West Coast EMT Chapter 35 -- Geriatric Emergencies, West Coast EMT Chapter 36 -- Patients with Special Challenges

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.

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.

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.

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.

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.

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.

Clouding of the lenses of the eyes is called:

Select one:

A. retinitis.

B. cataracts.

C. conjunctivitis.

D. glaucoma.

B. cataracts.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress. You should:

Select one:

A. reset the ventilator by unplugging it for 30 to 60 seconds.

B. disconnect the ventilator and apply a tracheostomy collar.

C. place a call to the home health agency treating this patient.

D. attempt to troubleshoot the mechanical ventilator problem.

B. disconnect the ventilator and apply a tracheostomy collar.

A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should:

Select one:

A. try repositioning the hearing aid or remove it and turn down the volume.

B. recognize that the batteries in his hearing aids are probably depleted.

C. remove his hearing aids, turn up the volume, and replace them in his ears.

D. remove both of his hearing aids and use pencil and paper to communicate.

A. try repositioning the hearing aid or remove it and turn down the volume.

A person is said to be obese when he or she is ________ over his or her ideal weight.

Select one:

A. 30% or more

B. 10% or more

C. 20% or more

D. 40% or more

A. 30% or more

A surgical procedure that creates an opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n):

Select one:

A. intestinal shunt.

B. colostomy.

C. gastric stoma.

D. gastrostomy.

B. colostomy.

According to the "E" in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?

Select one:

A. Attempt to pass a suction catheter into the tube.

B. Listen to breath sounds to assess for a pneumothorax.

C. Look for blood or other secretions in the tube.

D. Check the mechanical ventilator for malfunction.

D. Check the mechanical ventilator for malfunction.

According to the Emergency Medical Treatment and Active Labor Act (EMTALA):

Select one:

A. a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.

B. all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured.

C. all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

D. a health care facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical.

C. all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

Because a tracheostomy tube bypasses the nose and mouth:

Select one:

A. severe swelling of the trachea and bronchi can occur.

B. secretions can build up in and around the tube.

C. the risk of a local infection is significantly high.

D. bleeding or air leakage may occur around the tube.

B. secretions can build up in and around the tube.

Cerebral palsy is characterized by poorly controlled ________ movement.

Select one:

A. neck

B. eye

C. body

D. extremity

C. body

Common complications associated with central venous catheters include all of the following, EXCEPT:

Select one:

A. clotting of the line.

B. a local infection.

C. bleeding around the line.

D. rupture of a central vein.

D. rupture of a central vein.

Down syndrome is a genetic defect that occurs as the result of:

Select one:

A. a separation of chromosome 21.

B. an extra pair of chromosomes.

C. a sperm that contains 24 chromosomes.

D. a triplication of chromosome 21.

D. a triplication of chromosome 21.

Spina bifida is defined as:

Select one:

A. chronic pressure on the brain caused by excess cerebrospinal fluid.

B. congenital inflammation of the spinal cord, usually in the neck.

C. a birth defect in which the child is born without spinal vertebrae.

D. a birth defect caused by incomplete closure of the spinal column.

D. a birth defect caused by incomplete closure of the spinal column.

The purpose of a ventricular peritoneum shunt is to:

Select one:

A. prevent excess cerebrospinal fluid from accumulating in the brain.

B. monitor pressure within the skull in patients with a head injury.

C. remove fluid from the abdomen of patients with right-sided heart failure.

D. divert excess cerebrospinal fluid to the ventricles of the brain.

A. prevent excess cerebrospinal fluid from accumulating in the brain.

Under what circumstances is a left ventricular assist device used?

Select one:

A. To permanently replace the function of one or both of the ventricles

B. To reduce ventricular pumping force in patients with aortic aneurysms

C. To ensure that the ventricles contract at an adequate and consistent rate

D. As a bridge to heart transplantation while a donor heart is being located

D. As a bridge to heart transplantation while a donor heart is being located

When caring for a patient who is visually impaired, it is important to:

Select one:

A. allow a service dog to remain with the patient at all times, even if the patient is critically ill.

B. stand to the side of the patient when speaking if his or her peripheral vision is impaired.

C. tell him or her what is happening, identify noises, and describe the situation and surroundings.

D. leave items such as canes and walkers at the residence if the patient will be carried on a gurney.

C. tell him or her what is happening, identify noises, and describe the situation and surroundings.

Which of the following conditions would MOST likely be encountered in a patient with cerebral palsy?

Select one:

A. Paralysis

B. Brain tumors

C. Seizure disorder

D. Type 2 diabetes

C. Seizure disorder

Which of the following statements regarding autism is correct?

Select one:

A. The majority of patients with autism do not speak at all.

B. Most cases of autism are diagnosed by 3 years of age.

C. Impairment of motor activity is a classic sign of autism.

D. Autism affects females four times greater than males.

B. Most cases of autism are diagnosed by 3 years of age.

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?

Select one:

A. Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.

B. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

C. In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness.

D. In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver.

B. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

Which of the following statements regarding patients with intellectual disabilities is correct?

Select one:

A. Speaking with the patient's family is the least effective way to determine how much the patient understands.

B. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

C. Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.

D. An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.

B. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

Which of the following would be the MOST practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located?

Select one:

A. Using a piece of paper and writing utensil to ask questions

B. Contacting dispatch and requesting a sign language interpreter

C. Using a high-pitched voice while speaking directly into the ear

D. Attempting to use body language to determine the problem

A. Using a piece of paper and writing utensil to ask questions

You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your MOST immediate action should be to:

Select one:

A. ask a member of your team to locate the best route to move him to the ambulance.

B. perform a secondary assessment, focusing on his respiratory system and back.

C. avoid placing him in a supine position if possible and administer oxygen.

D. notify the receiving facility and advise them of the patient's weight and status.

C. avoid placing him in a supine position if possible and administer oxygen.