Geriatric Toxicological Emergencies

Question 1

Adverse drug reactions in elderly people are the result of:

Select one:

a. partial digestion secondary to delayed gastric emptying.
b. changes in body composition and an increase in body water.
c. changes in drug metabolism due to diminished hepatic function.
d. increased drug elimination due to decreased antidiuretic hormone.

Answer 1

c. changes in drug metabolism due to diminished hepatic function.

Question 2

Polypharmacy is MOST accurately defined as:

Select one:

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

Answer 2

b. the prescribing of multiple drugs to treat multiple conditions.

Question 3

Which of the following is the BEST example of inadvertent medication noncompliance?

Select one:

a. A person takes multiple doses of the same medication because of an inability to distinguish the flavors.
b. The person does not fill a prescription because of a lack of money or insufficient insurance coverage.
c. A person decreases the dosage of one or more prescribed medications to make them last longer.
d. A patient discontinues a medication because he or she feels better and deems the medication unnecessary.

Answer 3

A. a person takes multiple doses of the same medication because of an inability to distinguish the flavors.

Question 4

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

Select one:

a. diuretics.
b. beta-blockers.
c. antidepressants.
d. ACE inhibitors.

Answer 4

a. diuretics.

Question 5

Which of the following factors can prolong the half-life of a drug in the body?

Select one:

a. Increased thyroid gland function
b. Chronic elevation of blood pressure
c. Increased proportion of adipose tissue
d. Chronic dehydration caused by diuretics

Answer 5

c. Increased proportion of adipose tissue

Question 6

In contrast to a 30-year-old man, if a 70-year-old man were to consume an excessive amount of alcohol:

Select one:

a. he would experience a lower blood alcohol concentration secondary to a decrease in total body water.
b. the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug.
c. it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver.
d. he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Answer 6

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

Question 7

You are called to a home of a geriatric patient with a sudden onset of confusion and some expressive aphasia. Your patient is showing atrial fibrillation on the monitor. When asked, the patient is aware of their condition and states they were prescribed medication but have not been compliant. What is main concern with this patient?

Select one:

a. Right ventricular infarction
b. ARDS
c. Stroke
d. Hypovolemia

Answer 7

c. Stroke

Question 8

When elderly patients are prescribed medications, the risk for drug toxicity increases because of:

Select one:

a. an increase in the glomerular filtration rate.
b. age-related changes in hepatic enzyme systems.
c. the presence of chronic conditions, such as diabetes.
d. an increase in the production of antidiuretic hormone.

Answer 8

b. age-related changes in hepatic enzyme systems.

Question 9

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the:

Select one:

a. liver.
b. spleen.
c. gallbladder.
d. intestinal tract.

Answer 9

a. liver.

Question 10

Presbycusis is defined as:

Select one:

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

Answer 10

d. loss of high-frequency sounds and the inability to differentiate a particular sound from backround noise.

Question 11

Typical signs and symptoms of Ménière disease include all of the following, EXCEPT:

Select one:

a. vertigo.
b. tinnitus.
c. otorrhea.
d. hearing loss.

Answer 11

c. otorrhea.

Question 12

Delirium is MOST accurately defined as:

Select one:

a. an acute alteration in mentation that indicates an underlying condition.
b. any alteration in cognitive function that may or may not be reversible.
c. a pattern of disorganized thinking that progresses over several weeks.
d. an altered mental status that is caused by structural damage to the brain.

Answer 12

a. an acute alteration in mentation that indicates an underlying condition.

Question 13

In contrast to delirium, dementia is:

Select one:

a. often caused by conditions such as poisonings and infection.
b. an acute state of confusion that may last for up to 1 week.
c. often reversible if the underlying cause is identified rapidly.
d. a progressive disease that produces irreversible brain failure.

Answer 13

d. a progressive disease that produces irreversible brain failure.

Question 14

Which of the following statements regarding Alzheimer disease is NOT correct?

Select one:

a. Alzheimer disease is likely not a part of the normal process of aging.
b. Age alone is thought to be the underlying cause of Alzheimer disease.
c. The symptoms of Alzheimer disease are generally obvious at its onset. Incorrect
d. Common signs of Alzheimer disease include paranoia and delusions.

Answer 14

b. Age alone is thought to be the underlying cause of Alzheimer disease.

Question 15

Untreated depression in people over 65 years of age:

Select one:

a. causes homicidal behavior in as much as 50% of this age group.
b. is often recognized by the patient, who subsequently asks for help.
c. is associated with a higher suicide rate than in any other age group.
d. usually goes unrecognized because it is often mistaken for delirium.

Answer 15

c. is associated with a higher suicide rate than in any other age group.

Question 16

Which of the following conditions would MOST likely mimic depression?

Select one:

a. Delirium
b. Dementia
c. Hyperglycemia
d. Hypoglycemia

Answer 16

b. Dementia

Question 17

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

Select one:

a. he or she often makes up symptoms that do not exist.
b. caregivers typically prefer that you speak with them.
c. he or she often has more than one medical condition.
d. most elderly patients are hearing or visually impaired

Answer 17

c. he or she often has more than one medical condition.

Question 18

When interviewing an elderly patient with a medical complaint, you should avoid:

Select one:

a. detailed explanations of what you are doing to him or her.
b. looking directly at the patient as this may upset him or her.
c. speaking to the family member first rather than the patient.
d. talking about the patient in the absence of family members.

Answer 18

c. speaking to the family member first rather than the patient.

Question 19

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

Select one:

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

Answer 19

b. chronic problems may affect the acute problem.

Question 20

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?

Select one:

a. Blood glucose
b. Cardiac rhythm
c. Orthostatic vital signs
d. Cincinnati stroke scale

Answer 20

a. Blood glucose