Chapter 44

Which of the following statements regarding Alzheimer disease is NOT correct? Select one: A. Alzheimer disease is likely not a part of the normal process of aging. B. Age alone is thought to be the underlying cause of Alzheimer disease. C. The symptoms of Alzheimer disease are generally obvious at its onset. D. Common signs of Alzheimer disease include paranoia and delusions.

Age alone is thought to be the underlying cause of Alzheimer disease.

Which of the following cardiac dysrhythmias is associated with the highest risk of stroke? Select one: A. AV heart block B. Sinus tachycardia C. Junctional rhythm D. Atrial fibrillation

Atrial fibrillation

The son of a 76-year-old woman called 9-1-1 because his mother is "ill." The patient presents with mild confusion, poor skin turgor, and tachycardia. She is incontinent of urine and asks you for a glass of water. Her son tells you that she had not been feeling well for the past several weeks, but would not allow him to take her to the doctor. Which of the following assessment parameters will MOST likely reinforce your suspicion regarding the underlying cause of this patient's condition? Select one: A. Blood glucose B. Cardiac rhythm C. Orthostatic vital signs D. Cincinnati stroke scale

Blood glucose

Which of the following is NOT a predisposing risk factor for trauma in the elderly? Select one: A. Slower reflexes B. Decreased body water C. Equilibrium disorders D. Overall decrease in agility

Decreased body water

Which of the following may you be the LEAST likely to observe in a 90-year-old patient with a severe infection? Select one: A. Fever B. Weakness C. Loss of appetite D. Altered mentation

Fever

Considering the physiologic changes that occur with age, which of the following interventions would pose the GREATEST potential for further harm when caring for an elderly patient with a severe burn that is complicated by a spinal injury? Select one: A. Intubation B. Fluid replacement C. Thermal management D. Spinal immobilization

Fluid replacement

Which of the following central nervous system functions does NOT change as a person ages? Select one: A. Postural stability B. Cognitive speed C. Memory retrieval D. Intelligence level

Intelligence level

Which of the following conditions would MOST likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure? Select one: A. Asthma B. Kyphosis C. Spondylosis D. Osteoporosis

Kyphosis

Resting tremor of an extremity and bradykinesia are associated with: Select one: A. vascular dementia. B. focal motor seizures. C. Parkinson disease. D. Alzheimer disease.

Parkinson disease.

Which of the following risk factors is associated with the HIGHEST rate of mortality following a burn injury in an elderly person? Select one: A. Age over 55 years B. Musculoskeletal injury C. Preexisting medical condition D. Proportional increase in adipose tissue

Preexisting medical condition

A 71-year-old man with a history of emphysema, coronary artery disease, and hypertension presents with increased shortness of breath and fatigue. His oxygen saturation is 80% on home oxygen at 2 L/min via nasal cannula. His blood pressure is 140/76 mm Hg, pulse rate is 104 beats/min, and respirations are 28 breaths/min and labored. His medications include an albuterol inhaler, prednisone, hydrochlorothiazide, and lisinopril. Auscultation of his lungs reveals scattered wheezing in all fields. Which of the following prehospital interventions is NOT indicated for this patient? Select one: A. Nebulized ipratropium B. Subcutaneous epinephrine C. High-flow oxygen therapy D. Continuous positive airway pressure

Subcutaneous epinephrine

The heart hypertrophies with age, MOST likely in response to: Select one: A. a progressive increase in preload and chronic myocardial stretching. B. left-sided heart failure that results in chronic pulmonary hypertension. C. a chronically increased afterload caused by arteriosclerotic blood vessels. D. a significant decline in cardiac output due to a reduction in stroke volume.

a chronically increased afterload caused by arteriosclerotic blood vessels.

When elderly patients are prescribed medications, the risk for drug toxicity increases because of: Select one: A. an increase in the glomerular filtration rate. B. age-related changes in hepatic enzyme systems. C. the presence of chronic conditions, such as diabetes. D. an increase in the production of antidiuretic hormone.

age-related changes in hepatic enzyme systems.

Delirium is MOST accurately defined as: Select one: A. an acute alteration in mentation that indicates an underlying condition. B. any alteration in cognitive function that may or may not be reversible. C. a pattern of disorganized thinking that progresses over several weeks. D. an altered mental status that is caused by structural damage to the brain.

an acute alteration in mentation that indicates an underlying condition.

Decreased elasticity of the lungs and calcification of the costochondral cartilage results in: Select one: A. an increase in residual lung volume. B. a significant increase in vital capacity. C. a decrease in airway size and resistance. D. a decrease in the total amount of air in the lungs.

an increase in residual lung volume.

An increase in blood pressure that commonly occurs with aging is physiologically exacerbated by: Select one: A. a compensatory increase in preload and cardiac ejection fraction. B. a decrease in stroke volume due to age-induced cardiomyopathy. C. an overproduction of collagen and decreased quantities of elastin. D. the patient's noncompliance with his or her antihypertensive drugs.

an overproduction of collagen and decreased quantities of elastin.

You are called to a residence for a 74-year-old woman who fainted. During your assessment, the patient's son tells you that he was standing next to his mother when she fainted and that he caught her before she fell to the floor. He further tells you that his mother has angina and kidney disease. The patient is now conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 110 beats/min and weak, and respirations are 22 breaths/min and regular. As your partner administers supplemental oxygen to the patient, you should: Select one: A. assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one. B. quickly establish vascular access and administer a 20-mL/kg bolus of an isotonic crystalloid. C. obtain a detailed list of all of the patient's medical problems and the medications that she is taking. D. perform a rapid head-to-toe assessment to determine if she has gross injuries or any hidden conditions.

assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one.

Failure of the heart's primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in: Select one: A. junctional rhythms. B. atrioventricular block. C. ventricular ectopy. D. atrial fibrillation.

atrial fibrillation.

A decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to: Select one: A. heart block. B. bradycardia. C. tachycardia. D. atrial fibrillation.

bradycardia.

MOST age-related visual disturbances are the result of: Select one: A. diabetic retinopathy. B. cataracts or glaucoma. C. macular degeneration. D. retinal artery occlusion.

cataracts or glaucoma.

Adverse drug reactions in elderly people are the result of: Select one: A. partial digestion secondary to delayed gastric emptying. B. changes in body composition and an increase in body water. C. changes in drug metabolism due to diminished hepatic function. D. increased drug elimination due to decreased antidiuretic hormone.

changes in drug metabolism due to diminished hepatic function.

Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT: Select one: A. impaired circulation. B. chronic hyperthyroidism. C. atherosclerotic vessels. D. decreased sweat production.

chronic hyperthyroidism.

After obtaining an elderly patient's chief complaint, gathering additional information about the history of present illness would MOST likely be complicated because: Select one: A. the patient may ask you to repeat your questions. B. chronic problems may affect the acute problem. C. most elderly patients take numerous medications. D. the aging process causes difficulty in understanding.

chronic problems may affect the acute problem.

Physiologic age-related decreases in skin elasticity are the result of: Select one: A. decreased collagen and elastin production. B. chronic use of corticosteroid medications. C. slower replenishment of epidermal cells. D. frequent fungal or viral skin infections.

decreased collagen and elastin production.

An elderly person is at increased risk for aspiration, primarily from: Select one: A. atrophy of the epiglottis. B. a decreased ability to swallow. C. slowing of the ciliary mechanisms. D. decreased cough and gag reflexes.

decreased cough and gag reflexes.

Elderly patients experience a slower physiologic response to hypoxemia and hypercarbia because of: Select one: A. decreased sensitivity to changes in arterial blood content. B. a chronically elevated partial pressure of carbon dioxide. C. an increased PaO2 due to a natural increase in respirations. D. failure of the baroreceptors to detect blood pressure changes.

decreased sensitivity to changes in arterial blood content.

When assessing an unresponsive older person's airway, it is MOST important to remember that: Select one: A. delayed gastric emptying increases the risk of aspiration. B. age-related tooth loss may cause obstruction of the airway. C. a marked reduction in saliva causes dryness of the oral mucosa. D. the head should not be extended due to weakened cervical vertebrae.

delayed gastric emptying increases the risk of aspiration.

The social assessment component of the GEMS diamond includes: Select one: A. determining if activities of daily living are being provided by another person. B. considering that what appears to be a medical problem may have a trauma component. C. assessing the presence of functional smoke detectors in the patient's home. D. looking for multiple prescription medications that are used to treat the same condition.

determining if activities of daily living are being provided by another person.

Hypotension and orthostatic vital sign changes would MOST likely occur in elderly people who take: Select one: A. diuretics. B. beta-blockers. C. antidepressants. D. ACE inhibitors.

diuretics.

Elderly people are more susceptible to intracranial bleeding because of: Select one: A. a marked increase in brain size. B. depletion of cerebrospinal fluid. C. enlargement of the subdural space. D. constriction of the cerebral vessels.

enlargement of the subdural space.

Impaired proprioception predisposes an elderly person to: Select one: A. falls. B. skin tears. C. depression. D. hearing loss.

falls.

The medical assessment of an elderly patient can be complex because: Select one: A. he or she often makes up symptoms that do not exist. B. caregivers typically prefer that you speak with them. C. he or she often has more than one medical condition. D. most elderly patients are hearing or visually impaired.

he or she often has more than one medical condition.

In contrast to a 30-year-old man, if a 70-year-old man were to consume an excessive amount of alcohol: Select one: A. he would experience a lower blood alcohol concentration secondary to a decrease in total body water. B. the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug. C. it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver. D. he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Fall-related fractures in the elderly occur MOST often to the _______, usually in patients with underlying _______. Select one: A. hip, osteoporosis B. humerus, arthritis C. elbow, osteoporosis D. pelvis, osteoarthritis

hip, osteoporosis

Kyphosis is characterized by: Select one: A. cartilage degeneration. B. vertebral disc compression. C. a hunchback appearance. D. lateral curvature of the spine.

hunchback appearance.

Aging brings a widespread decrease in bone mass, especially: Select one: A. in postmenopausal women. B. in men over 50 years of age. C. if the person falls frequently. D. in the presence of hypertension.

in postmenopausal women.

Components of the environmental assessment of an elderly patient include all of the following, EXCEPT: Select one: A. assessing for the odor of urine or feces. B. looking for rotted floors or faulty wiring. C. ensuring that food is adequate and unspoiled. D. inquiring about any delays in obtaining food.

inquiring about any delays in obtaining food.

An 82-year-old man presents with confusion that has worsened progressively over the past 2 weeks. Because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter. She tells you that her father has high blood pressure but refuses to take medication for it. She also tells you that she thinks he fell about 3 weeks ago, although he denies falling. The patient's blood pressure is 168/98 mm Hg, pulse rate is 60 beats/min and occasionally irregular, and respirations are 22 breaths/min and regular. This patient MOST likely: Select one: A. has an acute onset of dementia. B. is experiencing a subdural hematoma. C. had a stroke secondary to atrial fibrillation. D. has normal age-related physiologic changes.

is experiencing a subdural hematoma.

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the: Select one: A. liver. B. spleen. C. gallbladder. D. intestinal tract.

liver.

Presbycusis is defined as: Select one: A. a progressive loss of hearing, particularly in the low frequencies, which explains why the television is turned up. B. an acute hearing impairment caused by idiopathic rupture of the tympanic membrane in the middle part of the ear. C. a degenerative condition in which the person experiences difficulty hearing both low and high frequency sounds. D. loss of high-frequency sounds and the inability to differentiate a particular sound from background noise.

loss of high-frequency sounds and the inability to differentiate a particular sound from background noise.

Due to the process of aging, an elderly person commonly experiences: Select one: A. increased thirst. B. moderate hyperglycemia. C. increased insulin secretion. D. high fever with a minor illness.

moderate hyperglycemia.

After falls, _______________ is/are the second leading cause of accidental death among elderly people. Select one: A. thermal burns B. drug interactions C. submersion injury D. motor vehicle crashes

motor vehicle crashes

Cervical spondylosis is a degenerative change in the cervical spine that causes: Select one: A. destruction of the intervertebral discs and vertebral fractures. B. narrowing of the spinal canal and pressure on the spinal cord. C. lateral curvature of the cervical spine with cord impingement. D. fracture of the odontoid process of the second cervical vertebra.

narrowing of the spinal canal and pressure on the spinal cord.

You are assessing an 80-year-old man who complains of generalized weakness. He denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days. His medical history is significant for two prior heart attacks, hypertension, chronic renal insufficiency, and atrial fibrillation. His blood pressure is 108/60 mm Hg, pulse rate is 94 beats/min and irregular, and respirations are 20 breaths/min and unlabored. Auscultation of his lungs reveals scattered crackles, and the ECG reveals atrial fibrillation. In addition to administering supplemental oxygen, you should: Select one: A. start an IV with D5W, assess his blood glucose level, and administer half the usual dose of diltiazem to lower the rate of his atrial fibrillation. B. obtain a 12-lead ECG tracing, start an IV line with normal saline and give a 250-mL fluid bolus, reassess his blood pressure, and transport him. C. establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport. D. obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport to the hospital.

obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport to the hospital.

Typical signs and symptoms of Ménière disease include all of the following, EXCEPT: Select one: A. vertigo. B. tinnitus. C. otorrhea. D. hearing loss.

otorrhea.

The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to: Select one: A. constipation. B. cholelithiasis. C. mesenteric ischemia. D. peptic ulcer disease.

peptic ulcer disease.

Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to all of the following conditions, EXCEPT: Select one: A. hyperkalemia. B. hypernatremia. C. profound dehydration. D. acute volume overload.

profound dehydration.

A key element of the "G" in the GEMS diamond includes: Select one: A. checking the physical condition of the patient's home. B. recalling that elderly patients often present atypically. C. assessing the elderly patient's activities of daily living. D. obtaining a complete medical history from the patient.

recalling that elderly patients often present atypically. Question 28

Hypertensive emergencies in the geriatric population: Select one: A. require a controlled decline in blood pressure that often cannot be achieved in the prehospital setting. B. can cause a ruptured cerebral or aortic aneurysm and should be treated in the field with antihypertensives. C. are relatively uncommon owing to increased elasticity of the blood vessels, which facilitates vasodilation. D. are typically treated in the prehospital setting with beta-blocker medications or a slow nitroglycerin infusion.

require a controlled decline in blood pressure that often cannot be achieved in the prehospital setting.

When assessing an older person, you should remember that it is common for him or her to: Select one: A. slur his or her words. B. present with hemiparesis. C. respond slowly to questions. D. not understand your questions.

respond slowly to questions.