Deck 13: Assessment of the Older Patient

Question 1

What is the most surprising clinical finding in older patients with pneumonia that disguises its presence?

A) Lack of fever
B) Cough
C) Diminished breath sounds
D) Purulent sputum production

Answer 1

Lack of fever

Question 2

Which of the following best describes the manner in which a clinician should address the older adult patient?

A) Use the patient's first name to promote an atmosphere of equality.
B) Address the patient by his or her last name with the appropriate title.
C) Approach the patient in a matter-of-fact, business-like manner.
D) Avoid physical contact with the elderly.

Answer 2

Address the patient by his or her last name with the appropriate title.

Question 3

Age is the major risk factor for developing which of the following eye disorders?

A) Cataract
B) Glaucoma
C) Vascular disorders
D) Diabetic retinopathy

Answer 3

Cataract

Question 4

What is the expected supine resting heart rate in healthy elderly men?

A) 50 to 60 beats/min
B) 60 to 100 beats/min
C) 90 to 110 beats/min
D) >110 beats/min

Question 5

Why is asthma thought to be underdiagnosed in the aged?

A) They do not wheeze during an asthma attack.
B) Their symptoms more closely match those of chronic obstructive pulmonary disease (COPD).
C) They do not wheeze when they have asthma.
D) Historically, asthma has been considered a childhood disorder.

Question 6

What would be a normal pulse pressure in the older adult?

A) 20
B) 70
C) 110
D) 130

Question 7

What is the impact of aging on the body's immune system?

A) A higher white blood cell (WBC) count
B) Higher fevers in response to bacterial infections
C) Diminished response to vaccines
D) Decreased occurrence of reactivation tuberculosis (TB)

Question 8

By age 79 years, about what percentage of older patients have hearing impairment?

A) 30%
B) 40%
C) 50%
D) 60%

Question 9

What percentage of adults older than 65 years have elevated systolic or diastolic pressure?

A) 20%
B) 30%
C) 40%
D) 60%

Question 10

How much does the incidence of congestive heart failure (CHF) increase with each decade of life between 45 and 75 years?

A) Doubles
B) Triples
C) Quadruples
D) Quintuples

Question 11

Which of the following factors contribute to a reduction in an elderly person's mucociliary clearance?
1) Increase in ciliary activity
2) Degenerative changes in the epithelial cells of the mucous membrane
3) Decrease in the phagocytic activity of macrophages in the mucous membrane
4) Decrease in the cough reflex

A)1 and 3
B)2 and 4
C)1, 2, and 3
D)2, 3, and 4

Question 12

Which heart chamber typically thickens with aging?

A) All four chambers
B) The left atrium
C) The left ventricle
D) The right ventricle

Question 13

In the 65- to 75-year-old age group, about what percentage of adults experience hearing loss?

A) 23%
B) 32%
C) 37%
D) 40%

Question 14

Which of the following statements is true about the effects of aging on the pulmonary system?
1) Alveolar septa gradually deteriorate.
2) The number of alveoli gradually decreases.
3) Loss of alveolar walls reduces the surface area for gas exchange.
4) Smooth muscle fibers in the lungs are progressively replaced with fibrous connective tissue.

A)1 and 3
B)2 and 4
C)1, 2, and 3
D)1, 3, and 4

Question 15

Which of the following is the most common complaint from a patient suffering from an acute myocardial infarction?

A) Chest pain
B) Throat pain
C) Shoulder pain
D) Abdominal pain

Question 16

What is the physiologic effect of aging on pulmonary function?

A) Decreased residual volume (RV)
B) Increased functional residual capacity (FRC)
C) Increased tidal volume (V_T)
D) Decreased total lung capacity (TLC)

Question 17

What fraction of patients older than 70 years have calcium deposits in their aortic or mitral valves?

A) One-fourth
B) One-third
C) One-half
D) Two-thirds

Question 18

At approximately what age do respiratory muscles begin to weaken?

A) 55 years
B) 65 years
C) 70 years
D) 75 years

Question 19

Ageism in the health care setting can lead to:

A) practitioners spending more time with older patients.
B) practitioners listening to older patients less carefully.
C) practitioners treating older patients with compassion.
D) better communication with elderly patients.

Question 20

Ototoxicity has a damaging effect on which cranial nerve?

A) Fifth cranial nerve
B) Sixth cranial nerve
C) Seventh cranial nerve
D) Eighth cranial nerve

Question 21

Which of the following laboratory values increases with age?

A) Albumin
B) Serum glucose
C) Serum creatinine
D) Creatinine clearance

Question 22

Why is pulmonary auscultation more difficult to assess in an elderly patient?

A) Pulmonary abnormalities do not result in abnormal breath sounds in this age group.
B) Coarse breath sounds are common even over normal lung tissue.
C) Fine inspiratory crackles may indicate the presence of asthma.
D) Patients often cannot sustain deep breathing of good quality.

Question 23

The normal resting respiratory rate in elderly patients is in what range?

A) 10 to 18 breaths/min
B) 12 to 21 breaths/min
C) 14 to 23 breaths/min
D) 16 to 25 breaths/min

Question 24

Which of the following would explain the presence of "clubbing" in the aged?

A) COPD
B) Simple aging process
C) CHF
D) Connective tissue disorders

Question 25

Which of the following disorders would be characterized by intermittent cutaneous pallor or cyanosis?

A) COPD
B) Asthma
C) Acute renal failure
D) Raynaud phenomenon

Question 26

An elderly patient who gains more than how many pound(s) in a week may be suffering from CHF?

A) 1 lb
B) 3 lb
C) 5 lb
D) 7 lb

Question 27

Which of the following is used to assess mobility and the ability to participate in personal hygiene and grooming?

A) Activities of daily living
B) Hygiene living log
C) Duration of ability
D) Quality of life

Question 28

Which of the following PaO₂ values would be normal for an 80-year-old individual who is breathing room air?

A) 60 mm Hg
B) 65 mm Hg
C) 50 mm Hg
D) 85 mm Hg

Question 29

Which of the following pulmonary function measurements decreases with age?

A) Tidal volume
B) Residual volume
C) Total lung capacity
D) Diffusing capacity

Question 30

Which clinical symptom that is indicative of dehydration in younger adults loses its significance in the elderly because of diminished skin turgor?

A) Tenting
B) Pitting edema
C) Cyanosis
D) Clubbing

Question 31

Which of the following pulmonary function measurements increases with age?

A) Vital capacity
B) Closing capacity
C) Diffusing capacity
D) Inspiratory capacity

Question 32

Which of the following laboratory values decreases with age?

A) Albumin
B) Hemoglobin
C) Serum glucose
D) Serum cholesterol

Question 33

Which of the following disorders would be characterized by Cheyne-Stokes breathing?

A) COPD
B) Asthma
C) CHF
D) Raynaud phenomenon