Chapter 36 - Geriatric Emergencies

Question 1

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’s disease.

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

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

Answer 1

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

Question 2

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. physician directive.

B. advance directive.

C. statute of care.

D. power of attorney.

Answer 2

B. advance directive.

Question 3

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. a subdural hematoma.

C. acute hyperglycemia.

D. a systemic infection.

Answer 3

D. a systemic infection.

Question 4

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. causes dull pain that often radiates to the shoulders.

D. can sometimes be palpated as a mass in the groin area.

Answer 4

A. is often the result of hypertension and atherosclerosis.

Question 5

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. limit your physical examination to the area of pain or injury.

C. attempt to differentiate between chronic and acute problems.

D. perform a rapid assessment on all geriatric patients you treat.

Answer 5

C. attempt to differentiate between chronic and acute problems.

Question 6

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. splenic dysfunction.

C. intentional overdose.

D. renal insufficiency.

Answer 6

D. renal insufficiency.

Question 7

Clouding of the lenses of the eyes is called:

Select one:

A. conjunctivitis.

B. retinitis.

C. glaucoma.

D. cataracts.

Answer 7

D. cataracts.

Question 8

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.

Answer 8

B. an acute onset of dementia.

Question 9

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. a decreased ability to cough.

D. baseline respiratory distress.

Answer 9

C. a decreased ability to cough.

Question 10

In contrast to younger patients, older patients are more prone to a decrease in blood pressure (BP) upon standing because:

Select one:

A. the aging process results in an overall increase in blood volume.

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

Answer 10

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

Question 11

Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse.

Select one:

A. physical

B. psychological

C. financial

D. emotional

Answer 11

A. physical

Question 12

Sedentary behavior while healing from a hip fracture would MOST likely predispose the older patient to:

Select one:

A. heart failure.

B. osteoporosis.

C. ischemic stroke.

D. pneumonia.

Answer 12

D. pneumonia.

Question 13

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

Select one:

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

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. is usually beneficial because the patient’s cognitive skills are typically impaired.

Answer 13

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

Question 14

The EMT should suspect left-sided heart failure in the geriatric patient who presents with:

Select one:

A. swelling of the lower extremities and weakness.

B. fever and a cough that produces green sputum.

C. jugular venous distention and peripheral edema.

D. tachypnea and paroxysmal nocturnal dyspnea.

Answer 14

D. tachypnea and paroxysmal nocturnal dyspnea.

Question 15

The leading cause of death in the geriatric patient is:

Select one:

A. altered mental status.

B. hypertension.

C. heart disease.

D. arthritis.

Answer 15

C. heart disease.

Question 16

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.

Answer 16

C. kyphosis.

Question 17

To minimize distractions and confusion when assessing an older patient, you should:

Select one:

A. perform a physical exam and then talk to the patient.

B. dismiss the family members from the room or area.

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

D. elevate your voice and speak directly to the patient.

Answer 17

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

Question 18

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. use a scoop stretcher instead of a log roll.

D. secure the patient’s head before the torso.

Answer 18

B. place blankets behind the patient’s head.

Question 19

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. A patient is assisted with his or her activities of daily living.

C. The patient’s medications have not been filled in 2 months.

D. The patient’s residence is cold due to a malfunctioning heater.

Answer 19

D. The patient’s residence is cold due to a malfunctioning heater.

Question 20

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.

Answer 20

C. hyperosmolar hyperglycemic nonketotic syndrome.

Question 21

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.

acute appendicitis.

a strangulated bowel.

myocardial infarction.

Answer 21

an aortic aneurysm.

Question 22

Which of the following statements regarding the aging process is correct?

A. Because he or she is younger and healthier, a 35-year-old person ages slower than a 75-year-old person.

B. Human growth and development peaks in the late 40s or early 50s, at which point the aging process sets in.

C. The older a person gets, the slower the decline in the function of vital organs, such as the kidneys and liver.

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

Answer 22

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

Question 23

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.

inquire about a history of Alzheimer’s disease.

obtain a complete list of the patient’s medications.

ask an attendant for the patient’s medical records.

Answer 23

determine the patient’s baseline mental status.

Question 24

Which of the following statements regarding suicide in the older patient is correct?

Older patients tend to use more lethal means than younger patients.

Older females have a higher rate of suicide than any other group.

Depression and hopeless feelings are often not predisposing factors.

Most suicidal patients readily seek care and do not deny the problem.

Answer 24

Older patients tend to use more lethal means than younger patients.

Question 25

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.

Answer 25

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

Question 26

Osteoporosis is defined as:

increased flexibility of bone mass

decreased bone marrow production

a decrease in bone mass and density

an abnormality near the growth plate

Answer 26

a decrease in bone mass and density

Question 27

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.

she attempted to catch herself before falling.

a family member regularly checks up on her.

she takes medications for Alzheimer disease.

Answer 27

she became dizzy or fainted before falling.

Question 28

When performing your secondary assessment on an older patient who has been injured, it is important to:

routinely perform a focused exam to minimize time at the scene.

perform an in-depth physical exam prior to initiating any treatment.

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

focus your assessment just on the area(s) of pain or obvious injury.

Answer 28

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

Question 29

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:

acute hyperglycemia.

a subdural hematoma.

acute ischemic stroke.

diabetic ketoacidosis.

Answer 29

a subdural hematoma

Question 30

Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown?

It has been largely hidden from society.

The definitions of abuse and neglect vary.

Human resource agencies fail to investigate.

Victims of elder abuse are hesitant to report it.

Answer 30

Human resource agencies fail to investigate.

Question 31

Good general communication techniques with the elderly include:

using medical terms to ensure patient understanding.

explaining procedures while you are performing them.

frequently asking the patient if he or she understands.

having at least two EMTs talk to the patient at a time.

Answer 31

frequently asking the patient if he or she understands.

Question 32

When caring for a geriatric patient with a traumatic injury, it is important to consider that:

geriatric patients usually present with little to no pain.

decreased bone density often results in incomplete fractures.

the injury may have been preceded by a medical condition.

geriatric patients typically present with classic signs of shock.

Answer 32

the injury may have been preceded by a medical condition.

Question 33

The purpose of the GEMS diamond is to:

help EMS personnel remember what is different about elderly patients.

provide the EMT with a standard format for assessing elderly patients.

replace the typical ABC approach to patient care when caring for the elderly.

provide clues about an elderly patient’s problem by observing his or her home.

Answer 33

help EMS personnel remember what is different about elderly patients.

Question 34

Syncope in the older patient is:

caused by an interruption of blood flow to the brain.

generally of no concern unless the patient was injured.

most commonly caused by a silent myocardial infarction.

rarely life threatening but should be evaluated by a physician.

Answer 34

caused by an interruption of blood flow to the brain.

Question 35

When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do all of the following, EXCEPT:

factually document all findings.

accuse a caregiver of physical abuse.

ask the patient how the bruises occurred.

review the patient’s activities of daily living.

Answer 35

accuse a caregiver of physical abuse.

Question 36

The use of multiple prescription drugs by a single patient, causing the potential for negative effects such as overdosing or drug interaction, is called:

potentiation.

polypharmacy.

drug tolerance.

drug dependency.

Answer 36

polypharmacy.

Question 37

In contrast to delirium, dementia:

is usually considered irreversible.

is the result of an acute condition.

is reversible with certain treatment.

often develops over a period of days.

Answer 37

is usually considered irreversible.

Question 38

In contrast to a living will, a “do not resuscitate” (DNR) order becomes valid when:

the patient has a terminal illness.

the patient develops cardiac arrest.

the patient is in a health care setting.

it is signed by three or more physicians.

Answer 38

the patient develops cardiac arrest

Question 39

As a person ages, the heart may enlarge as a result of:

widespread vascular dilation.

chronically increased afterload.

an overall decrease in blood volume.

decreased blood return to the heart.

Answer 39

chronically increased afterload.

Question 40

A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for:

heart failure.

bronchitis.

emphysema.

pneumonia.

Answer 40

pneumonia.

Question 41

A 75-year-old woman complains of shortness of breath. Which of the following findings should alert the EMT to the possibility of a pulmonary embolism?

Select one:

a. Frequent urinary tract infections
b. The patient is prescribed an inhaler.
c. History of deep venous thrombosis
d. The patient’s abdomen is swollen.

Answer 41

c. History of deep venous thrombosis

Question 42

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.

Answer 42

B. vasoconstriction.

Question 43

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.

Answer 43

D. recall that elderly patients have difficulty hearing high-frequency sounds.

Question 44

The reduction in brain weight and volume increases an older person’s risk for:

A. Dementia

B. Delirium

C. Head trauma

D. Stroke

Answer 44

C. Head trauma

Question 45

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 fear retribution from the abuser

C. Most of the early patients have dementia

D. They do not want to be bothersome

Answer 45

B. they fear retribution from the abuser

Question 46

Upon entering the residence of a geriatric patient with a medical or trauma complaint, the EMT should:

A. observe for conditions that may make the residence unsafe.

B. Begin his or her assessment after gathering any medication bottles

C. Talk to the patient after performing his or her primary assessment

D. Immediately seek out a family member or other caregiver

Answer 46

A. observe for conditions that may make the residence unsafe.

Question 47

Which of the following patients is at the highest risk for pulmonary embolism?

Select one:

A. 78-year-old female who takes blood-thinning medications

B. 66-year-old active female with a history of hypertension

C. 71-year-old male with recent surgery to a lower extremity

D. 59-year-old male who is recovering from pneumonia

Answer 47

C. 71-year-old male with recent surgery to a lower extremity

Question 48

A “silent” heart attack occurs when:

A. the patient minimizes the chest pain

B. A sudden dysrhythmia causes death

C. Sweating is the only presentation

D. The usual chest pain is not present

Answer 48

D. The usual chest pain is not present

Question 49

When an elderly patient presents you with multiple over-the-counter medications that he or she is taking, it is most important to:

A. Look up all the medications before providing care to the patient

B. Recall the patient is at risk for negative medication interactions

C. Contact each of the physicians whose names are on the medications

D. As the patient to explain what each of the medications is used for

Answer 49

B. Recall the patient is at risk for negative medication interactions

Question 50

A 70-year-old man complains of a sudden onset of difficulty breathing. He has dried blood on his lips and is very anxious. His left leg is red, swollen, and painful. The EMT should:

A. Apply a cold pack to his leg

B. Position the patient supine

C. Administer high flow oxygen

D. Suspect severe pneumonia

Answer 50

C. Administer high flow oxygen

Question 51

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.

Answer 51

D. compression fractures.

Question 52

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.

Answer 52

A. osteoporosis and low-energy trauma

Question 53

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.

Answer 53

B. attempt to resuscitate the patient

Question 54

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.

Answer 54

D. dementia.

Question 55

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. Idiopathic fracture

B. pathologic fracture

C. compression fracture

D. comminuted fracture

Answer 55

B. pathologic fracture

Question 56

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.

Answer 56

C. loss of balance, muscle weakness, and spasms.

Question 57

An elderly patient may understate or minimize the symptoms of his or her illness because:

A. the nervous system deteriorates.
B. of decreased perception of pain.
C. of conditions such as dementia.
D. he or she fears hospitalization.

Answer 57

D. he or she fears hospitalization.

Question 58

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.

Answer 58

D. avoid documenting any unsupported opinions.

Question 59

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.

Answer 59

B. transport him or her to a hospital that he or she is familiar with.

Question 60

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. determine the position in which the patient normally sleeps
D. place the patient supine to see if the problem worsens.

Answer 60

C. determine the position in which the patient normally sleeps