Name: __________________________ Date: _____________



1.
When assessing a 78-year-old female who complains of shortness of breath, the EMT should:
A.
give oxygen only if the patient has labored breathing.
B.
conclude that the patient is experiencing a heart attack.
C.
ask her how many pillows she uses when she sleeps.
D.
place the patient supine to see if the problem worsens.


2.
The slow onset of progressive disorientation, shortened attention span, and loss of cognitive function is known as:
A.
delirium.
B.
delusion.
C.
paranoia.
D.
dementia.


3.
Because of the complexity of the older patient and the vagueness of his or her complaint, you should:
A.
limit your physical examination to the area of pain or injury.
B.
rely exclusively on family members for the medical history.
C.
attempt to differentiate between chronic and acute problems.
D.
perform a rapid assessment on all geriatric patients you treat.


4.
When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, it is MOST important to:
A.
determine the onset of the patient's symptoms.
B.
ascertain about a history of atrial fibrillation.
C.
administer 324 mg of aspirin as soon as possible.
D.
determine if the patient has risk factors for a stroke.


5.
A 73-year-old female experienced a syncopal episode while watching TV. She is now conscious, but is diaphoretic, tachycardic, and hypotensive. Your assessment reveals abdominal tenderness and a pulsating mass to the left of her umbilicus. You should be MOST suspicious for:
A.
an aortic aneurysm.
B.
acute appendicitis.
C.
a strangulated bowel.
D.
myocardial infarction.


6.
You are dispatched to a residence for an 80-year-old female who fell. When you arrive, you find the patient conscious, lying in a recumbent position on the floor in her living room. In addition to providing the appropriate treatment, you should ask the patient if:
A.
she became dizzy or fainted before falling.
B.
she attempted to catch herself before falling.
C.
a family member regularly checks up on her.
D.
she takes medications for Alzheimer disease.


7.
When performing your secondary assessment on an older patient who has been injured, it is important to:
A.
routinely perform a focused exam to minimize time at the scene.
B.
perform an in-depth physical exam prior to initiating any treatment.
C.
recall that it will take a less severe mechanism of injury to cause significant injuries.
D.
focus your assessment just on the area(s) of pain or obvious injury.


8.
Poor maintenance of home, poor personal care, and dietary neglect are all possible indicators of ____________ elder abuse.
A.
physical
B.
financial
C.
emotional
D.
psychological


9.
Causes of delirium in the older patient include all of the following, EXCEPT:
A.
acute hypovolemia.
B.
Alzheimer disease.
C.
low blood sugar level.
D.
decreased cerebral perfusion.


10.
Motor nerve neuropathy is characterized by:
A.
numbness, tingling, and severe muscle pain.
B.
loss of bladder control and sensitivity to touch.
C.
loss of balance, muscle weakness, and spasms.
D.
constipation, low blood pressure, and bradycardia.


11.
Which of the following is the MOST common mechanism of injury in older patients?
A.
falls
B.
burns
C.
abuse
D.
suicide


12.
You are dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior. The patient is clearly confused and asks you if you are her husband. As your partner administers oxygen to the patient, you should:
A.
determine the patient's baseline mental status.
B.
inquire about a history of Alzheimer disease.
C.
obtain a complete list of the patient's medications.
D.
ask an attendant for the patient's medical records.


13.
Common causes of syncope in older patients include all of the following, EXCEPT:
A.
venous pooling.
B.
vasoconstriction.
C.
acute hypotension.
D.
blood volume loss.


14.
When immobilizing a patient with a kyphotic spine to a long backboard, the EMT would MOST likely have to:
A.
force the head into a neutral alignment.
B.
place blankets behind the patient's head.
C.
secure the patient's head before the torso.
D.
use a scoop stretcher instead of a log roll.


15.
When explaining the need for a particular procedure to an elderly patient, you should:
A.
use plain language and simple terms.
B.
use the appropriate medical terminology.
C.
be complex so the patient fully understands.
D.
realize that he or she will not understand you.


16.
General communication techniques with the elderly include:
A.
using medical terms to ensure patient understanding.
B.
explaining procedures while you are performing them.
C.
frequently asking the patient if he or she understands.
D.
having at least two EMTs talk to the patient at a time.


17.
A 10% to 20% reduction in brain weight and volume would MOST likely increase an older person's risk for:
A.
stroke.
B.
delirium.
C.
dementia.
D.
head trauma.


18.
The EMT should suspect left-sided heart failure in the geriatric patient who presents with:
A.
fever and a cough that produces green sputum.
B.
tachypnea and paroxysmal nocturnal dyspnea.
C.
jugular venous distention and peripheral edema.
D.
swelling of the lower extremities and weakness.


19.
In contrast to a living will, a “do not resuscitate” (DNR) order becomes valid when:
A.
the patient has a terminal illness.
B.
the patient develops cardiac arrest.
C.
the patient is in a health care setting.
D.
it is signed by three or more physicians.


20.
Which of the following is NOT a reason why the exact extent and prevalence of elder abuse is unknown?
A.
It has been largely hidden from society.
B.
The definitions of abuse and neglect vary.
C.
Human resource agencies fail to investigate.
D.
Victims of elder abuse are hesitant to report it.


21.
When assessing an older patient who has multiple bruises in various stages of healing, the EMT should do all of the following, EXCEPT:
A.
factually document all findings.
B.
accuse a caregiver of physical abuse.
C.
ask the patient how the bruises occurred.
D.
review the patient's activities of daily living.


22.
When caring for an elderly patient who is hearing-impaired, you should:
A.
speak directly into his or her ear with an elevated tone.
B.
remember that most hearing-impaired patients can read lips.
C.
request that he or she communicates with you by writing on paper.
D.
recall that elderly patients have difficulty hearing high-frequency sounds.


23.
Upon arriving at the residence of an elderly female who apparently fainted, you find the patient lying supine on her living room floor. She is not moving and her eyes are closed. A neighbor tells you that she found the patient this way, but did not move her. When you gently tap the patient, she does not respond. You should:
A.
suction her airway, apply a cervical collar, administer high-flow oxygen via a nonrebreathing mask, and perform a rapid assessment.
B.
open her airway with the head tilt–chin lift maneuver, insert an oral or nasal airway, and assess her blood glucose level to rule out hypoglycemia.
C.
direct your partner to manually stabilize her head while you quickly visualize her chest for signs of breathing.
D.
begin assisting her ventilations with a bag-mask device while your partner auscultates her lung sounds to ensure adequate positive-pressure ventilation.


24.
When transporting a stable older patient to the hospital, the MOST effective way to reduce his or her anxiety is to:
A.
allow at least two family members to accompany the patient.
B.
transport him or her to a hospital that he or she is familiar with.
C.
avoid the use of a long backboard, even if trauma is suspected.
D.
perform frequent detailed assessments to gain the patient's trust.


25.
The chief component of connective tissues and bones that deteriorates as people age is called:
A.
fibrin.
B.
elastin.
C.
sebum.
D.
collagen.


26.
You receive a call for a sick person. When you arrive, you find the patient, a 75-year-old male, lying unresponsive in his bed. His respirations are slow and irregular and his pulse is slow and weak. His daughter tells you that he fell the day before, but refused to allow her to call 9-1-1. His past medical history is significant for hypothyroidism, deep vein thrombosis, heavy alcohol use, and liver cirrhosis. His medications include blood thinners and vitamins. You should be MOST suspicious that this patient is experiencing:
A.
acute hyperglycemia.
B.
a subdural hematoma.
C.
acute ischemic stroke.
D.
diabetic ketoacidosis.


27.
Findings during the social assessment of an older patient include all of the following, EXCEPT:
A.
interaction with others.
B.
daily activity assistance.
C.
outdated medications.
D.
delays in obtaining meals.


28.
Many older victims of physical abuse may make false statements or lie about the origin of their injuries because:
A.
they are protective of the abuser.
B.
they do not want to be bothersome.
C.
most elderly patients have dementia.
D.
they fear retribution from the abuser.


29.
The use of multiple prescription drugs by a single patient, causing the potential for negative effects such as overdosing or drug interaction, is called:
A.
potentiation.
B.
polypharmacy.
C.
drug tolerance.
D.
drug dependency.


30.
Fractures of the pelvis in older patients often occur as the result of a combination of:
A.
osteoporosis and low-energy trauma.
B.
increased bone density and car crashes.
C.
arthritic joints and high-energy trauma.
D.
acetabular separation and severe falls.


31.
Syncope in the older patient is:
A.
caused by an interruption of blood flow to the brain.
B.
generally of no concern unless the patient was injured.
C.
most commonly caused by a silent myocardial infarction.
D.
rarely life threatening but should be evaluated by a physician.


32.
In contrast to younger patients, older patients are more prone to a decrease in blood pressure upon standing because:
A.
their red blood cells are destroyed at a faster than normal rate.
B.
the aging process results in an overall increase in blood volume.
C.
the baroreceptors have become less sensitive to blood pressure.
D.
any change in position causes blood to be shunted to the brain.


33.
During the natural process of aging, the number of functional cilia in the respiratory system decreases, resulting in:
A.
a decreased ability to cough.
B.
baseline respiratory distress.
C.
an increased risk of COPD.
D.
air-trapping within the alveoli.


34.
Common causes of depression in the elderly include all of the following, EXCEPT:
A.
chronic medical conditions.
B.
prescription medication use.
C.
an acute onset of dementia.
D.
alcohol abuse and dependence.


35.
When documenting a case of suspected elder abuse, it is MOST important for the EMT to:
A.
theorize as to why the patient was abused.
B.
document his or her perceptions of the event.
C.
list the names of all of the suspected abusers.
D.
avoid documenting any unsupported opinions.


36.
An older woman with osteoporosis presents with pain and deformity to her left hip after she shifted her weight onto her other foot. She has MOST likely experienced a(n):
A.
pathologic fracture.
B.
idiopathic fracture.
C.
compression fracture.
D.
comminuted fracture.


37.
A productive cough, fever, and chills in an 80-year-old patient with a compromised immune system should make you MOST suspicious for:
A.
heart failure.
B.
bronchitis.
C.
emphysema.
D.
pneumonia.


38.
Talking about an elderly patient in front of him or her to other members of the family:
A.
often causes the patient to become paranoid and untrusting of your help.
B.
may cause the patient to think that he or she has no say in making decisions.
C.
will anger the patient and result in his or her refusal to accept care or transport.
D.
is usually beneficial because the patient's cognitive skills are typically impaired.


39.
Which of the following observations or statements represents the “E” in the GEMS diamond?
A.
Elderly patients present atypically and deserve your respect.
B.
The patient's residence is cold due to a malfunctioning heater.
C.
A patient is assisted with his or her activities of daily living.
D.
The patient's medications have not been filled in 2 months.


40.
Upon entering the residence of a geriatric patient with a medical or trauma complaint, the EMT should:
A.
immediately seek out a family member or other caregiver.
B.
observe for conditions that may make the residence unsafe.
C.
begin his or her assessment after gathering any medication bottles.
D.
talk to the patient after performing his or her primary assessment.


41.
Patients who have experienced even minor-appearing head injuries should be suspected of having a brain injury, especially if they:
A.
have minor abrasions to the head area.
B.
are taking blood-thinning medications.
C.
do not have deformities to the skull.
D.
have a history of Alzheimer disease.


42.
To minimize distractions and confusion when assessing an older patient, you should:
A.
dismiss the family members from the room or area.
B.
have only one EMT speak to the patient at a time.
C.
elevate your voice and speak directly to the patient.
D.
perform a physical exam and then talk to the patient.


43.
The purpose of the GEMS diamond is to:
A.
help EMS personnel remember what is different about elderly patients.
B.
provide the EMT with a standard format for assessing elderly patients.
C.
replace the typical ABC approach to patient care when caring for the elderly.
D.
provide clues about an elderly patient's problem by observing his or her home.


44.
An abdominal aortic aneurysm:
A.
is usually not repairable, even if discovered early.
B.
causes dull pain that often radiates to the shoulders.
C.
is often the result of hypertension and atherosclerosis.
D.
can sometimes be palpated as a mass in the groin area.


45.
A 77-year-old female presents with an acute onset of altered mental status. Her son is present and advises that she has a history of hypertension, atrial fibrillation, type 2 diabetes, and glaucoma. He further advises that she takes numerous medications and that she is normally alert. When you assess this patient, it is important to note that:
A.
because of her age and medical history, you should suspect Alzheimer disease.
B.
the patient is experiencing delirious behavior, which suggests a new health problem.
C.
her mental status is likely the result of hypoglycemia and you should give her sugar.
D.
dementia typically presents as an acute onset of deterioration of cognitive function.


46.
An older patient with significant dehydration would MOST likely present with:
A.
an increase in blood pressure upon standing.
B.
dizziness or fainting upon standing.
C.
weakness to one side of the body.
D.
a drop in heart rate upon standing.


47.
In contrast to delirium, dementia:
A.
is usually considered irreversible.
B.
is the result of an acute condition.
C.
is reversible with certain treatment.
D.
often develops over a period of days.


48.
A 69-year-old female was involved in a motor vehicle crash. She is semiconscious with a blood pressure of 80/50 mm Hg and a heart rate of 74 beats/min that is weak. Her daughter, who was uninjured in the crash, tells you that her mother has a history of hypertension and takes beta-blockers. Considering the fact that this patient is probably in shock, what is the MOST likely explanation for the absence of tachycardia?
A.
deterioration of the cardiac conduction system
B.
intrathoracic bleeding and cardiac compression
C.
the effects of her antihypertensive medication
D.
failure of the parasympathetic nervous system


49.
Which of the following statements regarding suicide in the older patient is correct?
A.
Older patients tend to use more lethal means than younger patients.
B.
Older females have a higher rate of suicide than any other group.
C.
Depression and hopeless feelings are often not predisposing factors.
D.
Most suicidal patients readily seek care and do not deny the problem.


50.
The leading cause of death in the geriatric patient is:
A.
hypertension.
B.
altered mental status.
C.
arthritis.
D.
heart disease.



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