EMT Chapter 35: Geriatric Emergencies
T/F Changes in the cardiovascular performance of a geriatric patient are the direct consequence of aging.
F
T/F Decreased liver function makes it easier for the liver to detoxify the blood.
F
T/F Hip fractures are less likely to occur when the patient has osteoporosis.
F
T/F Inflammation of the gallbladder will present with left upper quadrant pain and fever.
F
T/F Loss of mechanisms to protect the upper airway include increased cough and gag reflexes.
F
T/F Many elderly patients take blood-thinning medications that can help correct internal bleeding.
F
T/F More responsive nerve stimulation may lower the heart rate and the strength of heart contractions.
F
T/F Neuropathy is a dysfunction of the central nervous system.
F
T/F Respiratory rates in an elderly patient with chest pain tend to be lower.
F
T/F There is a lower mortality from penetrating trauma in older adults.
F
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.
T/F 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.
T
T/F Broken bones are common in the geriatric population and should be splinted in a manner appropriate to the injury.
T
T/F Chest pain, shortness of breath, and an altered mental status should always be considered serious.
T
T/F Glaucoma, macular degeneration, and retinal detachment can all cause vision problems in the geriatric patient.
T
T/F Irritation of the lining stomach or ulcers can cause forceful vomiting that tears the esophagus.
T
T/F Most elderly suicides occur in people who have recently been diagnosed with depression.
T
T/F Most indoor hypothermia deaths involve geriatric patients.
T
T/F Multiple disease processes and multiple and/or vague complaints can make assessment complicated.
T
T/F Pneumonia and urinary tract infections are common in patients who are bedridden.
T
T/F Some elderly people may not take all of their medications to save money.
T
T/F Taste can be diminished in an older patient due to a decrease in the number of taste buds.
T
T/F The "S" in the GEMS diamond stands for social assessment.
T
T/F The blood glucose level will be greater than 500mg/dL in DKA.
T
T/F The treatment goal of a stroke is to salvage as much brain tissue as possible.
T
T/F Your first words to the patient and the attitude behind them can gain or lose a patient's trust.
T
Which of the following statements regarding the aging process is correct?
The process of aging is gradual, and the rate at which a person loses functions does not increase with age.
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
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
All of the following are common specific gastrointestinal problems in the elderly except: a. ulcerative colitis b. diverticulitis c. peptic ulcer disease d. gallbladder disease
a
Anatomic changes that occur as a person ages predisposes geriatric patients to: a. airway problems b. fungal infections c. communicable diseases d. mental status changes
a
Geriatric patients 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
In most states, for a DNR to be considered valid it must have been signed within the last: a. 12 months b. 18 months c. 24 months d. DNRs are valid regardless of the timeframe
a
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
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
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
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
_________ 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
Osteoporosis is defined as:
a decrease in bone mass or density
You receive a call for a sick person. When you arrive, you find the patient, a 75-year-old male, lying unresponsive in his bed. His respirations are slow and irregular and his pulse is slow and weak. His daughter tells you that he fell the day before, but refused to allow her to call 9-1-1. His past medical history is significant for hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis. His medications include blood thinners and vitamins. You should be MOST suspicious that this patient is experiencing:
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:
accuse a caregiver of physical abuse.
A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious, but is diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should suspect:
an aortic aneurysm
Severe blood loss can occur when a(n) ________ bursts.
aneurysm
_________ refers to stiffening of the blood vessel wall.
arteriosclerosis
All of the following are common predisposing events that can lead to suicide in the elderly except: a. death of a loved one b. hallucinations c. alcohol abuse d. physical illness
b
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
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 injury
b
Clues that might indicate elderly 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
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
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
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
_______ is the leading cause of death from infection in Americans older than age 65 years. a. chronic bronchitis b. pneumonia c. endocarditis d. influenza
b
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
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
Changes to the kidney and genitourinary tract in elderly 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
Elderly pedestrians struck by a vehicle commonly suffer injuries to the: a. chest b. abdomen c. extremities d. back
c
Geriatric patients are at risk for _________, an accumulation of fatty material in the arteries. a. vasculitis b. arteriosclerosis c. atherosclerosis d. varicose veins
c
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
Which of the following is not a common stereotype regarding geriatrics? a. most elderly people have dementia b. elderly people are hard of hearing c. geriatric patients are likely to die on an EMS call d. elderly people are immobile
c
Which of the following is not considered a common condition of the elderly? a. hypertension b. sinusitis c. gastroenteritis d. arthritis
c
Which of the following is not considered a typical intervention when treating an elderly patient? a. oxygenation b. administration of glucose c. immobilization d. psychological support
c
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
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 status. 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 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
________ 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
Syncope in the older patient is:
caused by an interruption of blood flow to the brain.
As a person ages, the heart may enlarge as a result of:
chronically increased after load
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. hypothyroidism
d
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
Burns in elderly abuse typically result from which of the following? a. cigarettes b. matches c. hot liquids d. all of the above
d
Elderly people are more likely to experience burns because of: a. altered mental status b. inattention c. compromised neurologic status d. all of the above
d
Geriatric patients are commonly found living in all of the following locations except: a. their homes b. nursing homes c. skilled nursing facilities d. churches
d
MRSA is commonly found on which of the following? a. decubitus ulcers b. feeding tubes c. indwelling catheters d. all of the above
d
Older people 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
Stereotyping of elderly people that often leads to discrimination is called: a. geritism b. geriographics c. oldism d. ageism
d
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
The brain decreases in terms of ___________ and volume as a person ages. a. length b. width c. size d. weight
d
The last meal is particularly important in a patient with: a. hypertension b. myocardial infarction c. COPD d. diabetes
d
Which of the following is not considered a risk factor for geriatric patients to develop heart failure? a. hypertension b. coronary artery disease c. atrial fibrillation d. palpitations
d
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
Which of the following statements regarding depression is true? a. treatment typically involves medication, because counseling typically 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 the elderly d. it is diagnosed three times more commonly in women than in men
d
You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The patient is clearly confused and asks you if you are her husband. You should:
determine the patient's baseline mental status.
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:
direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing.
The core body temperature should be assessed to determine the presence of a(n) __________.
fever
Good general communication techniques with the elderly include:
frequently asking the patient if he or she understands
The purpose of the GEMS diamond is to:
help EMS personnel remember what is different about elderly patients.
In contrast to delirium, dementia:
is usually considered irreversible.
With _________ heart failure, fluid backs up into the lungs.
left-sided
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
__________ is a useful therapy for many geriatric problems, including vague complaints of weakness or dizziness.
oxygen
A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for:
pneumonia
_________ is an inflammation/infection of the lung form bacterial, viral, or fungal causes.
pneumonia
The use of multiple prescription drugs by a single patient, causing the potential for negative effects such as overdosing or drug interaction, is called:
polypharmacy
__________ is the gradual hearing loss that occurs as we age.
presbycusis
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.
You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the patient conscious, lying in a recumbent position on the floor in her living room. In addition to providing the appropriate treatment, you should ask the patient if:
she became dizzy or fainted before falling.
When caring for a geriatric patient with a traumatic injury, it is important to consider that:
the injury may have been preceded by a medical condition.
In contrast to a living will, a "do not resuscitate" (DNR) order becomes valid when:
the patient develops cardiac arrest
An older person may have a decreased sense of _________ and _________ perception from the loss of end nerve fibers.
touch, pain
