Chapter 35 - Geriatric Emergencies

Liver, spleen, pancreas, and kidneys

A

Shoulder pain caused by blood irritating the diaphragm is caused by A. Kehr sign. C. Starling's law. B. Babinsky sign. D. none of the above.

A

The abdominal cavity is separated from the chest cavity by the A. diaphragm. B. stomach. C. lower ribs. D. pelvis.

A

Which of the following is generally NOT acceptable when interviewing an older patient? Select one: 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.

During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in: Select one: 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 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. advance directive. B. physician directive. C. power of attorney. D. statute of care.

A. advance directive.

The "E" of the GEMS diamond stands for: Select one: A. environmental assessment. B. events leading to the incident. C. extrication of the patient. D. emergency assessment.

A. environmental assessment.

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. dismiss the family members from the room or area. C. elevate your voice and speak directly to the patient. D. perform a physical exam and then talk to the patient.

A. 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. kyphosis. B. arthritis. C. scoliosis. D. miosis.

A. kyphosis.

A drop in blood pressure with a change in position is referred to as: Select one: A. orthostatic hypotension. B. metastatic hypotension. C. malignant hypotension. D. psychogenic hypotension.

A. orthostatic hypotension.

Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse. Select one: 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: Select one: A. pneumonia. B. osteoporosis. C. heart failure. D. ischemic stroke.

A. pneumonia.

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. their red blood cells are destroyed at a faster than normal rate. D. the aging process results in an overall increase in blood volume.

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

Geriatric patients present as a special problem for caregivers because: Select one: 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.

Pain in the shoulder

B

Your patient is the driver of a car that was hit head on. You find her lying on the sidewalk with her knees drawn toward her chest. She has no specific complaints. You suspect A. little or no injury because she has gotten out of the car. B. abdominal trauma due to mechanism of injury and positioning. C. cavitational injuries due to mechanism of injury. D. paradoxical motion due to patient positioning.

B

Which of the following observations or statements represents the "E" in the GEMS diamond? Select one: 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

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. The patient's residence is cold due to a malfunctioning heater. C. Elderly patients present atypically and deserve your respect. D. The patient's medications have not been filled in 2 months.

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

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. perform a rapid assessment on all geriatric patients you treat. D. limit your physical examination to the area of pain or injury.

B. attempt to differentiate between chronic and acute problems.

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

B. cataracts.

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

B. cataracts.

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

B. heart disease.

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

B. hyperosmolar hyperglycemic nonketotic syndrome.

Talking about an elderly patient in front of him or her to other members of the family: Select one: 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.

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. 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.

Because of the complexity of the older patient and the vagueness of his or her complaint, you should: Select one: 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.

B. rely exclusively on family members for the medical history.

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: 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.

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. swelling of the lower extremities and weakness. D. jugular venous distention and peripheral edema.

B. tachypnea and paroxysmal nocturnal dyspnea.

Abdominal aorta and inferior vena cava

C

Management of a female patient who has suffered a laceration to the genital area will include all of the following except A. direct pressure. C. vaginal packing. B. use of a moistened sanitary pad. D. assessment for hypoperfusion.

C

The damage that results from ruptured hollow abdominal organs is A. treatable in the field. C. caused by acids and bacteria. B. caused by profuse bleeding. D. non-life-threatening.

C

Which is the most common cause of blunt abdominal trauma? A. gunshot wounds B. assaults C. motor vehicle crashes D. falls

C

Your patient with evisceration becomes tachycardic, cool, and hypotensive during transport; your next action should be to A. replace the dressing. B. support the injury with the patient's arm. C. reevaluate priority status and expedite transport. D. loosen one corner of the dressing.

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? Select one: 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.

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

C. a decreased ability to cough.

Common causes of depression in the elderly include all of the following, EXCEPT: Select one: 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.

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

C. hyperosmolar hyperglycemic nonketotic syndrome.

An abdominal aortic aneurysm: Select one: 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.

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

C. kyphosis.

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

C. 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. heart failure. C. pneumonia. D. osteoporosis.

C. pneumonia.

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because: Select one: 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 body is less able to adapt the BP to rapid postural changes. D. any change in position causes blood to be shunted to the brain.

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

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. her mental status is likely the result of hypoglycemia and you should give her sugar. B. because of her age and medical history, you should suspect Alzheimer disease. C. the patient is experiencing delirious behavior, which suggests a new health problem. D. dementia typically presents as an acute onset of deterioration of cognitive function.

C. the patient is experiencing delirious behavior, which suggests a new health problem.

Abdominal aortic aneurysm may cause the pulses of the lower extremity to A. be weaker than the upper extremities. C. be absent. B. be different on either side. D. all of the above.

D

All of the following are hollow organs except the A. stomach. B. gallbladder. C. urinary bladder. D. liver.

D

Management of an injury caused by blunt trauma to the scrotum may include A. direct pressure. C. oxygen. B. cold compresses. D. all of the above.

D

Protrusion of the abdominal organs

D

Which of the following statements regarding depression is true? Select one: 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. It is diagnosed three times more commonly in women than in men.

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. hypovolemic shock. C. a subdural hematoma. D. a systemic infection.

D. a systemic infection.

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. hypovolemic shock. B. acute hyperglycemia. C. a subdural hematoma. D. a systemic infection.

D. a systemic infection.

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. power of attorney. C. physician directive. D. advance directive.

D. advance directive.

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

D. an acute onset of dementia.

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.

D. dementia typically presents as an acute onset of deterioration of cognitive function.

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.

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. often causes the patient to become paranoid and untrusting of your help. C. will anger the patient and result in his or her refusal to accept care or transport. D. may cause the patient to think that he or she has no say in making decisions.

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

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

D. physical

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

D. renal insufficiency.

Upon arrival at the residence of an elderly female who apparently fainted, you find the pt lying supine on her living room floor. She is not moving & her eyes are closed. A neighbor tells you that she found the pt this way but did not move her. When you gently tap the pt, She does not respond. You should:

Direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing.

Part of the secondary assessment

E

Retroperitoneal organs

F

Inflammation of the peritoneal lining

G

The inner lining of the peritoneum

H

Assess airway, breathing, and circulation

I

During inhalation moves down by as much as 3 inches

J

You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the pt conscious, lying in a recumbent position on the floor in her living room. In addition to providing the appropriate treatment, you should ask the pt if:

She became dizzy or fainted before falling.

Osteoporosis is defined as: A. increased flexibility of bone mass. B. decreased bone marrow production. C. a decrease in bone mass & density. D. an abnormality near the growth plate.

a decrease in bone mass & density.

When assessing an older pt 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 pt how the bruises occurred. D. review the pt's activities of daily living.

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, & hypotensive. Your assessment reveals abdominal tenderness & a pulsating tenderness & 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

an aortic aneurysm

Syncope in the older pt is: A. caused by an interruption of blood flow to the brain. B. generally of no concern unless the pt was injured. C. most commonly caused by a silent myocardial infarction. D. rarely life threatening but should be evaluated by a physician.

caused by an interruption of blood flow to the brain.

As a person ages, the heart may enlarge as a result of: A. widespread vascular dilation. B. chronically increased after load. C. an overall decrease in blood volume. D. decreased blood return to the heart.

chronically increased after load.

You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The pt is clearly confused & asks you if you are her husband. You should: A. determine the pt's baseline mental status. B. inquire about a history of Alzheimer's disease. C. obtain a complete list of the pt's medications. D. ask an attendant for the pt's medical records.

determine the pt's baseline mental status.

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

frequently asking the pt if he or she understands.

The purpose of the GEMS diamond is to: A. help EMS personnel remember what is different about elderly pt's. B. provide the EMT with a standard format for assessing elderly pt. C. replace the typical ABC approach to pt care when caring for the elderly.

help EMS personnel remember what is different about elderly pt's.

Which of the following statements is NOT a reason why the exact extent & prevalence of elder abuse is unknown? A. it has been largely hidden from society. B. the definition of abuse & neglect vary. C. human resources agencies fail to investigate. D. victims of elder abuse are hesitant to report it.

human resources agencies fail to investigate.

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.

is usually considered irreversible.

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

older pt's tend to use more lethal means than younger pt's.

A productive cough, fever, and chills in an 80-year-old pt with a compromised immune system should make you MOST suspicious for: A. heart failure B. bronchitis C. emphysema D. pneumonia

pneumonia

The use of multiple prescription drugs by a single pt, causing the potential for negative effects such as overdosing or drug interaction, is called: A. potentiation B. polypharmacy C. drug tolerance D. drug dependency

polypharmacy

When performing your secondary assessment on an older pt 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.

recall that it will take a less severe mechanism of injury to cause significant injuries.

When caring for a geriatric pt with traumatic injury, it is important to consider that: A. geriatric pt's 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 pmts typically present with classic signs of shock.

the injury may have been preceded by a medical condition.

Which of the following statements regarding the aging process is correct? A. the process of aging is gradual, & the rate at which a person loses functions does not increase with age. B. because he/she is younger & healthier, a 35-year-old person ages slower than a 75-years-old person. C. human growth & developmental peaks in the late 40s or early 50s, at which point the aging process sets in.

the process of aging is gradual, & the rate at which a person loses functions does not increase with age.

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

the pt develops cardiac arrest.