Geriatrics_Special Challenges – Flashcards

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question
When assessing a 91-year-old female who fell, what assessment finding should concern the EMT most?
answer
Sudden onset of confusion
question
A patient with cataracts would most likely complain of:
answer
intermittent blindness.
question
A 92-year-old male states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which one of the following in the patient's history is of greatest concern?
answer
The patient states his left calf is tender and painful.
question
A patient with postural hypotension would most likely make what statement?
answer
"I get so dizzy when I get up off of the couch."
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The EMT recognizes that dementia is typically observed as:
answer
a chronic and irreversible condition.
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You have been called to a skilled nursing home to transport a patient with fever and pneumonia to the hospital for further care and treatment. As such, you realize that the primary focus of your care will be:
answer
oxygen therapy.
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A patient with a history of arteriosclerosis suffers from:
answer
stiffened arteries.
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You are preparing to transport an 86-year-old female complaining of altered mental status and nausea and vomiting. Aspiration pneumonia would be best prevented by:
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transporting in a semi-Fowler's position.
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You have been summoned for a diabetic patient with altered mental status. What sign would cause you to suspect that the patient is suffering from hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
answer
Complaint of thirst and dry mouth
question
You have been called for a conscious and alert 83-year-old male complaining of a fever for three days. He has a history of peripheral vascular disease. When assessing the patient's circulation, you have a difficult time feeling his radial pulse. Your next action would be to:
answer
locate the patient's carotid pulse.
question
An 84-year-old male complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath, but has clear lung sounds and an SpO2 of 93%. When asked, he claims that the discomfort started after getting out of bed 2 hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and irritable bowel syndrome. Family members state that he has early dementia. There are no obvious life threats and his vital signs are normal for his age. The appropriate treatment for this patient would include:
answer
provide oxygen and treat as a cardiac patient.
question
You have just arrived by the side of an elderly patient who took excessive amounts of his daily medications after becoming confused about what to take and when. Which one of the following is the immediate priority in caring for this patient?
answer
Evaluate and support the patient's airway and breathing.
question
When assessing a patient, which finding should raise the EMT's suspicion that the patient may be suffering from a pulmonary embolism?
answer
Sudden onset of shortness of breath
question
A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. 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 few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?
answer
Take manual in-line spinal stabilization and begin assessment.
question
You have been called for an unknown medical emergency. On scene you are presented with an 84-year-old patient who is confused and does not obey commands. The best means of determining the patient's normal mental status would be to:
answer
question family members.
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You have been called to an assisted living facility to transport a patient who has been vomiting continuously for 6 hours. She is responsive to verbal stimuli. The patient suffers from arthritis and severe kyphosis. How should you transport this patient on the stretcher?
answer
Left lateral recumbent position
question
An 89-year-old female is short of breath and has a fever. Her SpO2 is low and she has crackles and coarse breath sounds to both lungs. When getting history from her family caregivers, which of the following would make you suspicious that the patient has aspiration pneumonia?
answer
She was fine until just after eating lunch.
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Family members tell you that 3 hours ago, their 76-year-old mother suddenly became confused and had great difficulty speaking. However, within 15 minutes she returned to normal. Based on this description, the EMT should be suspicious of:
answer
transient ischemic attack.
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Which statement indicates an accurate understanding of administering positive pressure ventilation (PPV) to a geriatric patient?
answer
"Gentle ventilations that make the chest rise are adequate to provide oxygen into lungs."
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You have just arrived by the side of a nonverbal patient with snoring respirations. The caregiver states that they were eating lunch when she suddenly collapsed face first onto the table. She also states that she has a history of a stroke, high blood pressure, and colon cancer. Your priority in caring for this patient at this time would be:
answer
open and look into the patient's mouth.
question
An 86-year-old female fell while walking to her bathroom. She is on the floor with severe pain to her right hip. Her airway is patent and breathing adequate. 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?
answer
Heart rate of 120 beats per minute
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An elderly female fell down three steps and is complaining of back pain. After performing the primary assessment, what question would be most important to ask first?
answer
"Did you become dizzy before you fell?"
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An 83-year-old male has fallen down five stairs to the 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?
answer
"What caused you to fall?"
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A hearing-impaired patient with a hearing aid is having a difficult time hearing your questions. Your initial action would be to:
answer
ensure that his hearing aid is turned on.
question
Which one of the following is the fundamental danger associated with a pulmonary embolism?
answer
Hypoxia
question
Which of the following statements regarding traumatic injuries and the elderly is true?
answer
Injuries are most commonly caused by falls.
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The EMT understands that vision disturbances caused by glaucoma occur secondary to:
answer
damage to the optic nerve.
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The family of an 87-year-old female has called 911. She is confused and exhibiting improper and out of character behavior. They inform you that she is a diabetic, but takes pills and not insulin. They also state that he has been complaining of dizziness and has been drinking water nonstop as well as urinating. 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 and treat her for:
answer
elevated blood sugar.
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Narrowing of the valves within the heart is best described as:
answer
stenosis
question
You have been called for a 77-year-old female with altered mental status. On scene you note the patient's inability to speak and vomitus in her airway. Her breathing is labored and inadequate, and radial pulse rapid and weak. She is not moving her right arm or right leg. Which one of the following should be your first priority?
answer
Suction the airway and determine adequate breathing.
question
The family of an 87-year-old female has called 911. She is confused and exhibiting improper and out of character behavior. They inform you that she is a diabetic, but takes pills and not insulin. They also state that he has been complaining of dizziness and has been drinking water nonstop as well as urinating. 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 and treat her for:
answer
elevated blood sugar.
question
When assessing a 91-year-old female who fell, what assessment finding should concern the EMT most?
answer
Sudden onset of confusion
question
A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. 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 few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?
answer
Correct Take manual in-line spinal stabilization and begin assessment.
question
You have been called for an 84-year-old female 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 suggests that the patient is suffering from delirium?
answer
"She could not remember her name yesterday."
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You have been called to the side of a confused geriatric patient complaining of abdominal pain. Before palpating the patient's abdomen, you would first:
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inform the patient that you will be pressing on her abdomen.
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A hearing-impaired patient with a hearing aid is having a difficult time hearing your questions. Your initial action would be to:
answer
ensure that his hearing aid is turned on.
question
Ageism would occur when the EMT:
answer
does not attempt to assess combative elderly patients with dementia.
question
A new EMT asks you why the elderly are at a higher risk for developing pneumonia, as compared to those of a younger age. You inform him that the elderly are more susceptible to respiratory infections because of a(n):
answer
decreased cough reflex.
question
The EMT recognizes that dementia is typically observed as:
answer
a chronic and irreversible condition.
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The son of an 88-year-old patient states that he told his mother to double the dose of her antibiotic so she would "get better faster." This represents a problem given that the elderly have a(n):
answer
decreased liver and kidney function.
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A patient with kyphosis has fallen and is complaining of numbness in both arms. Regarding immobilization, you should:
answer
place pillows in voids between the patient and the long board.
question
You have been called for a 91-year-old female who fell. Since your assessment reveals bruises to her body in various stages of healing and inconsistencies in information provided by her family, you are suspicious of geriatric abuse. Your best action would be to:
answer
quietly transport and inform the emergency department physician.
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A patient with advanced dementia cannot provide an accurate medical history. In this situation, the EMT's best course of action would be to:
answer
ask family members about the patient's past medical history.
question
Your partner believes the 90-year-old male you are caring for is dehydrated. What sign best reinforces his suspicion?
answer
Dry mouth and tongue
question
An 82-year-old female with nausea and vomiting has called 911. When obtaining her past medical history, she informs you that she suffered a transient ischemic attack (TIA) two months ago. Based on this, what should the EMT expect to find?
answer
The absence of any neurological deficits
question
You have been called for an unknown medical emergency. On scene you are presented with an 84-year-old patient who is confused and does not obey commands. The best means of determining the patient's normal mental status would be to:
answer
question family members.
question
An 86-year-old female fell while walking to her bathroom. She is on the floor with severe pain to her right hip. Her airway is patent and breathing adequate. 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?
answer
Heart rate of 120 beats per minute
question
When assessing a geriatric patient for pneumonia, the EMT must remember that:
answer
a normal body temperature may be observed.
question
When assessing a patient, which finding should raise the EMT's suspicion that the patient may be suffering from a pulmonary embolism?
answer
Sudden onset of shortness of breath
question
The EMT would recognize potential elder neglect when the patient makes what statement?
answer
"They do not give me my high blood pressure medications."
question
A 92-year-old male states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which one of the following in the patient's history is of greatest concern?
answer
The patient states his left calf is tender and painful.
question
An 81-year-old female called 911 when she suddenly lost vision in her right eye. Based on this description, the EMT should be suspicious of:
answer
retinal detachment.
question
You have been called for a conscious and alert 83-year-old male complaining of a fever for three days. He has a history of peripheral vascular disease. When assessing the patient's circulation, you have a difficult time feeling his radial pulse. Your next action would be to:
answer
locate the patient's carotid pulse.
question
A patient with a history of arteriosclerosis suffers from:
answer
stiffened arteries.
question
An 84-year-old male complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath, but has clear lung sounds and an SpO2 of 93%. When asked, he claims that the discomfort started after getting out of bed 2 hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and irritable bowel syndrome. Family members state that he has early dementia. There are no obvious life threats and his vital signs are normal for his age. The appropriate treatment for this patient would include:
answer
provide oxygen and treat as a cardiac patient.
question
You have been called for a 79-year-old female complaining of shortness of breath. Due to the increased respiratory rate, cough, and production of discolored sputum, you are suspicious of pneumonia. A family member asks you how she can have pneumonia, when her temperature is only 97.9°F. Your best response is:
answer
"It is not uncommon for the elderly to have pneumonia without the signs of high fever or chills."
question
Which one of the following statements about peritoneal dialysis is true?
answer
A catheter is inserted into the abdomen.
question
You have been called to a residence for an unknown medical problem. As you enter the house, what scene clue would most likely suggest the use of home medical oxygen?
answer
No smoking sign located on the front door
question
A skilled nursing facility has called you for a patient who has a problem with his intraventricular shunt. The patient is a 21-year-old man who was born with hydrocephalus and had the shunt placed shortly after. When assessing the patient, which sign would raise your suspicion that the shunt is occluded?
answer
Blood pressure of 210/126 mmHg
question
Family has called you after the apnea alarm for their 1-month-old baby sounded. They state that the settings seem too high and the alarm goes off frequently. They would like the home health nurse to readjust the settings, so this scenario can be avoided in the future. They do not want the patient transported to the hospital and are prepared to sign a refusal. Assessment reveals no life threats to the airway, breathing, or circulation. Given the situation, you would:
answer
contact medical direction.
question
On scene you are presented with a 21-year-old female with multiple disfigurements from birth defects. She is nonverbal and according to her home health nurse, has a fever, which requires transport to the emergency department. Your partner is familiar with her since he transported her last week for the same condition. When obtaining the patient's past medical history, which source should be tried first?
answer
Nurse
question
When assessing a dialysis patient and his AV graft, which one of the following is of most concern?
answer
Red and hot skin at the graft site
question
At a long-term care facility, a nurse informs you that the patient you will be transporting has a peripherally inserted central catheter (PICC) in place. To find this catheter, you should look at the patient's:
answer
antecubital fossa.
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To find an implanted port on a patient, the EMT should:
answer
palpate the anterior chest.
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A patient with quadriplegia most likely suffered an injury to his:
answer
cervical spine.
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Which of the following would be true regarding a 42-year-old female with traumatic paraplegia?
answer
She would require a wheelchair.
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While assessing a patient on a home mechanical ventilator, the low pressure alarm sounds. Your immediate action would be to:
answer
check the connection between the tubing and tracheostomy.
question
A 66-year-old male has summoned your assistance because he is short of breath and his home pulse oximeter is reading 89%, despite 3 lpm of home medical oxygen. Assessment reveals an intact airway and adequate breathing. His radial pulse is normal and skin hot and dry. Vital signs are: pulse 84, respirations 18, and blood pressure 166/86 mmHg. Breath sounds are clear bilaterally. His pulse oximeter is fluctuating between 88% and 90%. In this situation you would first:
answer
check his SpO2 with your pulse oximeter.
question
When assessing a patient at an extended care facility, you note the presence of an ostomy bag. As such, you realize that the patient has impaired function of:
answer
fecal elimination.
question
You have been called to a residence for a 63-year-old female with a history of COPD who is short of breath. The patient is moderately dyspneic with the following vital signs: pulse 124, respirations 20, blood pressure 162/56, and SpO2 at 86%. She is using an oxygen concentrator set at 5 lpm. What is your best course of action?
answer
Remove the oxygen concentrator and administer high-concentration oxygen to the patient.
question
You have been called to a nursing home for a 39-year-old male with shortness of breath. On scene you discover that the patient unsuccessfully attempted suicide several years ago by shooting himself in the head. The patient is belligerent and swearing at you as you assess him. Of the following questions, which one should you ask the nurse first?
answer
"Is this his normal mental status?"
question
The father of a 45-year-old male with mental retardation summoned EMS because his son was not acting right. The patient is awake, but is nonverbal, which is not typical per the father. Your assessment reveals no abnormalities, and vital signs are normal. When calling the chief complaint into the hospital you would state that the patient:
answer
"is not acting himself per his father."
question
The friend of an impoverished 50-year-old male called 911 because his friend had chest pain. On scene, the patient informs you that he does have a cardiac history and has not seen his cardiologist in over a year since he lost his job. Additionally, he does not want treatment or transport since he knows that both are expensive and will be unable to pay for it. In this situation your best response would be:
answer
"You may be eligible for free or reduced-cost medical care."
question
Poor position of an obese patient on the stretcher would most likely result in:
answer
respiratory distress.
question
When assessing a 65-year-old male patient, you note a tube-like device inserted into the lower portion of his trachea. You recognize that the device has most likely been placed to:
answer
to permit the exchange of O2 and CO2.
question
A 77-year-old male who is blind and has a guide dog called 911 for chest pain. On scene you note no immediate life threats and now must move him to the stretcher, located in another room. Which one of the following is most appropriate, given his impairment of sight?
answer
Carry him to the stretcher.
question
A central intravenous catheter is typically placed for what reason?
answer
Repeated administration of medications
question
You have been called to a residence for a patient who is sick and not feeling well. The patient has multiple medical problems and is bed confined, with care provided by family members. The patient has a gastric tube and indwelling urinary catheter. What assessment finding should raise your suspicion that the patient has a urinary tract infection?
answer
Cloudy urine in the bag of the urinary catheter
question
You are responding to a patient with a tracheostomy tube who is weak and has a fever. In this situation, you can assume:
answer
the tracheostomy tube is below the larynx.
question
When suctioning a 46-year-old male with a tracheostomy tube, which of the following is appropriate?
answer
Insert the suction cannula until resistance is met.
question
A patient on a ventilator presents as cyanotic and listless. Alarms are sounding. Your immediate action would be to:
answer
disconnect the ventilator and start positive pressure ventilation.
question
The fundamental reason a patient uses BiPAP when sleeping is to:
answer
keep the small airways open.
question
When assessing a 32-year-old male with a history of mental retardation, you note the protrusion of a clamped tube from her back in the area of her right kidney. The best method of determining what the tube is and why it is in place would be to:
answer
Correct
question
Which one of the following best describes an oxygen concentrator?
answer
Portable oxygen device that extracts oxygen from the air
question
On scene, you must lead a patient's visually impaired wife from the house to the ambulance. This is best accomplished by:
answer
placing her hand on your shoulder.
question
Which of the following correctly identifies a stoma?
answer
The opening in the neck for a tracheostomy tube
question
A 92-year-old female informs you that she suffers from diabetic retinopathy. Subsequently, you recognize that this condition has occurred in relation to:
answer
damage to blood vessels in the eye.
question
The EMT would recognize a sensory impairment when he encounters which of the following?
answer
49-year-old male who is hearing impaired in one ear
question
A terminally ill female with ovarian cancer is receiving palliative care when she:
answer
has a morphine pump implanted in her abdomen.
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