CH 45 Flashcards by Allegra Osorio

Which of the following symptoms are less likely to be observed in a 90-year-old patient with a severe infection?

Weakness
Loss of appetite
Altered mentation
Fever

Fever

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Decreased elasticity of the lungs and calcification of the costochondral cartilage results in a(n):

significant increase in vital capacity.
decrease in the total amount of air in the lungs.
decrease in airway size and resistance.
increase in residual lung volume

increase in residual lung volume.

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Which of the following risk factors is associated with the highest rate of mortality following a burn injury in an elderly person?

Musculoskeletal injury
Proportional increase in adipose tissue
Age over 55 years
Preexisting medical condition

Preexisting medical condition

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You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is correct?

You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg.
This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure.
This patient’s vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.

This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.

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Which of the following central nervous system functions change as a person ages?

Intelligence level
Enzyme activity
Postural stability
Hormone levels

Postural stability

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After obtaining an elderly patient’s chief complaint, gathering additional information about the history of present illness would most likely be complicated because:

the patient may ask you to repeat your questions.
most elderly patients take numerous medications.
chronic problems may affect the acute problem.
the aging process causes difficulty in understanding.

chronic problems may affect the acute problem

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Aging brings a widespread decrease in bone mass, especially:

in postmenopausal women.
if the person falls frequently.
in men older than 50 years of age.
in the presence of hypertension.

in postmenopausal women

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Typical signs and symptoms of Meniere disease include:

viral infections.
otorrhea.
weight loss.
vertigo

Vertigo

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Polypharmacy is defined as:

a harmful interaction when several drugs are taken together.
the unintentional ingestion of multiple doses of the same drug.
the prescribing of multiple drugs to treat multiple conditions.
unnecessarily prescribing numerous drugs to prevent a disease.

The prescribing of multiple drugs to treat multiple conditions

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Which of the following cardiac dysrhythmias is associated with the highest risk of stroke?

Atrial fibrillation
Junctional rhythm
AV heart block
Sinus tachycardia

Atrial fibrillation

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When assessing an unresponsive older person’s airway, it is most important to remember that:

age-related tooth loss may cause obstruction of the airway.
the head should not be extended due to weakened cervical vertebrae.
delayed gastric emptying increases the risk of aspiration.
a marked reduction in saliva causes dryness of the oral mucosa.

delayed gastric emptying increases the risk of aspiration.

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Which of the following is a key element of the “G” in the GEMS diamond?

Obtaining a complete medical history from the patient
Checking the physical condition of the patient’s home
Assessing the elderly patient’s activities of daily living
Recalling that elderly patients often present atypically

Recalling that elderly patients often present atypically

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Which of the following statements regarding aging is correct?

Health care providers may attribute genuine disease symptoms to age, resulting in inadequate care.
Health care providers typically recognize the normal changes of aging and tend not to render unnecessary care.
All of the tissues and organs in the human body undergo the effects of aging at the same rate.
Although aging causes various anatomic changes, physiologic functions generally remain intact.

Health care providers may attribute genuine disease symptoms to age, resulting in inadequate care.

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An elderly person is at increased risk for aspiration, primarily from:

decreased cough and gag reflexes.
atrophy of the epiglottis.
slowing of the ciliary mechanisms.
a decreased ability to swallow.

decreased cough and gag reflexes.

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An increase in blood pressure that commonly occurs with aging is physiologically exacerbated by:

an overproduction of collagen and decreased quantities of elastin.
the patient’s noncompliance with their antihypertensive drugs.
a compensatory increase in preload and cardiac ejection fraction.
-f a decrease in stroke volume due to age-induced cardiomyopathy.

an overproduction of collagen and decreased quantities of elastin.

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Type I osteoporosis tends to progress more rapidly in:

postmenopausal women.
patients with excess calcium.
the bones of the lower extremities.
males older than 60 years of age.

postmenopausal women.

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The medical assessment of an elderly patient can be complex because:

elderly adults often make up symptoms that do not exist.
elderly adults often have more than one medical condition.
caregivers typically prefer that you speak with them.
most elderly adults are hearing or visually impaired.

elderly adults often have more than one medical condition.

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Which of the following conditions would most likely mimic depression?

Dementia
Delirium
Hyperglycemia
Hypoglycemia

Dementia

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The risk of a pulmonary embolus increases with age because of:

chronic use of aspirin.
frequent lung infections.
drug-induced bradycardia.
increased immobility.

Increases immobility

Most age-related visual disturbances are the result of:

cataracts or glaucoma.
retinal artery occlusion.
macular degeneration.
diabetic retinopathy.

Cataracts or glaucoma

Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to which of the following conditions?

Profound dehydration
Dementia
Malnutrition
Hyperkalemia

Hyperkalemia

A 71-year-old man with a history of emphysema, coronary artery disease, and hypertension presents with increased shortness of breath and fatigue. His oxygen saturation is 80% on home oxygen at 2 L/min via nasal cannula. His blood pressure is 140/76 mm Hg, pulse rate is 104 beats/min, and respirations are 28 breaths/min and labored. His medications include an albuterol inhaler, prednisone, hydrochlorothiazide, and lisinopril. Auscultation of his lungs reveals scattered wheezing in all fields. Which of the following prehospital interventions is contraindicated for this patient?

High-flow oxygen therapy
Nebulized ipratropium
Subcutaneous epinephrine
Continuous positive airway pressure

Subcutaneous epinephrine

Following retirement, many older people:

return to work within 6 months because their retirement pension does not support them adequately.
experience a rapid decline in their underlying health and become incapacitated within 12 months.
commonly experience decreased self-esteem because they no longer feel useful or productive in society.
often experience an improvement in their overall health because the stress of working has been eliminated.

commonly experience decreased self-esteem because they no longer feel useful or productive in society.

Hypotension and orthostatic vital sign changes would most likely occur in elderly people who take:

diuretics.
ACE inhibitors.
antidepressants.
beta blockers.

Diuretics

When assessing an older person, you should remember that it is common for older people to: - not understand your questions. - respond slowly to questions. - present with hemiparesis. - slur their words.

Respond slowly to questions

Which of the following conditions would most likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure? - Kyphosis - Spondylosis - Osteoporosis - Asthma

Kyphosis

Heat gain or loss in response to environmental changes is delayed in elderly people due to: - atherosclerotic vessels. - chronic hyperthyroidism. - increased sweat production. - chronic renal disease.

atherosclerotic vessels

You are assessing an 80-year-old man who complains of generalized weakness. He denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days. His medical history is significant for two prior heart attacks, hypertension, chronic renal insufficiency, and atrial fibrillation. His blood pressure is 108/60 mm Hg, pulse rate is 94 beats/min and irregular, and respirations are 20 breaths/min and unlabored. Auscultation of his lungs reveals scattered crackles, and the ECG reveals atrial fibrillation. In addition to administering supplemental oxygen, you should: - establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport. - obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport. - start an IV with D5W, assess his blood glucose level, and administer half the usual dose of diltiazem to lower the rate of his atrial fibrillation. - obtain a 12-lead ECG tracing, start an IV line with normal saline and give a 250-mL fluid bolus, reassess his blood pressure, and transport.

obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport

Physiologic age-related decreases in skin elasticity are the result of: - chronic use of corticosteroid medications. - frequent fungal or viral skin infections. - decreased collagen and elastin production. - slower replenishment of epidermal cells.

Decreased collagen and elastin production

In contrast to a 30-year-old man, if a 70-year-old man were to consume an excessive amount of alcohol: - it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver. - he would experience a higher blood alcohol concentration due to decreases in body mass and total body water. - the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug. - he would experience a lower blood alcohol concentration secondary to a decrease in total body water.

he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Which of the following statements regarding Alzheimer disease is correct? - Common signs of Alzheimer disease include dyskinesia and tremors. - Alzheimer disease is typically the result of tumors within the brain. - The symptoms of Alzheimer disease are generally obvious at its onset. - Autopsy is the only way to confirm Alzheimer disease.

Autopsy is the only way to confirm Alzheimer disease

Which of the following is a component of an environmental assessment of an elderly patient? - Inquiring about any delays in obtaining food - Obtaining a medical history - Assessing activities of daily living - Assessing for the odor of urine or feces

Assessing for the odor of urine or feces

An 82-year-old man presents with confusion that has worsened progressively over the past 2 weeks. Because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter. She tells you that her father has high blood pressure but refuses to take medication for it. She also tells you that she thinks he fell about 3 weeks ago, although he denies falling. The patient's blood pressure is 168/98 mm Hg, pulse rate is 60 beats/min and occasionally irregular, and respirations are 22 breaths/min and regular. This patient most likely: - had a stroke secondary to atrial fibrillation. - is experiencing a subdural hematoma. - has normal age-related physiologic changes. - has an acute onset of dementia.

Is experiencing a subdural hematoma

Failure of the heart's primary pacemaker and the development of alternate pacemakers in the atria would most likely result in: - atrioventricular block. - atrial fibrillation. - ventricular ectopy. - junctional rhythms.

Atrial fibrillation

Which of the following disease processes would most likely present with signs and symptoms that mimic those seen with normal aging? - Thyrotoxicosis - Type 2 diabetes - Hyperglycemia - Hypothyroidism

Hypothyroidism

You are called to a residence for a 74-year-old woman who fainted. During your assessment, the patient's son tells you that he was standing next to his mother when she fainted and that he caught her before she fell to the floor. He further tells you that his mother has angina and kidney disease. The patient is now conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 110 beats/min and weak, and respirations are 22 breaths/min and regular. As your partner administers supplemental oxygen to the patient, you should: - obtain a detailed list of all of the patient's medical problems and the medications that she is taking. - assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one. - perform a rapid head-to-toe assessment to determine if she has gross injuries or any hidden conditions. - quickly establish vascular access and administer a 20-mL/kg bolus of an isotonic crystalloid.

assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one.

Which of the following is a predisposing risk factor for trauma in the elderly? - Overall increase in agility - Decreased body water - Equilibrium disorders - Faster reflexes

Equilibrium disorders.

Resting tremor of an extremity and bradykinesia are associated with: - vascular dementia. - focal motor seizures. - Parkinson disease. - Alzheimer disease.

Parkinson’s disease

Cervical spondylosis is a degenerative change in the cervical spine that causes: - narrowing of the spinal canal and pressure on the spinal cord. - fracture of the odontoid process of the second cervical vertebra. - destruction of the intervertebral discs and vertebral fractures. - lateral curvature of the cervical spine with cord impingement.

narrowing of the spinal canal and pressure on the spinal cord.

An elderly person is more likely to sustain serious injury following trauma due to: - chronic renal hypertrophy. - decreased respiratory function. - brittle, demineralized bone. - ineffective vasoconstriction.

brittle, demineralized bone.

In contrast to delirium, dementia is: • an acute state of confusion that may last for up to 1 week. • a progressive disease that produces irreversible brain failure. • often reversible if the underlying cause is identified rapidly. • often caused by conditions such as poisonings and infection.

A progressive disease that produces irreversible brain failure.

The son of a 76-year-old woman called 9-1-1 because his mother is “ill.” The patient presents with mild confusion, poor skin turgor, and tachycardia. She is incontinent of urine and asks you for a glass of water. Her son tells you that she had not been feeling well for the past several weeks, but would not allow him to take her to the doctor. Which of the following assessment parameters will most likely reinforce your suspicion regarding the underlying cause of this patient's condition? • Orthostatic vital signs • Blood glucose • Cincinnati stroke scale •Cardiac rhythm

Blood glucose.

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the: • gallbladder. • spleen. • intestinal tract. • liver.

Liver.

Presbycusis is defined as: - an acute hearing impairment caused by idiopathic rupture of the tympanic membrane in the middle part of the ear. - loss of high-frequency sounds and the inability to differentiate a particular sound from background noise. - a progressive loss of hearing, particularly in the low frequencies, which explains why the television is turned up. - a degenerative condition in which the person experiences difficulty hearing both low- and high-frequency sounds.

Loss of high-frequency sounds and the inability to differentiate a particular sound from background noise

After falls, which of the following is the second leading cause of accidental death among elderly people? - Drug interactions - Submersion injury - Motor vehicle crashes - Thermal burns

Motor vehicle crashes