Quiz 21 - Geriatrics & Patients with Special Challenges

Question 1

Multiple sclerosis is:

A. chronic in most cases, and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density.

B. a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.

C. most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons.

D. a progressive disease in 90% of patients who have it, and is characterized by unrelenting pain, weakness, and visual impairment.

Answer 1

B. a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.

Question 2

Which of the following is an extrinsic cause of falls in the elderly?

A. A pathologic fracture

B. An uneven sidewalk

C. Dizziness or syncope

D. Postural hypotension

Answer 2

B. An uneven sidewalk

Question 3

Components of the environmental assessment of an elderly patient include all of the following, EXCEPT:

A. looking for rotted floors or faulty wiring.

B. assessing for the odor of urine or feces.

C. inquiring about any delays in obtaining food.

D. ensuring that food is adequate and unspoiled.

Answer 3

C. inquiring about any delays in obtaining food.

Question 4

A 90-year-old nursing home resident presents with confusion and a cough after several days of complaining of being weak. She is bedridden, has numerous medical conditions, and takes a variety of medications. Your assessment reveals that her temperature is 99.0°F, her skin is cool and dry, her blood pressure is 118/66 mm Hg, and her heart rate is 68 beats/min and regular. She is not experiencing obvious respiratory distress, and her oxygen saturation is 93% on room air. This patient is MOST likely experiencing:

A. pneumonia.

B. hypoglycemia.

C. a pulmonary embolism.

D. heart failure.

Answer 4

A. pneumonia.

Question 5

Aging brings a widespread decrease in bone mass, especially:

A. in postmenopausal women.

B. if the person falls frequently.

C. in men over 50 years of age.

D. in the presence of hypertension.

Answer 5

A. in postmenopausal women.

Question 6

When treating a dialysis patient, it is especially important to:

A. treat acidosis with sodium bicarbonate.

B. carefully titrate any IV fluids given.

C. elevate the arm with the AV fistula.

D. keep the patient in a supine position.

Answer 6

B. carefully titrate any IV fluids given.

Question 7

Which of the following factors complicates airway management in an obese patient?

A. Limited neck mobility

B. Smaller patient head size

C. Proportionately small tongue

D. Larger upper airway

Answer 7

A. Limited neck mobility

Question 8

Elderly people are more susceptible to intracranial bleeding because of:

A. enlargement of the subdural space.

B. a marked increase in brain size.

C. constriction of the cerebral vessels.

D. depletion of cerebrospinal fluid.

Answer 8

A. enlargement of the subdural space.

Question 9

Which of the following is a proper technique when accessing an implantable venous access device?

A. Remove the syringe from the needle and then block the flow in the line with the crimping device.

B. Flush the device with 20 mL of normal saline as soon as you are able to aspirate blood.

C. Stabilize the implantable device and insert the needle at a 45-degree angle to the skin.

D. Aspirate 5 mL of blood and then block the flow in the line with the crimping device.

Answer 9

D. Aspirate 5 mL of blood and then block the flow in the line with the crimping device.

Question 10

Several attempts to clear a plugged tracheostomy tube with suction have failed. The patient, who is on a mechanical ventilator, has a pulse rate of 150 beats/min and is making exaggerated attempts to breathe. You should:

A. administer high-flow oxygen via nonrebreathing mask as you prepare to replace the tracheostomy tube.

B. remove the tracheostomy tube, place a mask over the stoma, and ventilate with a bag-mask device.

C. deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.

D. provide free-flow oxygen as you remove the tracheostomy tube and replace it with a similarly sized endotracheal tube.

Answer 10

C. deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.

Question 11

During your assessment of a 4-year-old female, you find injury patterns that are highly suggestive of abuse. The child’s mother is present; she is apprehensive and is hesitant to allow you to transport her daughter. Your MOST appropriate action should be to:

A. advise the mother that the child’s injuries are inconsistent with accidental trauma and let her know that the child needs to be transported.

B. ask the mother to leave the room so that you can ask the girl if the injuries that she has were intentionally inflicted by someone else.

C. ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police.

D. act as though you are not suspicious, but call the child’s father and inquire about the relationship between the child and her mother.

Answer 11

C. ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police.

Question 12

Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT:

A. chronic hyperthyroidism.

B. atherosclerotic vessels.

C. impaired circulation.

D. decreased sweat production.

Answer 12

A. chronic hyperthyroidism.

Question 13

Spina bifida occurs when:

A. growth of the fetus’s spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.

B. the fetus’s spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

C. hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord.

D. trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury.

Answer 13

B. the fetus’s spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

Question 14

Dysarthria is:

A. the loss of ability to communicate in speech or writing.

B. a speech disorder that primarily affects adults.

C. the inability to make speech sounds correctly.

D. caused by damage to the language center of the brain.

Answer 14

C. the inability to make speech sounds correctly.

Question 15

Which of the following statements regarding autism is correct?

A. Common causes of autism include traumatic brain injury and severe emotional trauma.

B. The vast majority of patients with autism are mute and have an IQ of less than 20.

C. You should expect that a patient with autism will respond favorably to physical contact.

D. Some patients with autism are able to easily solve complex mathematical problems.

Answer 15

D. Some patients with autism are able to easily solve complex mathematical problems.

Question 16

A 66-year-old man with severe left heart failure is receiving an inotropic medication via an infusion pump. He presents with an altered mental status, increased breathing difficulty, and hypotension. You should:

A. assist his breathing, slowly increase the dose of his inotropic medication, and transport.

B. administer oxygen and discontinue the medication infusion by turning the pump off.

C. administer oxygen, discontinue the medication infusion, and establish a peripheral IV.

D. support his breathing, continue his medication infusion, and contact medical control

Answer 16

D. support his breathing, continue his medication infusion, and contact medical control

Question 17

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?

A. Orthostatic vital signs

B. Blood glucose

C. Cincinnati stroke scale

D. Cardiac rhythm

Answer 17

B. Blood glucose

Question 18

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:

A. had a stroke secondary to atrial fibrillation.

B. has an acute onset of dementia.

C. is experiencing a subdural hematoma.

D. has normal age-related physiologic changes.

Answer 18

C. is experiencing a subdural hematoma.

Question 19

Signs and symptoms of anticholinergic medication toxicity include:

A. epistaxis, abdominal pain, and blood in the urine.

B. Hypotension, palpitations, and respiratory distress.

C. urinary difficulty, constipation, and hypertension.

D. hypoglycemia, depression, and poor muscle movement

Answer 19

C. urinary difficulty, constipation, and hypertension.

Question 20

Which of the following is NOT a predisposing risk factor for trauma in the elderly?

A. Decreased body water

B. Slower reflexes

C. Overall decrease in agility

D. Equilibrium disorders

Answer 20

A. Decreased body water

Question 21

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

A. Sinus tachycardia

B. Junctional rhythm

C. Atrial fibrillation

D. AV heart block

Answer 21

C. Atrial fibrillation

Question 22

When a patient is receiving palliative care, medical care:

A. ceases, and the disease process is allowed to continue until the point of death.

B. ceases, and efforts focus on relieving pain until the point at which the patient dies.

C. continues, although aggressive, invasive, and uncomfortable interventions cease.

D. continues, and only minimally invasive procedures are performed to prolong life.

Answer 22

C. continues, although aggressive, invasive, and uncomfortable interventions cease.

Question 23

The MOST common risk factor for the development of type 2 diabetes in people over 65 years of age is:

A. hypertension of longer than 5 years’ duration.

B. the presence of more than one chronic disease.

C. poor dietary habits and a sedentary lifestyle.

D. frequent infections that do not heal properly.

Answer 23

B. the presence of more than one chronic disease.

Question 24

Patients with a colostomy:

A. have a temporary surgical opening in the abdomen that collects waste material and allows the bowel to rest and heal.

B. require a collection bag to collect solid fecal material after a section of large intestine is surgically removed.

C. have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.

D. have a stoma that directs the small intestine to the outside of the abdomen where a collection bag is attached.

Answer 24

C. have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.

Question 25

You respond to a residence for an unknown emergency involving an 83-year-old man. When you arrive, you find the patient, who is conscious and alert, sitting on his couch with his head held over a bowl. He tells you that his nose started bleeding about 20 minutes ago and he cannot get it to stop. As your partner assists the patient in controlling the bleeding, you inquire about his medical history. He tells you that he has chronic atrial fibrillation, has high blood pressure, and is occasionally depressed. When you ask him about compliance with his medications, he tells you, “I take my medicine every day, but the writing on the bottles is so small.” The patient’s blood pressure is 112/58 mm Hg, pulse rate is 88 beats/min and irregular, and respirations are 18 and unlabored. This patient has MOST likely inadvertently:

A. underdosed on his Toprol.

B. overdosed on his warfarin.

C. underdosed on his digoxin.

D. overdosed on his Xanax.

Answer 25

B. overdosed on his warfarin.

Question 26

The leading cause of death from infection in Americans older than 65 years of age is:

A. nephritis.

B. pneumonia.

C. meningitis.

D. encephalitis.

Answer 26

B. pneumonia.

Question 27

Which of the following conditions would MOST likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure?

A. Kyphosis

B. Osteoporosis

C. Asthma

D. Spondylosis

Answer 27

A. Kyphosis

Question 28

Characteristic physical features of Down syndrome include:

A. a protruding tongue.

B. downward slanting eyes.

C. an excessively long neck.

D. bulging of the nose and face

Answer 28

A. a protruding tongue.

Question 29

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:

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

B. obtain a detailed list of all of the patient’s medical problems and the medications that she is taking.

C. perform a rapid head-to-toe assessment to determine if she has gross injuries or any hidden conditions.

D. quickly establish vascular access and administer a 20-mL/kg bolus of an isotonic crystalloid.

Answer 29

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

Question 30

The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to:

A. constipation.

B. cholelithiasis.

C. mesenteric ischemia.

D. peptic ulcer disease.

Answer 30

D. peptic ulcer disease.

Question 31

The purpose of hospice care is to:

A. restore a person to his or her maximum physical and emotional potential.

B. render quality care to patients with a debilitating but temporary disease.

C. provide quality end-of-life care through pain and symptom management.

D. render around-the-clock intensive care to prevent cardiopulmonary arrest

Answer 31

C. provide quality end-of-life care through pain and symptom management.

Question 32

You respond to the residence of a 68-year-old man with terminal cancer. As you begin your assessment, the patient’s wife tells you that he has an out-of-hospital do not resuscitate order, and hands you a document that appears to be valid. The patient, who is clearly emaciated, is conscious but is in severe pain. Your MOST appropriate action should be to:

A. advise the wife that the do not resuscitate order prohibits you from rendering any prehospital care.

B. provide supportive care, administer narcotic analgesia as indicated, and transport the patient to the hospital.

C. accept the stipulations of the do not resuscitate order, obtain a signed refusal from the wife, and return to service.

D. recall that do not resuscitate orders are invalid in the prehospital setting and be prepared to provide full ACLS.

Answer 32

B. provide supportive care, administer narcotic analgesia as indicated, and transport the patient to the hospital.

Question 33

In contrast to delirium, dementia is:

A. often caused by conditions such as poisonings and infection.

B. a progressive disease that produces irreversible brain failure.

C. an acute state of confusion that may last for up to 1 week.

D. often reversible if the underlying cause is identified rapidly

Answer 33

B. a progressive disease that produces irreversible brain failure.

Question 34

Common complications associated with cerebral palsy include all of the following, EXCEPT:

A. seizures.

B. mental retardation.

C. cardiovascular disease.

D. visual impairment.

Answer 34

C. cardiovascular disease.

Question 35

Approximately 70% of all child abuse or neglect cases involve:

A. females over 8 years of age.

B. substance abuse by the perpetrator.

C. an otherwise healthy child.

D. males under 6 years of age

Answer 35

B. substance abuse by the perpetrator.

Question 36

Your assessment of an elderly man gives you reason to suspect that he has been abused. The patient does not appear to have any life-threatening injuries. His son, who is the only family member present at the scene, asks you if he can accompany his father in the back of the ambulance during transport. You should:

A. allow the son to accompany his father in the back of the ambulance.

B. ask the son why he wants to accompany his father in the ambulance.

C. remain at the scene until law enforcement arrives and questions the son.

D. advise the son to follow the ambulance in his own personal vehicle.

Answer 36

A. allow the son to accompany his father in the back of the ambulance.

Question 37

Elderly patients experience a slower physiologic response to hypoxemia and hypercarbia because of:

A. failure of the baroreceptors to detect blood pressure changes.

B. an increased PaO2 due to a natural increase in respirations.

C. decreased sensitivity to changes in arterial blood content.

D. a chronically elevated partial pressure of carbon dioxide.

Answer 37

C. decreased sensitivity to changes in arterial blood content.

Question 38

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 NOT indicated for this patient?

A. High-flow oxygen therapy

B. Subcutaneous epinephrine

C. Continuous positive airway pressure

D. Nebulized ipratropium

Answer 38

B. Subcutaneous epinephrine

Question 39

Which of the following statements regarding Mongolian spots is correct?

A. They are abnormal bruising patterns on the back and are an indicator of abuse.

B. They resemble bruises and are found most commonly on the back and buttocks.

C. They indicate abnormal bleeding and are associated with a high mortality rate.

D. They are bruiselike patterns that most often appear in severely premature

Answer 39

B. They resemble bruises and are found most commonly on the back and buttocks.

Question 40

Fall-related fractures in the elderly occur MOST often to the _______, usually in patients with underlying _______.

A. humerus, arthritis

B. pelvis, osteoarthritis

C. hip, osteoporosis

D. elbow, osteoporosis

Answer 40

C. hip, osteoporosis

Question 41

Polypharmacy is MOST accurately defined as:

A. the unintentional ingestion of multiple doses of the same drug.

B. unnecessarily prescribing numerous drugs to prevent a disease.

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

D. a harmful interaction when several drugs are taken together.

Answer 41

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

Question 42

Which of the following behaviors or actions should make you the MOST suspicious that a caregiver has abused his or her child?

A. Demanding that you take the child to the hospital as soon as possible

B. Difficulty recalling the last time the child was seen by a physician

C. Offering unsolicited explanations for abnormal physical exam findings

D. Asking other siblings to leave the room while the child is examined

Answer 42

C. Offering unsolicited explanations for abnormal physical exam findings

Question 43

The majority of acquired hearing loss in children and adults is the result of:

A. long-term use of salicylates.

B. frequent middle ear infections.

C. excessive exposure to loud noise.

D. a tumor on the acoustic nerve.

Answer 43

C. excessive exposure to loud noise.

Question 44

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:

A. 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.

B. establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport.

C. 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 to the hospital.

D. 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 him.

Answer 44

C. 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 to the hospital.

Question 45

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

A. The symptoms of Alzheimer disease are generally obvious at its onset.

B. Common signs of Alzheimer disease include paranoia and delusions.

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

D. Alzheimer disease is likely not a part of the normal process of aging.

Answer 45

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