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

D. a decreased ability to cough. Chapter 35, page 1286, Changes in the Respiratory System

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: Select one: A. acute hyperglycemia. B. a subdural hematoma. C. hypovolemic shock. D. a systemic infection.

D. a systemic infection. Chapter 35, pages 1295-1296, Changes in the Immune System

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. statute of care. B. power of attorney. C. physician directive. D. advance directive.

D. advance directive.

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.

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

D. heart disease.

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.

Venous stasis in an older patient creates problems such as superficial phlebitis and ________. Ascites Aneurysm Deep venous thrombosis Hemoptysis

DVT Correct. Venous stasis in an older patient creates problems such as superficial phlebitis and deep venous thrombosis, which can lead to pulmonary embolism.

In arteriosclerosis, overproduction of abnormal collagen and decreased quantities of elastin lead to what? Decreased coronary artery perfusion Increased coronary artery perfusion Narrowing pulse pressure Hypotension

Decreased coronary artery perfusion Overproduction of abnormal collagen and decreased quantities of elastin lead to decreased coronary artery perfusion.

A geriatric patient with cholecystitis generally presents with left lower quadrant pain and fever.TrueFalse

False Correct. A geriatric patient with diverticulitis generally presents with left lower quadrant pain and fever. Patients with inflammation of the gallbladder (cholecystitis) will have fever and right upper quadrant pain that may radiate to the shoulder.

Delirium is the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function. TrueFalse

False Correct. Dementia is the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function. Delirium is a sudden change in mental status, consciousness, or cognitive processes, and is marked by the inability to focus, think logically, and maintain attention.

You should remove the patient's dentures when assessing the airway.TrueFalse

False Correct. Dentures should not be removed unless they obstruct the airway or interfere with ventilation when rescue breathing is needed.

Function of the small and large bowel changes significantly as a consequence of aging.TrueFalse

False Correct. Function of the small and large bowel changes little as a consequence of aging, although the incidence of certain diseases involving the bowel (such as diverticulosis) increases as a person grows older.

The respiratory rate in an older patient is faster than that of a younger adult.TrueFalse

False Correct. The respiratory rate should be in the same range as in a younger adult, but chest rise will be compromised by increased chest wall stiffness.

Which of the following is true regarding delirium? It has a slow onset of progressive disorientation. Memory remains intact. It is a result of an irreversible metabolic disorder. It is rare in older hospitalized patients.

In delirium, memory generally remains intact.

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? Orthopnea Exertional dyspnea Intermittent sleep apnea Paroxysmal nocturnal dyspnea

PND Paroxysmal nocturnal dyspnea is a condition that is characterized by a sudden attack of respiratory distress that wakes the person at night when the patient is in a reclining position. The respiratory distress is caused by fluid accumulation in the lungs.

Although more typically seen in children, ________ can also cause serious illness in older people, especially those with lung disease or weakened immune systems. Clostridium difficile Methicillin-resistant Staphylococcus aureus (MRSA) Respiratory syncytial virus (RSV) Vancomycin-resistant enterococci (VRE)

RSV Correct. Although more typically seen in children, RSV can also cause serious illness in older people, especially those with lung disease or weakened immune systems.

dyspnea

Shortness of breath or difficulty breathing.

geriatrics

The assessment and treatment of disease in someone who is 65 years or older.

Which interview technique should you use when addressing a geriatric patient? Speak loudly and slowly. Listen carefully to the answers the patient provides. Refer to the patient by his first name. Have both you and your partner ask questions.

The best thing you can do is listen carefully to the answers the patient provides.

deep venous thrombosis

The formation of a blood clot within the larger veins of an extremity, typically following a period of prolonged immobilization.

dementia

The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function; this condition is generally chronic and irreversible.

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? Abdominal aortic aneurysm Peptic ulcer disease Pulmonary embolism Venous stasis

These signs are indicative of an abdominal aortic aneurysm (AAA).

Autonomic nerve neuropathy affects involuntary functions such as blood pressure and heart rate, constipation, and bladder and sexual dysfunction.TrueFalse

True Correct. Autonomic nerve neuropathy affects involuntary functions such as blood pressure and heart rate, constipation, and bladder and sexual dysfunction.

Forcing an older patient who is short of breath into a supine position may result in respiratory distress or failure. TrueFalse

True Correct. Forcing an older patient who is short of breath into a supine position may result in respiratory distress or failure.

Nearly half of fatal falls in geriatric patients result in traumatic brain injury. TrueFalse

True Correct. Nearly half of fatal falls in geriatric patients result in traumatic brain injury.

Which of the following groups are most likely to commit suicide? Teenage girls (any ethnicity) African American women older than 65 years College-educated males aged 45-65 years White males older than 85 years

White males older than the age of 85 years are at the highest risk for suicide.

Advance directives

Written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions; also called a living will or health care directive.

On auscultation of a patient's lungs, you hear crackles. These lung sounds are caused by air passing through what? Constricted airways Thick secretions in the airways Fluid in the alveoli Inflamed airways

You will hear crackles when there is fluid in the lungs and alveoli.

Atherosclerosis

an accumulation of fat and cholesterol in the arteries

penumonia

an inflammation of the lung from a bacterial, viral, or fungal cause

hemoptysis

coughing up blood

Ascites

fluid in the abdomen

decubitus ulcer

sores caused by the pressure of skin against a surface for long periods; can range from a pink discoloration of the skin to a deep wound that may invade into bone or organs; also known as bedsores

polypharmacy

the use of multiple medications on a regular basis