Deck 39: Geriatrics

Question 1

A new EMT asks you why the elderly are at a higher risk for developing pneumonia, as compared to those of a younger age. You inform him that the elderly are more susceptible to respiratory infections because of a(n):

A) impaired swallowing of saliva.
B) decreased alveolar gas exchange.
C) decreased cough reflex.
D) hardening of the major arteries.

Answer 1

C

Question 2

You have just arrived by the side of an elderly patient who took excessive amounts of his daily medications after becoming confused about what to take and when. Which one of the following is the immediate priority in caring for this patient?

A) Determine what medications were taken and how much.
B) Determine the patient's past medical history.
C) Gather up all medications for transport with the patient.
D) Evaluate and support the patient's airway and breathing.

Answer 2

D

Question 3

When getting a medical history from a patient, you refer to him as Mr. Adamo. He stops you and asks you to call him Robert. You should:

A) call him Robert.
B) continue to address him as Mr. Adamo.
C) avoid calling him by his name.
D) ask family members how they would like him addressed.

Answer 3

A

Question 4

In reviewing prehospital care reports, you note that over 75 percent of the patients from a nursing home suffer from hypertension. As a knowledgeable EMT, you would recognize that:

A) hypertension is common among the elderly.
B) the patients are not taking blood pressure medications.
C) an infectious disease is spreading through the nursing home.
D) all of the patients must have the same physician.

Question 5

When assessing a 91-year-old female who fell, what assessment finding should concern the EMT most?

A) Skin tear that appears infected on her arm
B) Heart rate of 90 beats per minute
C) Sudden onset of confusion
D) History of osteoporosis and leg pain

Question 6

You have been called for a conscious and alert 83-year-old male complaining of a fever for three days. He has a history of peripheral vascular disease. When assessing the patient's circulation, you have a difficult time feeling his radial pulse. Your next action would be to:

A) start cardiopulmonary resuscitation.
B) check the patient's blood pressure.
C) locate the patient's carotid pulse.
D) apply supplemental oxygen.

Question 7

Family members tell you that 3 hours ago, their 76-year-old mother suddenly became confused and had great difficulty speaking. However, within 15 minutes she returned to normal. Based on this description, the EMT should be suspicious of:

A) stroke.
B) dementia.
C) Alzheimer's disease.
D) transient ischemic attack.

Question 8

You have been called to an assisted living facility to transport a patient who has been vomiting continuously for 6 hours. She is responsive to verbal stimuli. The patient suffers from arthritis and severe kyphosis. How should you transport this patient on the stretcher?

A) Semi-Fowler's position
B) Left lateral recumbent position
C) Immobilized to a long board
D) Prone with her head turned to the side

Question 9

You have been called for a 79-year-old female complaining of shortness of breath. Due to the increased respiratory rate, cough, and production of discolored sputum, you are suspicious of pneumonia. A family member asks you how she can have pneumonia, when her temperature is only 97.9°F. Your best response is:

A) "It is not uncommon for the elderly to have pneumonia without the signs of high fever or chills."
B) "You will have to ask the doctor because I cannot give out medical information."
C) "There is less need for an increased body temperature since the elderly have a higher number of white blood cells."
D) "Higher blood pressure, typically seen in the elderly, tends to inhibit the body from producing a fever."

Question 10

You have been called for a 77-year-old male with chest pain. On scene the patient denies ever having chest pain and requests to sign a refusal. Before having the refusal signed, the EMT must consider that many geriatric patients may deny symptoms because of:

A) fear of losing independence and dignity.
B) apprehension about having to take medications.
C) confusion chest pain often creates in geriatric patients.
D) acute onset of dementia and other neurological diseases.

Question 11

A patient with advanced dementia cannot provide an accurate medical history. In this situation, the EMT's best course of action would be to:

A) transport the patient to a hospital he has been to previously.
B) have the patient sign a release-of-medical-information form.
C) determine medical conditions based on assessment findings.
D) ask family members about the patient's past medical history.

Question 12

Your partner believes the 90-year-old male you are caring for is dehydrated. What sign best reinforces his suspicion?

A) Increased blood pressure
B) Dry and flaky skin
C) Poor skin turgor
D) Dry mouth and tongue

Question 13

Which statement indicates an accurate understanding of administering positive pressure ventilation (PPV) to a geriatric patient?

A) "An increase in the force of ventilation is needed to get air into the stiff lungs."
B) "If the patient is breathing between 10 and 20 breaths per minute, PPV is not needed."
C) "If the geriatric patient has a history of COPD, a pediatric bag-valve mask may be needed."
D) "Gentle ventilations that make the chest rise are adequate to provide oxygen into lungs."

Question 14

An elderly female fell down three steps and is complaining of back pain. After performing the primary assessment, what question would be most important to ask first?

A) "Did you become dizzy before you fell?"
B) "Why did you not use the ramp on the other side?"
C) "Do you have a history of high blood pressure?"
D) "What medications are you taking?"

Question 15

You have been asked to deliver a talk about EMS and its interaction with the geriatric population. Which point would you emphasize in your presentation?

A) Assessment can be difficult since most persons older than 70 have some degree of dementia.
B) Many of the elderly have a combination of different diseases in various stages.
C) Geriatrics actually comprise a smaller number of EMS calls and transports than thought.
D) Dementia and chronic disease are both an inevitable part of the aging process.

Question 16

You have just arrived by the side of a nonverbal patient with snoring respirations. The caregiver states that they were eating lunch when she suddenly collapsed face first onto the table. She also states that she has a history of a stroke, high blood pressure, and colon cancer. Your priority in caring for this patient at this time would be:

A) rapid transfer of the patient to the cot.
B) feel for a radial or carotid pulse.
C) open and look into the patient's mouth.
D) obtain a heart rate and blood pressure.

Question 17

A patient with kyphosis has fallen and is complaining of numbness in both arms. Regarding immobilization, you should:

A) avoid immobilization and transport in a position of comfort.
B) transport the patient fully immobilized and in a prone position.
C) apply a cervical collar and transport in a semi-Fowler's position.
D) place pillows in voids between the patient and the long board.

Question 18

Which one of the following statements demonstrates an accurate understanding of vital signs in relation to the geriatric patient?

A) "The typical resting heart rate is less than 60 beats per minute."
B) "Fever tends to be more common and more severe in elderly patients."
C) "The resting respiratory rate is typically higher in the elderly."
D) "There is no difference between the vital signs of a geriatric patient and a young adult."

Question 19

You have been called for an unknown medical emergency. On scene you are presented with an 84-year-old patient who is confused and does not obey commands. The best means of determining the patient's normal mental status would be to:

A) examine the patient's pupils.
B) question family members.
C) look at the patient's medications.
D) check the patient's vital signs.

Question 20

The son of an 88-year-old patient states that he told his mother to double the dose of her antibiotic so she would "get better faster." This represents a problem given that the elderly have a(n):

A) decreased respiratory function.
B) increased amount of body water.
C) decreased liver and kidney function.
D) increased tolerance to medication.

Question 21

An 86-year-old male has experienced a seizure and is now lethargic and confused. His family states that the patient has a history of seizures and was sleeping in bed when the seizure was witnessed by his wife. He remains in bed with an intact airway, adequate breathing, and a radial pulse that is rapid. You also note him to be incontinent of urine. Appropriate care of this patient would include:

A) considering oxygen and transport with him positioned on his left side.
B) securing the patient tightly to the stretcher to prevent injury should he seize again.
C) inserting an oral airway and starting positive pressure ventilation with supplemental oxygen.
D) considering supplemental oxygen and immobilizing with a cervical collar and long board.

Question 22

An 81-year-old female called 911 when she suddenly lost vision in her right eye. Based on this description, the EMT should be suspicious of:

A) cataracts.
B) glaucoma.
C) macular degeneration.
D) retinal detachment.

Question 23

You have been called for a 77-year-old female with altered mental status. On scene you note the patient's inability to speak and vomitus in her airway. Her breathing is labored and inadequate, and radial pulse rapid and weak. She is not moving her right arm or right leg. Which one of the following should be your first priority?

A) Start positive pressure ventilation with supplemental oxygen.
B) Check the blood sugar and immediately transport to a stroke center.
C) Suction the airway and determine adequate breathing.
D) Establish the time of stroke onset and start high-concentration oxygen.

Question 24

You have been called to a skilled nursing home to transport a patient with fever and pneumonia to the hospital for further care and treatment. As such, you realize that the primary focus of your care will be:

A) oxygen therapy.
B) safe and rapid transport.
C) cooling the patient.
D) administering a bronchodilator.

Question 25

You are preparing to transport an 86-year-old female complaining of altered mental status and nausea and vomiting. Aspiration pneumonia would be best prevented by:

A) suctioning her airway as soon as she vomits.
B) providing high-concentration oxygen.
C) giving the patient aspirin prior to transport.
D) transporting in a semi-Fowler's position.

Question 26

Which of the following statements regarding traumatic injuries and the elderly is true?

A) MVCs are responsible for over 75 percent of deaths.
B) Head injuries are easy to detect in the elderly.
C) Hyperthermia is an early sign of blood loss.
D) Injuries are most commonly caused by falls.

Question 27

A hearing-impaired patient with a hearing aid is having a difficult time hearing your questions. Your initial action would be to:

A) write the questions on paper.
B) slow your speech and increase the pitch of your voice.
C) ensure that his hearing aid is turned on.
D) position yourself in front of the patient and speak loudly.

Question 28

You have been called to the side of a confused geriatric patient complaining of abdominal pain. Before palpating the patient's abdomen, you would first:

A) explain to family members why you are feeling the patient's abdomen.
B) find out if the patient has a Do Not Resuscitate (DNR) order.
C) inform the patient that you will be pressing on her abdomen.
D) determine if the patient has a history of respiratory disease.

Question 29

When assessing a geriatric patient for pneumonia, the EMT must remember that:

A) a cough with bloody sputum is typically observed.
B) hypotension is commonly associated with the infection.
C) a normal body temperature may be observed.
D) chest pain and chills are almost always present.

Question 30

An 85-year-old male with a history of heart attacks has called 911 for chest pain. He states that the pain started 2 hours ago when he was sitting on his porch. When asked, he states that it feels similar to his last heart attack, only this time he is also dizzy. The primary assessment indicates no life threats and the Emergency Medical Responder on scene reports the following vital signs: pulse 92, respirations 18, blood pressure 88/52, and SpO₂ at 93% on room air. The patient has nitroglycerin, but has not taken it yet (you have a standing order to administer nitroglycerin without calling medical direction). After applying oxygen, you should:

A) perform the secondary exam.
B) assist the patient with his nitroglycerin.
C) provide immediate and rapid transport.
D) assess for neurological deficits.

Question 31

Which one of the following best describes the term "silent heart attack"?

A) The chest pain was so intense the patient could not speak.
B) The patient had a single episode of chest pain followed by cardiac arrest.
C) The chest pain did not radiate into the arms, neck, or back.
D) The patient had little to no chest pain or discomfort.

Question 32

You have been called to a nursing home for a 91-year-old female with pneumonia. The patient is to be transported to a local hospital for further treatment. When asked, the staff confirms and then produces the patient's Do Not Resuscitate (DNR) order. The patient's airway is patent, respirations labored, and skin warm, with an intact radial pulse. The vital signs are: pulse 124, respirations 20, blood pressure 104/58, SpO₂ at 91%, and temperature 101.2∘F. The patient also complains of chest pain and has a cough. Given this situation, the focus of your care should be:

A) transport to the hospital.
B) adequate oxygenation.
C) decreasing the fever.
D) eliminating the chest pain.

Question 33

An 82-year-old female with nausea and vomiting has called 911. When obtaining her past medical history, she informs you that she suffered a transient ischemic attack (TIA) two months ago. Based on this, what should the EMT expect to find?

A) Decreased sensation to the left side of her body
B) Difficulty in moving her right arm and right leg
C) Decreased sensation to her left leg
D) The absence of any neurological deficits

Question 34

To best communicate with a geriatric patient with diminished eyesight, the EMT should:

A) write questions in large print on paper.
B) increase both the pitch and volume of his voice.
C) stand in front of the patient and talk normally.
D) obtain needed information from family members.

Question 35

An 84-year-old male complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath, but has clear lung sounds and an SpO₂ of 93%. When asked, he claims that the discomfort started after getting out of bed 2 hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and irritable bowel syndrome. Family members state that he has early dementia. There are no obvious life threats and his vital signs are normal for his age. The appropriate treatment for this patient would include:

A) continue to monitor and transport.
B) provide oxygen and treat as a cardiac patient.
C) immobilize his right arm and shoulder.
D) apply ice and a sling to his shoulder and transport.

Question 36

When assessing a patient, which finding should raise the EMT's suspicion that the patient may be suffering from a pulmonary embolism?

A) Bradycardia with normal SpO₂ reading
B) Sudden onset of shortness of breath
C) Chest pain that is "dull" and radiates to the arm
D) Crackles in the bases of both lungs

Question 37

You have been called for a 91-year-old female who fell. Since your assessment reveals bruises to her body in various stages of healing and inconsistencies in information provided by her family, you are suspicious of geriatric abuse. Your best action would be to:

A) contact the police and wait on scene until they arrive.
B) confront the family members with your suspicion.
C) inform your medical director and include it in the PCR.
D) quietly transport and inform the emergency department physician.

Question 38

A 92-year-old male states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which one of the following in the patient's history is of greatest concern?

A) He had hip surgery two years ago.
B) The patient took nitroglycerin and now has a headache.
C) The patient states his left calf is tender and painful.
D) The patient injured his wrist when he fell.

Question 39

The family of an 87-year-old female has called 911. She is confused and exhibiting improper and out of character behavior. They inform you that she is a diabetic, but takes pills and not insulin. They also state that he has been complaining of dizziness and has been drinking water nonstop as well as urinating. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. Based on this history, you should be suspicious of and treat her for:

A) elevated blood sugar.
B) urinary tract infection.
C) stroke or transient ischemic attack (TIA).
D) hypoglycemia.

Question 40

Which one of the following is the fundamental danger associated with a pulmonary embolism?

A) Infection
B) Hypertension
C) Pulmonary edema
D) Hypoxia

Question 41

A patient with a history of arteriosclerosis suffers from:

A) weakened heart.
B) stiffened arteries.
C) hypotension.
D) occluded veins.

Question 42

You have been called for a geriatric patient with advanced dementia. The staff at the skilled nursing facility believes her to be suffering from a urinary tract infection. At bedside, you find her to be confused and aggressive. She is on constant oxygen at 3 lpm for COPD. During transport, she repeatedly spits and tries to strike you. You would respond by:

A) applying a nonrebreather face mask with 3 lpm of oxygen.
B) contacting advanced life support for administration of a sedative.
C) tightening the straps so that she is tightly restrained to the stretcher.
D) moving away from the patient so she cannot strike you.

Question 43

An 89-year-old female is short of breath and has a fever. Her SpO₂ is low and she has crackles and coarse breath sounds to both lungs. When getting history from her family caregivers, which of the following would make you suspicious that the patient has aspiration pneumonia?

A) Her legs and ankles seem more swollen today.
B) She was fine until just after eating lunch.
C) Her doctor prescribed an antibiotic for her sinus infection.
D) She has not been feeling well for three days.

Question 44

An 83-year-old male has fallen down five stairs to the floor below. He hit his head and is complaining of a headache. When getting a history from this patient, what question should you ask first?

A) "What caused you to fall?"
B) "What medications are you taking?"
C) "Do you have a history of medical problems?"
D) "Have you ever been diagnosed with dementia?"

Question 45

The EMT would recognize potential elder neglect when the patient makes what statement?

A) "They are rough with me when I wet myself."
B) "They do not give me my high blood pressure medications."
C) "They are spending my money on illegal drugs."
D) "They wake me up every 3 hours at night to see if I am incontinent."

Question 46

A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. You find him sitting on the floor with his wife next to him. His wife states that he did not lose consciousness and that this has happened several times over the past few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?

A) Provide supplemental oxygen to maintain a SpO₂ of 94% or greater.
B) Take manual in-line spinal stabilization and begin assessment.
C) Position the patient supine with his feet elevated and get vital signs.
D) Check the patient's airway, breathing, and circulatory status.

Question 47

You have been called by the caregiver of a 91-year-old female with dementia. The patient is complaining of pain and deformity to her upper left arm. As you assess the patient, you note various bruises to the patient's body, and become suspicious of elder abuse. What action is most appropriate at this time?

A) Contact the police to report your suspicion.
B) Confront the caregiver regarding the bruises to the patient's arm.
C) Ask the patient if she is being abused.
D) Treat the patient for a possible broken arm.

Question 48

The EMT understands that vision disturbances caused by glaucoma occur secondary to:

A) clouding of the lens.
B) lack of tear production.
C) persistent hypotension.
D) damage to the optic nerve.

Question 49

A patient with cataracts would most likely complain of:

A) cloudy vision.
B) color blindness.
C) loss of peripheral vision.
D) intermittent blindness.

Question 50

You have been summoned for a diabetic patient with altered mental status. What sign would cause you to suspect that the patient is suffering from hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?

A) Blood glucose level of 52 mg/dL
B) Inability to urinate
C) Complaint of thirst and dry mouth
D) Fruity smell on his breath

Question 51

The EMT recognizes that dementia is typically observed as:

A) a chronic and irreversible condition.
B) altered mental status with a reversible underlying cause.
C) a chronic condition with a sudden onset.
D) altered mental status rooted in a psychiatric disorder.

Question 52

You have been called for an 84-year-old female who fell and hit her head. The patient is confused and has a laceration on her forehead. When getting the history from family members, which statement suggests that the patient is suffering from delirium?

A) "She has a history of progressive dementia."
B) "Her memory has been fading over the last two years."
C) "She could not remember her name yesterday."
D) "She only wants to eat junk food anymore."

Question 53

A patient with postural hypotension would most likely make what statement?

A) "When lying in bed, I have a hard time breathing."
B) "My shoes are tight because my ankles are swollen."
C) "I get so dizzy when I get up off of the couch."
D) "I go through periods where my heartbeat seems irregular."

Question 54

Narrowing of the valves within the heart is best described as:

A) stenosis.
B) cardiac hypertrophy.
C) dysrhythmia.
D) pulmonary edema.

Question 55

An 86-year-old female fell while walking to her bathroom. She is on the floor with severe pain to her right hip. Her airway is patent and breathing adequate. Family members tell you that she takes medication for high blood pressure, high cholesterol, and depression. When assessing the patient, what assessment finding is most concerning?

A) Heart rate of 120 beats per minute
B) External rotation of the hip
C) Weak pedal pulse in the right foot
D) Respiratory rate of 18 breaths per minute

Question 56

Alzheimer's disease is diagnosed by:

A) blood tests.
B) autopsy.
C) neurological exams.
D) involved memory test.

Question 57

Ageism would occur when the EMT:

A) asks all geriatric males if they remember World War II.
B) asks family members for medical information when the patient is confused.
C) does not attempt to assess combative elderly patients with dementia.
D) disregards an advance directive when a geriatric patient requests you to do so.

Question 58

A heavy dresser fell onto a 76-year-old's foot as he attempted to move it across his bedroom floor. His right foot and ankle are bruised, but he is refusing treatment or transport since it does not hurt. Which of the following statements made by the patient would be most concerning and warrant contact with medical command for further advisement?

A) "I have a history of congestive heart failure."
B) "I was recently diagnosed with cataracts."
C) "I have been told I have peripheral neuropathy."
D) "I fell and broke my left ankle last year."