Chapter 35: Geriatric Emergencies

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? (a) Abdominal aortic aneurysm (b) Peptic ulcer disease (c) Pulmonary embolism (d) Venous stasis

(a) Abdominal aortic aneurysm

Which of the following would be part of the "S" component of the GEMS diamond? (a) Activities of daily living (b) Hazardous living conditions (c) Normal changes of aging (d) Polypharmacy

(a) Activities of daily living

Which of the following is a nonpreventable factor in stroke? (a) Age (b) Atrial fibrillation (c) Hypertension (d) Obesity

(a) Age

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

(a) Decreased coronary artery perfusion

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.

Which of the following statements regarding the aging process is correct? (a) The process of aging is gradual, and 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) The process of aging is gradual, and the rate at which a person loses functions does not increase with 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: (a) an aortic aneurysm. (b) acute appendicitis. (c) a strangulated bowel. (d) myocardial infarction.

(a) an aortic aneurysm.

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.

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: (a) determine the patient's baseline mental status. (b) inquire about a history of Alzheimer's 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 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.

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.

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

(b) Listen carefully to the answers the patient provides.

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

(b) Memory remains intact.

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.

As a person ages, the heart may enlarge as a result of: (a) widespread vascular dilation. (b) chronically increased afterload. (c) an overall decrease in blood volume. (d) decreased blood return to the heart.

(b) chronically increased afterload.

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.

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.

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

(c) "How many pillows do you sleep on?"

Venous stasis in an older patient creates problems such as superficial phlebitis and ________. (a) Ascites (b) Aneurysm (c) Deep venous thrombosis (d) Hemoptysis

(c) Deep venous thrombosis

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

(c) Fluid in the alveoli

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.

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

(c) Respiratory syncytial virus (RSV)

Osteoporosis is 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.

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-valve mask 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.

Good 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.

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.

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.

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? (a) Orthopnea (b) Exertional dyspnea (c) Intermittent sleep apnea (d) Paroxysmal nocturnal dyspnea

(d) Paroxysmal nocturnal dyspnea

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

(d) White males older than 85 years

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.

True or False: A geriatric patient with cholecystitis generally presents with left lower quadrant pain and fever.

False. 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.

True or False: Delirium is the slow onset of progressive disorientation, shortened attention span, and loss of cognitive function.

False. 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.

True or False: You should remove the patient's dentures when assessing the airway.

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

True or False: Function of the small and large bowel changes significantly as a consequence of aging.

False. 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.

True or False: The respiratory rate in an older patient is faster than that of a younger adult.

False. 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.

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.