Emc103 (Chapter 36: Geriatrics (pre q))

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

 

elevate your voice and speak directly to the patient.

 

perform a physical exam and then talk to the patient.

 

dismiss the family members from the room or area.

 

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

have only one EMT speak to the patient at a time

Good general communication techniques with the elderly include:

 

explaining procedures while you are performing them.

 

using medical terms to ensure patient understanding.

 

frequently asking the patient if he or she understands.

 

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

frequently asking the patient if he or she understands

When explaining the need for a particular procedure to an elderly patient, you should:

 

be complex so the patient fully understands.

 

realize that he or she will not understand you.

 

use the appropriate medical terminology.

 

use plain language and simple terms.

use plain language and simple terms

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

 

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

 

often causes the patient to become paranoid and untrusting of your help.

 

will anger the patient and result in his or her refusal to accept care or transport.

 

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

might cause the patient to think that he or she has no say in making decisions

Which of the following statements regarding communications with the elderly is correct?

 

Older patients have difficulty understanding when they are stressed.

 

The majority of elderly patients are hearing or visually impaired.

 

Explain the justification for a procedure after it has been completed.

 

Attempt to calm the elderly patient by using his or her first name.

Older patients have difficulty understanding when they are stressed.

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

 

ischemic stroke.

 

heart failure.

 

osteoporosis.

 

pneumonia.

pneumonia

The leading cause of death in the geriatric patient is:

 

heart disease.

 

arthritis.

 

altered mental status.

 

hypertension.

heart disease

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 might have been preceded by a medical condition.

 

geriatric patients typically present with classic signs of shock.

the injury might have been preceded by a medical condition

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

 

rely exclusively on family members for the medical history.

 

perform a rapid assessment on all geriatric patients you treat.

 

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

 

attempt to differentiate between chronic and acute problems.

attempt to differentiate between chronic and acute problems.

When transporting a stable older patient to the hospital, the most effective way to reduce his or her anxiety is to:

 

perform frequent detailed assessments to gain the patient's trust.

 

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

 

allow at least two family members to accompany the patient.

 

avoid the use of a long backboard, even if trauma is suspected.

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

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

 

of decreased perception of pain.

 

of conditions such as dementia.

 

the nervous system has deteriorated.

 

he or she fears hospitalization

he or she fears hospitalization.

Which of the following statements regarding a decreased level of consciousness in the elderly patient is correct?

 

The AVPU scale is an ineffective tool when assessing an elderly patient's level of consciousness.

 

A decreased level of consciousness is not a normal part of the aging process.

 

A decreased level of consciousness is most often the result of chronic dementia.

 

Most elderly patients have some deterioration in their level of consciousness.

A decreased level of consciousness is not a normal part of the aging process

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:

 

inquire about a history of Alzheimer disease.

 

determine the patient's baseline mental status.

 

obtain a complete list of the patient's medications.

 

ask an attendant for the patient's medical records.

determine the patient's baseline mental status

A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of 80/50 mm Hg and a heart rate of 74 beats/min that is weak. Her daughter, who was uninjured in the crash, tells you that her mother has a history of hypertension and takes beta-blockers. Because this patient is probably in shock, what is the most likely explanation for the absence of tachycardia?

 

Failure of the parasympathetic nervous system

 

Intrathoracic bleeding and cardiac compression

 

Deterioration of the cardiac conduction system

 

The effects of her antihypertensive medication

The effects of her antihypertensive medication

The purpose of the GEMS diamond is to:

 

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

 

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

 

help EMS personnel remember what is different about elderly patients.

 

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

help EMS personnel remember what is different about elderly patients

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

 

observe for conditions that might make the residence unsafe.

 

immediately seek out a family member or other caregiver.

 

talk to the patient after performing his or her primary assessment.

 

begin his or her assessment after gathering any medication bottles.

observe for conditions that might make the residence unsafe.

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

 

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

 

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

 

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

 

Elderly patients present atypically and deserve your respect.

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

Findings during the social assessment of an older patient include all of the following, except:

 

outdated medications.

 

daily activity assistance.

 

interaction with others.

 

delays in obtaining meals.

outdated medications.

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

 

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

 

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

 

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

 

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

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

During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in:

 

baseline respiratory distress.

 

a decreased ability to cough.

 

an increased risk of COPD.

 

air-trapping within the alveoli.

a decreased ability to cough

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

 

pneumonia.

 

emphysema.

 

bronchitis.

 

heart failure.

pneumonia

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

 

decreased blood return to the heart.

 

an overall decrease in blood volume.

 

widespread vascular dilation.

 

chronically increased afterload.

chronically increased afterload

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

 

59-year-old male who is recovering from pneumonia

 

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

 

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

 

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

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

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

 

any change in position causes blood to be shunted to the brain.

 

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

 

their red blood cells are destroyed at a faster than normal rate.

 

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

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

A "silent" heart attack occurs when:

 

a sudden dysrhythmia causes death.

 

the usual chest pain is not present.

 

sweating is the only presentation.

 

the patient minimizes the chest pain.

the usual chest pain is not present

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

 

swelling of the lower extremities and weakness.

 

fever and a cough that produces green sputum.

 

tachypnea and paroxysmal nocturnal dyspnea.

 

jugular venous distention and peripheral edema.

tachypnea and paroxysmal nocturnal dyspnea

When assessing a 78-year-old female who complains of shortness of breath, the EMT should:

 

give oxygen only if the patient has labored breathing.

 

place the patient supine to see if the problem worsens.

 

determine the position in which the patient normally sleeps.

 

conclude that the patient is experiencing a heart attack.

determine the position in which the patient normally sleeps

When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, it is most important to:

 

determine if the patient has risk factors for a stroke.

 

determine the onset of the patient's symptoms.

 

ascertain about a history of atrial fibrillation.

 

administer 324 mg of aspirin as soon as possible.

determine the onset of the patient's symptoms

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

 

dementia.

 

head trauma.

 

stroke.

 

delirium.

head trauma

Clouding of the lenses of the eyes is called:

 

retinitis.

 

conjunctivitis.

 

cataracts.

 

glaucoma.

cataracts

When caring for an elderly patient who is hearing-impaired, you should:

 

request that he or she communicate with you by writing on paper.

 

remember that most hearing-impaired patients can read lips.

 

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

 

speak directly into his or her ear with an elevated tone.

recall that elderly patients have difficulty hearing high-frequency sounds

The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is known as:

 

paranoia.

 

dementia.

 

delirium.

 

delusion.

dementia

In contrast to delirium, dementia:

 

often develops over a period of days.

 

is usually considered irreversible.

 

is reversible with certain treatment.

 

is the result of an acute condition.

is usually considered irreversible

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 is normally alert. When you assess this patient, it is important to note that:

 

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

 

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

 

because of her age and medical history, you should suspect Alzheimer disease.

 

her mental status is likely the result of hypoglycemia and you should give her sugar.

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

Causes of delirium in the older patient include all of the following, except:

 

low blood sugar level.

 

Alzheimer disease.

 

acute hypovolemia.

 

decreased cerebral perfusion.

Alzheimer disease

Syncope in the older patient is:

 

most commonly caused by a silent myocardial infarction.

 

caused by an interruption of blood flow to the brain.

 

rarely life threatening but should be evaluated by a physician.

 

generally of no concern unless the patient was injured.

caused by an interruption of blood flow to the brain

Motor nerve neuropathy is characterized by:

 

numbness, tingling, and severe muscle pain.

 

constipation, low blood pressure, and bradycardia.

 

loss of balance, muscle weakness, and spasms.

 

loss of bladder control and sensitivity to touch.

loss of balance, muscle weakness, and spasms

Common causes of syncope in older patients include all of the following, except:

 

venous pooling.

 

blood volume loss.

 

acute hypotension.

 

vasoconstriction.

vasoconstriction

An abdominal aortic aneurysm:

 

is usually not repairable, even if discovered early.

 

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

 

is often the result of hypertension and atherosclerosis.

 

causes dull pain that often radiates to the shoulders.

is often the result of hypertension and atherosclerosis

A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious but diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should suspect:

 

myocardial infarction.

 

a strangulated bowel.

 

acute appendicitis.

 

an aortic aneurysm.

an aortic aneurysm

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:

 

diabetic ketoacidosis.

 

hyperglycemia with moderate dehydration.

 

acute renal failure with associated hyperglycemia.

 

hyperosmolar hyperglycemic nonketotic syndrome.

hyperosmolar hyperglycemic nonketotic syndrome

The stooped posture of some older people, which gives them a humpback appearance, is called:

 

arthritis.

 

scoliosis.

 

kyphosis.

 

miosis.

kyphosis

Osteoporosis is defined as:

 

decreased bone marrow production.

 

a decrease in bone mass and density.

 

increased flexibility of bone mass.

 

an abnormality near the growth plate.

a decrease in bone mass and density

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:

 

position the patient supine.

 

suspect severe pneumonia.

 

apply a cold pack to his leg.

 

administer high-flow oxygen.

administer high-flow oxygen

Blood levels of medications might rise in the elderly, sometimes to toxic levels. This is most likely due to:

 

splenic dysfunction.

 

pancreatic failure.

 

intentional overdose.

 

renal insufficiency.

renal insufficiency

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

 

look up all of the medications before providing care to the patient.

 

contact each of the physicians whose names are on the medications.

 

ask the patient to explain what each medication is used for.

 

recall that the patient is at risk for negative medication interactions.

recall that the patient is at risk for negative medication interactions

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.

 

drug dependency.

 

potentiation.

 

drug tolerance.

polypharmacy

Common causes of depression in the elderly include all of the following, except:

 

chronic medical conditions.

 

prescription medication use.

 

alcohol abuse and dependence.

 

an acute onset of dementia

an acute onset of dementia

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

 

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

 

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

 

Depression and hopeless feelings are often not predisposing factors.

 

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

Older patients tend to use more lethal means than younger patients

Which of the following is the most common mechanism of injury in older patients?

 

Abuse

 

Suicide

 

Falls

 

Burns

Falls

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.

 

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.

 

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.

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:

 

begin assisting her ventilations with a bag-valve mask while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation.

 

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

 

suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment.

 

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.

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

When immobilizing a patient with a kyphotic spine to a long backboard, the EMT would most likely have to:

 

place blankets behind the patient's head.

 

force the head into a neutral alignment.

 

use a scoop stretcher instead of a log roll.

 

secure the patient's head before the torso.

place blankets behind the patient's head

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.

 

a family member regularly checks up on her.

 

she attempted to catch herself before falling.

 

she takes medications for Alzheimer disease.

she became dizzy or fainted before falling.

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):

 

idiopathic fracture.

 

pathologic fracture.

 

comminuted fracture.

 

compression fracture.

pathologic fracture.

Fractures of the pelvis in older patients often occur as the result of a combination of:

 

arthritic joints and high-energy trauma.

 

acetabular separation and severe falls.

 

osteoporosis and low-energy trauma.

 

increased bone density and car crashes.

osteoporosis and low-energy trauma

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:

 

distracting injuries.

 

severe kyphosis.

 

compression fractures.

 

spinal cord tearing.

compression fractures

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.

 

diabetic ketoacidosis.

 

acute ischemic stroke.

 

acute hyperglycemia.

a subdural hematoma

Patients who have experienced even minor-appearing head injuries should be suspected of having a brain injury, especially if they:

 

do not have deformities to the skull.

 

have minor abrasions to the head area.

 

are taking blood-thinning medications.

 

have a history of Alzheimer disease.

are taking blood-thinning medications

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):

 

advance directive.

 

statute of care.

 

physician directive.

 

power of attorney.

advance directive

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 healthcare setting.

 

it is signed by three or more physicians.

the patient develops cardiac arrest

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:

 

allow the patient to die in peace.

 

try to locate the documentation.

 

attempt to resuscitate the patient.

 

contact medical control for advice.

attempt to resuscitate the patient

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.

 

Human resource agencies fail to investigate.

 

Victims of elder abuse are hesitant to report it.

 

The definitions of abuse and neglect vary.

Human resource agencies fail to investigate.

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

 

physical

 

emotional

 

psychological

 

financial

physical

Many older victims of physical abuse might make false statements or lie about the origin of their injuries because:

 

most elderly patients have dementia.

 

they fear retribution from the abuser.

 

they do not want to be bothersome.

 

they are protective of the abuser.

they fear retribution from the abuser.

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.

 

factually document all findings.

 

review the patient's activities of daily living.

 

ask the patient how the bruises occurred.

accuse a caregiver of physical abuse.

When documenting a case of suspected elder abuse, it is most important for the EMT to:

 

theorize as to why the patient was abused.

 

list the names of all of the suspected abusers.

 

avoid documenting any unsupported opinions.

 

document his or her perceptions of the event.

avoid documenting any unsupported opinions

EMTs are dispatched to a residence for an 80-year-old woman who is ill. The patient's daughter states that her mother almost fainted after going to the bathroom and that her pulse was very slow. The patient's pulse rate is 80 beats/min and irregular, and she is conscious and alert. The EMTs should suspect that the patient:

 

has a gastrointestinal hemorrhage.

 

experienced a vasovagal response.

 

has an abdominal aortic aneurysm.

 

took too much of her medication.

experienced a vasovagal response

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:

 

hypovolemic shock.

 

a systemic infection.

 

a subdural hematoma.

 

acute hyperglycemia.

a systemic infection

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?

 

The patient is prescribed an inhaler

 

History of deep venous thrombosis

 

The patient's abdomen is swollen

 

Frequent urinary tract infections

History of deep venous thrombosis