CH 45 Flashcards
(43 cards)
After obtaining an elderly patient’s chief complaint, gathering additional information about the history of present illness would most likely be complicated because:
the patient may ask you to repeat your questions.
most elderly patients take numerous medications.
chronic problems may affect the acute problem.
the aging process causes difficulty in understanding.
chronic problems may affect the acute problem
Decreased elasticity of the lungs and calcification of the costochondral cartilage results in a(n):
increase in residual lung volume.
decrease in the total amount of air in the lungs.
decrease in airway size and resistance.
significant increase in vital capacity.
increase in residual lung volume.
Aging brings a widespread decrease in bone mass, especially:
in postmenopausal women.
in the presence of hypertension.
in men older than 50 years of age.
if the person falls frequently.
in postmenopausal women.
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?
Blood glucose
Orthostatic vital signs
Cardiac rhythm
Cincinnati stroke scale
Blood glucose
Which of the following cardiac dysrhythmias is associated with the highest risk of stroke?
Atrial fibrillation
Sinus tachycardia
AV heart block
Junctional rhythm
Atrial fibrillation
You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is correct?
This patient’s vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.
This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg.
Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure.
This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
An elderly person is at increased risk for aspiration, primarily from:
atrophy of the epiglottis.
decreased cough and gag reflexes.
a decreased ability to swallow.
slowing of the ciliary mechanisms.
decreased cough and gag reflexes.
Which of the following conditions would most likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure?
Spondylosis
Osteoporosis
Asthma
Kyphosis
Kyphosis
Failure of the heart’s primary pacemaker and the development of alternate pacemakers in the atria would most likely result in:
ventricular ectopy.
atrial fibrillation.
atrioventricular block.
junctional rhythms.
atrial fibrillation
After falls, which of the following is the second leading cause of accidental death among elderly people?
Submersion injury
Motor vehicle crashes
Thermal burns
Drug interactions
Motor vehicle crashes
Which of the following central nervous system functions change as a person ages?
Enzyme activity
Intelligence level
Hormone levels
Postural stability
Postural stability
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:
had a stroke secondary to atrial fibrillation.
has an acute onset of dementia.
has normal age-related physiologic changes.
is experiencing a subdural hematoma.
is experiencing a subdural hematoma.
Type I osteoporosis tends to progress more rapidly in:
postmenopausal women.
the bones of the lower extremities.
patients with excess calcium.
males older than 60 years of age.
postmenopausal women.
Which of the following is a predisposing risk factor for trauma in the elderly?
Faster reflexes
Decreased body water
Overall increase in agility
Equilibrium disorders
Equilibrium disorders
In contrast to delirium, dementia is:
often caused by conditions such as poisonings and infection.
often reversible if the underlying cause is identified rapidly.
an acute state of confusion that may last for up to 1 week.
a progressive disease that produces irreversible brain failure.
a progressive disease that produces irreversible brain failure.
In contrast to a 30-year-old man, if a 70-year-old man were to consume an excessive amount of alcohol:
it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver.
he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.
the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug.
he would experience a lower blood alcohol concentration secondary to a decrease in total body water.
he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.
The medical assessment of an elderly patient can be complex because:
elderly adults often make up symptoms that do not exist.
most elderly adults are hearing or visually impaired.
elderly adults often have more than one medical condition.
caregivers typically prefer that you speak with them.
elderly adults often have more than one medical condition.
Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to which of the following conditions?
Malnutrition
Hyperkalemia
Profound dehydration
Dementia
Hyperkalemia
Which of the following is a key element of the “G” in the GEMS diamond?
Checking the physical condition of the patient’s home
Recalling that elderly patients often present atypically
Obtaining a complete medical history from the patient
Assessing the elderly patient’s activities of daily living
Recalling that elderly patients often present atypically
Following retirement, many older people:
experience a rapid decline in their underlying health and become incapacitated within 12 months.
return to work within 6 months because their retirement pension does not support them adequately.
commonly experience decreased self-esteem because they no longer feel useful or productive in society.
often experience an improvement in their overall health because the stress of working has been eliminated.
commonly experience decreased self-esteem because they no longer feel useful or productive in society.
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:
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.
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.
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.
establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport.
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.
Which of the following disease processes would most likely present with signs and symptoms that mimic those seen with normal aging?
Thyrotoxicosis
Hypothyroidism
Type 2 diabetes
Hyperglycemia
Hypothyroidism
Heat gain or loss in response to environmental changes is delayed in elderly people due to:
chronic hyperthyroidism.
increased sweat production.
chronic renal disease.
atherosclerotic vessels.
atherosclerotic vessels.
The risk of a pulmonary embolus increases with age because of:
drug-induced bradycardia.
chronic use of aspirin.
increased immobility.
frequent lung infections.
increased immobility.
