Geriatrics Flashcards

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1
Q

Your 78-year-old patient gives a history of congestive heart failure, renal insufficiency, and type 2 diabetes. Together, these conditions are called:
Question 1 options:

A)

confounding conditions.

B)

polypathophysiology.

C)

comorbid conditions.

D)

functional impairments.

A

comorbid conditions

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2
Q

The study of the effects of aging and age-related diseases in human beings is called:
Question 2 options:

A)

geriatrics.

B)

senescence.

C)

gerontology.

D)

dementiology.

A

gerontology

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3
Q

The term elderly applies to a person beginning at age:
Question 3 options:

A)

80.

B)

55.

C)

70.

D)

65.

A

65

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4
Q

Elderly people who live alone are more likely to be:
Question 4 options:

A)

male, under age 80.

B)

male, age 85 or older.

C)

female, age 85 or older.

D)

female, under age 80.

A

female age 85 or older

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5
Q

You have been asked to deliver a talk about the geriatric population. Which of the following points would you emphasize in your presentation?
Question 5 options:

A)

Dementia and chronic disease are both an inevitable part of the aging process.

B)

Many of the elderly have a combination of different diseases in various stages.

C)

Assessment can be difficult because most persons older than 70 have some degree of dementia.

D)

Geriatric patients actually comprise a smaller number of EMS calls and transports than generally thought.

A

many of the elderly have a combination of different diseases in varying stages

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6
Q

Which of the following statements regarding EMS consideration of psychosocial issues in elderly patients is TRUE?
Question 6 options:

A)

It is unlikely that an elderly patient in a nursing facility will be as well cared for as one who lives at home.

B)

Most elderly patients are lonely and isolated, and may not be able to care for themselves.

C)

Successful medical treatment of elderly patients involves an understanding of the broader social situation in which they live.

D)

Elderly patients usually have limited income, and are likely to be unable to afford expensive medication.

A

successful medical treatment of elderly patients involves understanding the broader social situation in which they live

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7
Q

Which of the following is an appropriate question to ask of an elderly patient who lives alone?
Question 7 options:

A)

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

B)

“Are you sure you are capable of taking care of yourself?”

C)

“Don’t you know living alone is dangerous at your age?”

D)

“Isn’t there anyone who could move in with you to help you?”

A

is there someone you can call if you have trouble with your medications tonight

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8
Q

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?
Question 8 options:

A)

The local community senior center

B)

AARP

C)

OSHA

D)

Department of Health and Human Services

A

OSHA

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9
Q

Which of the following is NOT a factor in altered pharmacokinetics in the elderly?
Question 9 options:

A)

Decreased hepatic function

B)

Increased total body water

C)

Decreased renal function

D)

Slowed drug absorption from the gastrointestinal tract

A

increased total body water

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10
Q

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:
Question 10 options:

A)

COPD, stroke, and medication overdose.

B)

trauma, pulmonary embolism, and pneumonia.

C)

myocardial infarction, stroke, and musculoskeletal trauma.

D)

aortic dissection, pulmonary embolism, and myocardial infarction.

A

myocardial infarction stroke and musculoskeletal trauma

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11
Q

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?
Question 11 options:

A)

“Have you ever had a stroke?”

B)

“Did the doctor prescribe any new medications?”

C)

“Why didn’t you call 911 when he fell before?”

D)

“When was the last time you ate or drank anything?”

A

did the doctor prescribe any new medications

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12
Q

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:
Question 12 options:

A)

administer 1 mg of epinephrine 1:10,000.

B)

administer glucagon.

C)

apply pads and perform synchronized cardioversion.

D)

apply pacer pads and pace at a rate of 80 per minute.

A

administer glucagon

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13
Q

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?
Question 13 options:

A)

Coumadin

B)

Pradaxa

C)

Enalapril

D)

Digitalis

A

Digitalis

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14
Q

Which of the following statements regarding pharmacokinetics and the aging process is TRUE?
Question 14 options:

A)

Functional changes in the kidneys, liver, and gastrointestinal system slow the absorption and elimination of many medications.

B)

Cardiac cells become more sensitive to medication as they age, meaning that lower doses of cardiac medications are necessary.

C)

Aging causes the kidneys to filter out more waste products, enhancing the absorption of many medications.

D)

The GI tract of an elderly patient quickly processes medications, meaning that medications have a shorter half-life than in younger patients.

A

functional changes in the kidneys liver and gastrointestinal system slow the absorption and elimination of many medications

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15
Q

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?
Question 15 options:

A)

Ask a family member to “translate,” because the family is probably able to understand him better.

B)

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

C)

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.

D)

Tell him to respond to your questions with simple hand gestures.

A

ask him to put in his dentures if he has them. locate them for him if necessary

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16
Q

Which of the following statements is TRUE of falls in the elderly?
Question 16 options:

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 these are true.

A

falls are the leading cause of accidental death in the elderly

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17
Q

Which of the following statements is TRUE of falls in the elderly?
Question 16 options:

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 these are true.

A

transport the patient because she has a potentially serious medical problem

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18
Q

Which of the following is NOT a complication caused by incontinence?
Question 18 options:

A)

Sepsis

B)

Urinary tract infection

C)

Skin ulcer

D)

Diverticulosis

A

diverticulosis

19
Q

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:
Question 19 options:

A)

exposing the patient to look for signs of physical abuse.

B)

contacting the patient’s physician to obtain an accurate history.

C)

contacting adult protective services to report an unsafe living situation.

D)

an assessment of living conditions, nutrition, and social support.

A

an assessment of living conditions nutrition and social support

20
Q

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?
Question 20 options:

A)

“Have you ever been diagnosed with dementia?”

B)

“Do you have a history of medical problems?”

C)

“What medications are you taking?”

D)

“What caused you to fall?”

A

what caused you to fall

21
Q

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?
Question 21 options:

A)

Weak pedal pulse in the left foot

B)

Heart rate of 118 beats per minute

C)

Respiratory rate of 20 breaths per minute

D)

External rotation of the hip

A

heart rate of 118 beats per min

22
Q

Which of the following statements demonstrates an accurate understanding of vital signs in relation to the geriatric patient?
Question 22 options:

A)

The typical resting heart rate is less than 50 beats per minute.

B)

The vital signs of an elderly patient are similar to those of an adolescent.

C)

The resting respiratory rate is typically higher in the elderly.

D)

Blood pressure is typically higher in elderly women.

A

the resting respiratory rate is typically higher in the elderly

23
Q

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:
Question 23 options:

A)

apprehension about medical bills.

B)

confusion regarding their rights as a patient.

C)

acute onset of dementia and other neurological diseases.

D)

fear of losing independence and dignity.

A

fear of losing independence and dignity

24
Q

Common mental health problems in the geriatric population include all of the following EXCEPT:
Question 24 options:

A)

depression.

B)

affective disorders.

C)

post-traumatic stress disorder.

D)

suicide.

A

post traumatic stress disorder

25
Q

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?
Question 25 options:

A)

Transport the patient for evaluation of a potentially serious medical problem.

B)

Call a family member to come and stay with the patient.

C)

Advise the patient to make an appointment with her doctor.

D)

Reassure the patient that there is nothing to worry about, and that you don’t believe she needs to go to the hospital.

A

transport the patient for evaluation of a potentially serious medical condition

26
Q

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:
Question 26 options:

A)

hypothermia.

B)

a suicide attempt.

C)

head trauma.

D)

elder abuse.

A

hypothermia

27
Q

Age-related changes in ________ make elderly patients more susceptible to ________.
Question 27 options:

A)

circulation; hyperglycemia.

B)

lung tissue; hypokalemia.

C)

cardiac cells; ventricular fibrillation.

D)

sweat glands; hyperthermia.

A

sweat glands; hyperthermia

28
Q

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?
Question 28 options:

A)

“I don’t think she needs a hospital evaluation; the daughter can take her to her primary physician.”

B)

“She may be being abused; you should question the daughter about it.”

C)

“Actually, elderly patients have a high rate of depression and suicide.”

D)

“You’re right, she probably wouldn’t. Let me see if she wants to sign a refusal of care form.”

A

actually elderly patients have a high rate of depression and suicide

29
Q

The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock?
Question 29 options:

A)

Tachycardia

B)

Hypothermia

C)

Altered mental status

D)

Cardiac dysrhythmias

A

tachycardia

30
Q

When assessing a 90-year-old woman who fell, what assessment finding should concern the paramedic most?
Question 30 options:

A)

History of osteoporosis and leg pain

B)

Heart rate of 90 beats per minute

C)

Sudden onset of confusion

D)

Skin tear that appears infected on her arm

A

sudden onset of confusion

31
Q

Which of the following statements regarding traumatic injuries and the elderly is TRUE?
Question 31 options:

A)

Hip fractures are responsible for 85% of traumatic deaths.

B)

Injuries are most commonly caused by falls.

C)

Head injuries are easy to detect in the elderly.

D)

Bradycardia is an early sign of blood loss.

A

injuries are most commonly caused by falls

32
Q

Which of the following is an intrinsic factor in falls in the elderly?
Question 32 options:

A)

High shelving for storage

B)

Glaucoma

C)

Ice on a driveway or sidewalk

D)

Throw rugs in the living area

A

glaucoma

33
Q

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:

Question 33 options:

A)

transport to the hospital.

B)

eliminating the chest pain.

C)

obtaining a 12-lead ECG.

D)

adequate oxygenation.

A

adequate oxygenation

34
Q

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:
Question 34 options:

A)

urinary tract infection.

B)

hypoglycemia.

C)

hyperglycemia.

D)

sepsis.

A

hyperglycemia

35
Q

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?
Question 35 options:

A)

“She has been drinking more water than normal.”

B)

“She has been getting fatigued faster lately.”

C)

“She suddenly could not remember her name yesterday.”

D)

“She has a history of progressive dementia.”

A

she suddenly could not remember her name yesterday

36
Q

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?
Question 36 options:

A)

COPD

B)

Thyroid storm

C)

Myocardial infarction

D)

Cerebrovascular accident

A

myocardial infarction

37
Q

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:
Question 37 options:

A)

hypokalemia.

B)

subdural hematoma.

C)

internal hemorrhage.

D)

acute alcohol intoxication.

A

subdural hematoma

38
Q

Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient?
Question 38 options:

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 these

A

all of the above

39
Q

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:
Question 39 options:

A)

ask the family members why their stories are different.

B)

provide care and transport, and inform the emergency department physician that you suspect abuse.

C)

contact the police and wait on scene until they arrive.

D)

document elder abuse in your PCR.

A

provide care and transport, inform the emergency department physician that you suspect abuse

40
Q

Which of the following conditions increases the likelihood that an elder may be abused or neglected?
Question 40 options:

A)

Incontinence

B)

Dementia

C)

Immobility

D)

All of these

A

all of the above

41
Q

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?
Question 41 options:

A)

“Family members are unable to agree upon history of event, causing suspicion for elder abuse.”

B)

“Family members are unable to provide accurate history of event.”

C)

“Son states that the patient fell while getting out of bed; daughter-in-law states that the patient fell while getting dressed.”

D)

“The patient may have fallen while getting out of bed, or while getting dressed.”

A

son states that the patient fell while getting out of bed daughter in law states that the patient fell while getting dressed

42
Q

Which of these factors does not typically decrease compliance in the elderly?
Question 42 options:

A)

Childproof containers

B)

Fear of toxicity

C)

Limited mobility

D)

Poor skin integrity

A

poor skin integrity

43
Q

Which of these is the least important physical requirement for effective continence?
Question 43 options:

A)

Competent sphincter mechanism

B)

Adequate cognition and mobility

C)

Anatomically correct GI/GU tract

D)

Adequate tissue perfusion

A

adequate tissue perfusion