Deck 5: Geriatrics

Question 1

You are at the home of a 92-year-old male patient. He is alert and oriented and in good spirits and, although mildly hearing impaired, can hear you if you speak clearly and face him as you speak. He has no teeth and is not wearing dentures. His speech is indistinct and difficult to understand. Which of the following is the best course of action?

A) See if he can write down what he wants to say. His speech may be impaired from a stroke rather than a lack of dentition.
B) Tell him to respond to your questions with simple hand gestures.
C) Ask him to put in his dentures if he has them. Locate them for him if necessary.
D) Ask a family member to "translate," because the family is probably able to understand him better.

Answer 1

Ask him to put in his dentures if he has them. Locate them for him if necessary.

Question 2

You are called to a residence for an unresponsive patient. The patient, an 86-year-old man, has reportedly been depressed recently. An empty bottle of Inderal is next to the patient, who is bradycardic and hypotensive. To best care for this patient, you should:

A) apply pacer pads and pace at a rate of 80 per minute.
B) administer 1 mg of epinephrine 1:10,000.
C) administer glucagon.
D) apply pads and perform synchronized cardioversion.

Answer 2

administer glucagon.

Question 3

Which of the following is an appropriate question to ask of an elderly patient who lives alone?

A) "Are you sure you are capable of taking care of yourself?"
B) "Isn't there anyone who could move in with you to help you?"
C) "Is there someone you can call if you have trouble with your medications tonight?"
D) "Don't you know living alone is dangerous at your age?"

Answer 3

"Is there someone you can call if you have trouble with your medications tonight?"

Question 4

The term elderly applies to a person beginning at age:

A) 70.
B) 55.
C) 80.
D) 65.

Question 5

Your patient is a 75-year-old woman complaining of constipation and abdominal pain for two days. Your physical examination reveals a moderately distended abdomen. Which of the following is the best course of action?

A) Advise the patient to use an enema.
B) Suggest that the patient see her primary care physician.
C) Transport the patient, because she has a potentially serious medical problem.
D) Advise the patient to use a laxative.

Question 6

Which of the following statements regarding EMS consideration of psychosocial issues in elderly patients is TRUE?

A) Successful medical treatment of elderly patients involves an understanding of the broader social situation in which they live.
B) Most elderly patients are lonely and isolated, and may not be able to care for themselves.
C) Elderly patients usually have limited income, and are likely to be unable to afford expensive medication.
D) It is unlikely that an elderly patient in a nursing facility will be as well cared for as one who lives at home.

Question 7

A 78-year-old woman complains of dizziness, visual disturbances, fatigue, and loss of appetite. Which of the following medications would be most likely to cause these symptoms?

A) Coumadin
B) Enalapril
C) Pradaxa
D) Digitalis

Question 8

The study of the effects of aging and age-related diseases in human beings is called:

A) dementiology.
B) geriatrics.
C) gerontology.
D) senescence.

Question 9

You have been asked to deliver a talk about the geriatric population. Which of the following points would you emphasize in your presentation?

A) Assessment can be difficult because 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) Geriatric patients actually comprise a smaller number of EMS calls and transports than generally thought.
D) Dementia and chronic disease are both an inevitable part of the aging process.

Question 10

Which of the following is NOT a complication caused by incontinence?

A) Skin ulcer
B) Urinary tract infection
C) Diverticulosis
D) Sepsis

Question 11

Which of the following statements is TRUE of falls in the elderly?

A) Falls in the elderly are not preventable.
B) Falls are the leading cause of accidental death in the elderly.
C) The elderly have the highest incidence of falls.
D) All of the above are true.

Question 12

An 84-year-old man complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath and has clear lung sounds and an SpO₂ of 96%. When asked, he claims that the discomfort started after getting out of bed two hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and dementia. Your differential diagnosis for this patient should include:

A) aortic dissection, pulmonary embolism, and myocardial infarction.
B) myocardial infarction, stroke, and musculoskeletal trauma.
C) trauma, pulmonary embolism, and pneumonia.
D) COPD, stroke, and medication overdose.

Question 13

Elderly people who live alone are more likely to be:

A) male, under age 80.
B) female, age 85 or older.
C) female, under age 80.
D) male, age 85 or older.

Question 14

A 97-year-old man became dizzy and fell onto the floor. 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 two days. Currently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension, and states that he saw his doctor two days ago. Which one of the following questions would be most helpful in identifying the cause of this patient's signs and symptoms?

A) "Have you ever had a stroke?"
B) "Did the doctor prescribe any new medications?"
C) "When was the last time you ate or drank anything?"
D) "Why didn't you call 911 when he fell before?"

Question 15

An 85-year-old man has fallen down five stairs to the carpeted 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 16

You are caring for an elderly patient who lives alone. The patient is complaining of feeling unwell for a period of several days and seems to be unable to provide a detailed personal medical history. An appropriate assessment of this patient should include:

A) an assessment of living conditions, nutrition, and social support.
B) contacting adult protective services to report an unsafe living situation.
C) contacting the patient's physician to obtain an accurate history.
D) exposing the patient to look for signs of physical abuse.

Question 17

Your 78-year-old patient gives a history of congestive heart failure, renal insufficiency, and type 2 diabetes. Together, these conditions are called:

A) comorbid conditions.
B) confounding conditions.
C) functional impairments.
D) polypathophysiology.

Question 18

Which of the following is NOT a factor in altered pharmacokinetics in the elderly?

A) Decreased hepatic function
B) Slowed drug absorption from the gastrointestinal tract
C) Increased total body water
D) Decreased renal function

Question 19

While you are off-duty, a friend, who knows you are a paramedic, expresses concern about her elderly parents. She knows that their health needs are changing, but does not know what to do to help. Which of the following would NOT be an appropriate resource for her to use?

A) AARP
B) Department of Health and Human Services
C) The local community senior center
D) OSHA

Question 20

Which of the following statements regarding pharmacokinetics and the aging process is TRUE?

A) Aging causes the kidneys to filter out more waste products, enhancing the absorption of many medications.
B) Functional changes in the kidneys, liver, and gastrointestinal system slow the absorption and elimination of many medications.
C) Cardiac cells become more sensitive to medication as they age, meaning that lower doses of cardiac medications are necessary.
D) The GI tract of an elderly patient quickly processes medications, meaning that medications have a shorter half-life than in younger patients.

Question 21

Age-related changes in ________ make elderly patients more susceptible to ________.

A) circulation; hyperglycemia.
B) sweat glands; hyperthermia.
C) lung tissue; hypokalemia.
D) cardiac cells; ventricular fibrillation.

Question 22

Police have called for EMS assistance at the home of a 78-year-old woman. The patient's daughter called 911 after her mother stated that she "didn't want to live anymore." The police officer tells you, "I don't think she'd actually hurt herself, since she's almost 80 years old." Which of the following is an appropriate response to this statement?

A) "You're right, she probably wouldn't. Let me see if she wants to sign a refusal of care form."
B) "Actually, elderly patients have a high rate of depression and suicide."
C) "I don't think she needs a hospital evaluation; the daughter can take her to her primary physician."
D) "She may be being abused; you should question the daughter about it."

Question 23

Common mental health problems in the geriatric population include all of the following EXCEPT:

A) affective disorders.
B) post-traumatic stress disorder.
C) depression.
D) suicide.

Question 24

Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient?

A) Failing to pad the backboard for a patient in need of spinal immobilization
B) Allowing the patient to remain in the same position during an extended transport time
C) Failing to remove wet or soiled clothing of the incontinent patient
D) All of the above

Question 25

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

A) Hip fractures are responsible for 85% of traumatic deaths.
B) Head injuries are easy to detect in the elderly.
C) Bradycardia is an early sign of blood loss.
D) Injuries are most commonly caused by falls.

Question 26

Which of the following is an intrinsic factor in falls in the elderly?

A) High shelving for storage
B) Glaucoma
C) Throw rugs in the living area
D) Ice on a driveway or sidewalk

Question 27

You have been called to a nursing home for an 86-year-old woman with pneumonia. The patient's airway is patent, respirations labored, and skin cool and pale, with an intact radial pulse. The vital signs are: pulse 124, respirations 20, blood pressure 104/58 mmHg, SpO₂ at 91%, and temperature 98.2^°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) obtaining a 12-lead ECG.
D) eliminating the chest pain.

Question 28

You have been called for an elderly woman 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 would be most indicative of a stroke?

A) "She has a history of progressive dementia."
B) "She has been getting fatigued faster lately."
C) "She suddenly could not remember her name yesterday."
D) "She has been drinking more water than normal."

Question 29

An 87-year-old woman fell while getting out of bed. She is on the floor with severe pain to her left hip. 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 118 beats per minute
B) External rotation of the hip
C) Weak pedal pulse in the left foot
D) Respiratory rate of 20 breaths per minute

Question 30

A 77-year-old woman is confused and combative. Her daughter states that she has been gradually "acting strange" since waking up this morning. The patient has a history of alcoholism, and reportedly fell two weeks ago. Given your knowledge of the changes associated with aging, you should maintain a high index of suspicion for:

A) acute alcohol intoxication.
B) internal hemorrhage.
C) subdural hematoma.
D) hypokalemia.

Question 31

Your patient is a 75-year-old woman who is complaining of generalized weakness and loss of appetite. Your physical exam reveals no remarkable findings, and the patient has no significant past medical history. You reassure the patient that these are common complaints among people in her age group. Which of the following should you do next?

A) Advise the patient to make an appointment with her doctor.
B) Transport the patient for evaluation of a potentially serious medical problem.
C) Call a family member to come and stay with the patient.
D) Reassure the patient that there is nothing to worry about, and that you don't believe she needs to go to the hospital.

Question 32

When assessing a 90-year-old woman who fell, what assessment finding should concern the paramedic 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 33

You respond to a low-income apartment complex for a report of an unresponsive patient. The landlord reports that the patient, a 90-year-old man, is two months behind on his rent and has not paid his utility bills. The patient presents unresponsive on a tile floor with a slow carotid pulse and skin that is pale and cold. You should have a high index of suspicion for:

A) a suicide attempt.
B) head trauma.
C) hypothermia.
D) elder abuse.

Question 34

You have been called for a 72-year-old woman with chest pain. On scene, the patient denies ever having chest pain and requests to sign a refusal. Before having the refusal signed, the paramedic must consider that many geriatric patients may deny symptoms because of:

A) fear of losing independence and dignity.
B) apprehension about medical bills.
C) confusion regarding their rights as a patient.
D) acute onset of dementia and other neurological diseases.

Question 35

The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock?

A) Altered mental status
B) Cardiac dysrhythmias
C) Hypothermia
D) Tachycardia

Question 36

Which 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 50 beats per minute.
B) Blood pressure is typically higher in elderly women.
C) The resting respiratory rate is typically higher in the elderly.
D) The vital signs of an elderly patient are similar to those of an adolescent.

Question 37

The son of a 73-year-old woman has called 911. The patient is confused and exhibiting out-of-character behavior. The son informs you that she is a diabetic, and takes pills and not injectable insulin. 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:

A) hyperglycemia.
B) urinary tract infection.
C) sepsis.
D) hypoglycemia.

Question 38

You have been called for an 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Your best action would be to:

A) contact the police and wait on scene until they arrive.
B) ask the family members why their stories are different.
C) document elder abuse in your PCR.
D) provide care and transport, and inform the emergency department physician that you suspect abuse.

Question 39

Which of the following conditions increases the likelihood that an elder may be abused or neglected?

A) Incontinence
B) Dementia
C) Immobility
D) All of the above

Question 40

Your patient is an 82-year-old woman whose daughter called EMS because the patient became very short of breath as they walked from their parking spot to the front of their church. On your arrival, the patient states that she just needed a little rest and now feels much better. On questioning, she admits to several such episodes in the past month. She denies chest pain and she says, "I just got winded because I'm getting so old." The patient has a heart rate of 104, a respiratory rate of 20, and blood pressure of 172/90 mmHg. Your history and physical examination should focus on which of the following possibilities?

A) Myocardial infarction
B) Thyroid storm
C) Cerebrovascular accident
D) COPD

Question 41

Which of these is the least important physical requirement for effective continence?

A) Anatomically correct GI/GU tract
B) Adequate tissue perfusion
C) Competent sphincter mechanism
D) Adequate cognition and mobility

Question 42

Which of these factors does not typically decrease compliance in the elderly?

A) Limited mobility
B) Fear of toxicity
C) Childproof containers
D) Poor skin integrity

Question 43

You have been called for an 86-year-old man who fell. The patient is incontinent and has an ulcerative rash beneath his adult diaper. During your assessment, you also find many bruises to his body in various stages of healing. The son reports that the patient fell getting out of bed; however, the daughter-in-law states that the patient fell while getting dressed. Which of the following is the BEST example of how to document the patient's history in your PCR?

A) "Family members are unable to provide accurate history of event."
B) "Son states that the patient fell while getting out of bed; daughter-in-law states that the patient fell while getting dressed."
C) "The patient may have fallen while getting out of bed, or while getting dressed."
D) "Family members are unable to agree upon history of event, causing suspicion for elder abuse."