Late Adulthood: 61 Years and Older Practice Questions

90 multiple-choice questions on Late adulthood: 61 years and older for paramedic and EMT students, from Chapter 10 (Life Span Development). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

90 practice questions

1. Cardiovascular changes with aging include:

   1. A. Stiffer vessels and lower maximum heart rate
   2. B. More elastic vessels and greater cardiac reserve
   3. C. Thinner heart walls and faster conduction speed
   4. D. Lower resting blood pressure and larger stroke volume
   Show answer

   Answer: A. Stiffer vessels and lower maximum heart rate

   Older patients tolerate blood loss and rapid rhythms poorly. Heart walls also thicken; older patients tolerate blood loss and rapid rhythms poorly.

2. Because of these changes, an older patient's response to blood loss may be:

   1. A. Marked tachycardia earlier than in young adults
   2. B. Blunted, with less tachycardia
   3. C. Immediate hypotension without other signs
   4. D. Identical to that of a young adult
   Show answer

   Answer: B. Blunted, with less tachycardia

   Do not be reassured by a normal heart rate. Beta blockers blunt the response further.

3. Respiratory changes with aging include:

   1. A. Increased vital capacity and stronger cough
   2. B. A more compliant, flexible chest wall
   3. C. Lower vital capacity and a weaker cough
   4. D. Improved gas exchange and more alveoli
   Show answer

   Answer: C. Lower vital capacity and a weaker cough

   These changes raise the risk of pneumonia and hypoxia. The chest wall also stiffens.

4. Renal changes with aging include:

   1. A. Better urine concentration with age
   2. B. More nephrons and faster drug clearance
   3. C. Fewer nephrons and reduced filtration
   4. D. Greater fluid reserve during illness
   Show answer

   Answer: C. Fewer nephrons and reduced filtration

   Medication doses often need adjustment for this reason. Reduced filtration slows drug clearance.

5. Neurologic changes with aging include:

   1. A. Reduced brain mass and slower conduction
   2. B. Improved balance and proprioception
   3. C. More neurons and quicker reaction time
   4. D. Increased brain mass and faster reflexes
   Show answer

   Answer: A. Reduced brain mass and slower conduction

   The brain shrinking away from the skull also allows bleeding to accumulate before symptoms appear. Reaction times slow as well.

6. An older patient with a subdural hematoma may:

   1. A. Develop symptoms days or weeks after a minor fall
   2. B. Be at low risk because the brain fills the skull
   3. C. Develop one only after high-energy trauma
   4. D. Always show symptoms within minutes of the injury
   Show answer

   Answer: A. Develop symptoms days or weeks after a minor fall

   Ask about falls even when the patient has forgotten them. Symptoms are often gradual.

7. Thermoregulation in older adults is:

   1. A. Improved by most daily medications
   2. B. More efficient, due to lifelong adaptation to temperature
   3. C. Less efficient, raising heat and cold risk
   4. D. Unchanged from that of middle age
   Show answer

   Answer: C. Less efficient, raising heat and cold risk

   Reduced sweating, thinner skin, and blunted thirst all contribute. Both hypothermia and hyperthermia become more likely.

8. Skin changes with aging include:

   1. A. Thin, fragile skin that tears easily
   2. B. More subcutaneous fat and padding
   3. C. Faster healing of cuts and abrasions
   4. D. Thicker skin with greater elasticity
   Show answer

   Answer: A. Thin, fragile skin that tears easily

   Be gentle with tape, straps, and movement. Skin also bruises easily and loses elasticity.

9. Musculoskeletal changes with aging include:

   1. A. Loss of bone and muscle, often with kyphosis
   2. B. Greater muscle mass and tone from a lifetime of physical activity
   3. C. Increased bone density and joint strength
   4. D. Increased height from joint changes
   Show answer

   Answer: A. Loss of bone and muscle, often with kyphosis

   Padding and positioning improve comfort and prevent injury. Kyphosis is common.

10. Falls in older adults are significant because they:

    1. A. Are an unavoidable and expected part of aging
    2. B. Mainly occur outside the home in public places
    3. C. Rarely cause injuries serious enough to need medical care
    4. D. Are the leading cause of injury death in this group
    Show answer

    Answer: D. Are the leading cause of injury death in this group

    Look for the medical reason behind the fall. A fall often signals an underlying problem.

11. Polypharmacy refers to:

    1. A. Using one drug to treat several conditions at once
    2. B. Relying mainly on over-the-counter medications
    3. C. Filling prescriptions at several different pharmacies
    4. D. Taking many drugs, raising interaction risk
    Show answer

    Answer: D. Taking many drugs, raising interaction risk

    Bring the medications or a list to the hospital. Side effects increase as well.

12. Older adults often present atypically, which means:

    1. A. They tend to report many unrelated symptoms at the same time
    2. B. Their symptoms are typically more dramatic
    3. C. They feel no pain from serious illness
    4. D. Illness may show as confusion, weakness, or falls
    Show answer

    Answer: D. Illness may show as confusion, weakness, or falls

    A myocardial infarction may present without chest pain. Classic symptoms may be absent.

13. Sensory changes in aging include:

    1. A. Increased sensitivity to painful stimuli and temperature
    2. B. A heightened sense of smell and taste
    3. C. Reduced acuity and high-pitch hearing loss
    4. D. Sharper near vision and better hearing
    Show answer

    Answer: C. Reduced acuity and high-pitch hearing loss

    Make sure glasses and hearing aids travel with the patient. Smell and taste also diminish.

14. Depression in older adults is:

    1. A. Common and often missed
    2. B. A normal part of aging
    3. C. Rare and usually mild
    4. D. Easy to tell apart from dementia
    Show answer

    Answer: A. Common and often missed

    Ask about mood and isolation. It is sometimes mistaken for dementia.

15. Delirium differs from dementia in that delirium:

    1. A. Occurs mainly in younger adult patients
    2. B. Develops gradually and progressively over months to years
    3. C. Is permanent once it has developed
    4. D. Starts acutely, often from a treatable cause
    Show answer

    Answer: D. Starts acutely, often from a treatable cause

    A sudden change in mental status is a medical emergency. Delirium usually has a medical cause.

16. The best way to learn an older patient's baseline mental status is to:

    1. A. Repeat orientation questions every few minutes
    2. B. Rely on the medical record or chart alone
    3. C. Assume it from your initial exam findings
    4. D. Ask family or caregivers what is normal
    Show answer

    Answer: D. Ask family or caregivers what is normal

    Change from baseline is what matters. Facility staff are also a good source.

17. The fastest growing population segment is:

    1. A. Adults over 85
    2. B. Infants
    3. C. Middle-aged adults
    4. D. Adolescents
    Show answer

    Answer: A. Adults over 85

    Adults over 85, the 'oldest old,' are the fastest growing segment.

18. Older adults account for what share of EMS calls?

    1. A. About 5 percent of all calls
    2. B. Almost exactly half of all calls
    3. C. Roughly the same as their share of the general population
    4. D. A disproportionate share, often over a third
    Show answer

    Answer: D. A disproportionate share, often over a third

    The share is rising with the aging population.

19. A healthy 78-year-old has a normal resting heart rate and blood pressure but becomes short of breath climbing two flights of stairs. Which age-related cardiac change best explains this?

    1. A. Resting cardiac output rises to compensate for age
    2. B. Maximum cardiac output during exertion declines
    3. C. The heart rate climbs higher with exercise than in youth
    4. D. Stroke volume at rest falls by half after age 70
    Show answer

    Answer: B. Maximum cardiac output during exertion declines

    In healthy older adults, resting cardiac output is largely preserved, but the heart's reserve shrinks: maximum heart rate falls (about 220 minus age), the stiffer ventricle fills less well, and the response to catecholamines is blunted, so peak output during exertion or illness drops. Resting output does not rise with age, the maximum heart rate falls rather than climbs, and resting stroke volume does not fall by half in healthy aging.

20. Maximum heart rate in older adults:

    1. A. Declines, limiting stress response
    2. B. Increases with years of aerobic conditioning
    3. C. Rises when blood pressure is high
    4. D. Stays the same as in young adults
    Show answer

    Answer: A. Declines, limiting stress response

    Maximum heart rate is roughly 220 minus age.

21. Heart valves in older adults:

    1. A. Become thinner and more pliable
    2. B. Calcify only in patients with diabetes
    3. C. Thicken and stiffen, causing murmurs
    4. D. Remain thin and fully flexible
    Show answer

    Answer: C. Thicken and stiffen, causing murmurs

    Aortic stenosis is common.

22. Conduction system changes in older adults include:

    1. A. Fibrosis causing bradycardia and blocks
    2. B. No measurable change in conduction speed
    3. C. Faster conduction through the AV node
    4. D. More pacemaker cells in the SA node
    Show answer

    Answer: A. Fibrosis causing bradycardia and blocks

    Pacemakers are common in this group.

23. Blood vessels in older adults:

    1. A. Stiffen, raising systolic pressure
    2. B. Dilate, lowering diastolic pressure
    3. C. Become more elastic, lowering pressure
    4. D. Are unchanged unless the patient smokes
    Show answer

    Answer: A. Stiffen, raising systolic pressure

    This produces isolated systolic hypertension.

24. Orthostatic hypotension in older adults results from:

    1. A. Long-standing untreated hypertension
    2. B. Increased cardiac output when standing
    3. C. Blunted baroreflexes and medications
    4. D. Overly strong baroreceptor reflexes
    Show answer

    Answer: C. Blunted baroreflexes and medications

    Orthostatic hypotension is a major fall risk.

25. A healthy, active 86-year-old has a resting SpO2 of 94% on room air and no distress. How should you interpret this?

    1. A. Always indicates that an acute pneumonia is present
    2. B. Means the pulse oximeter must be malfunctioning
    3. C. May be normal; oxygenation falls slightly with age
    4. D. Requires high-flow oxygen by nonrebreather now
    Show answer

    Answer: C. May be normal; oxygenation falls slightly with age

    With age the lungs lose elastic recoil, small airways close earlier, and ventilation-perfusion mismatch increases, so resting arterial oxygen falls gradually. A slightly lower SpO2 without distress may be this patient's baseline, so compare with known values and look for other signs. It does not prove pneumonia or a device fault, and high-flow oxygen is not indicated for a patient who is not hypoxic or distressed.

26. Chest wall changes in older adults include:

    1. A. No significant change with age
    2. B. Calcification and kyphosis
    3. C. Increased flexibility from loosened joints
    4. D. Improved breathing mechanics
    Show answer

    Answer: B. Calcification and kyphosis

    Reduced vital capacity. The chest wall stiffens, reducing vital capacity.

27. Lung capacity in older adults:

    1. A. Doubles to compensate for weaker muscles
    2. B. Stays constant if they don't smoke
    3. C. Decreases, leaving less reserve
    4. D. Increases with years of breathing
    Show answer

    Answer: C. Decreases, leaving less reserve

    Dyspnea with exertion is common.

28. Older adults are more susceptible to pneumonia because of:

    1. A. Overactive immunity causing lung inflammation
    2. B. Weak cough, poor cilia, and immune decline
    3. C. Smaller lungs that limit exposure to germs
    4. D. Extra alveoli that trap inhaled bacteria
    Show answer

    Answer: B. Weak cough, poor cilia, and immune decline

    Vaccination helps reduce risk.

29. An 82-year-old's usual medication dose suddenly causes toxicity after a bout of dehydration. Which aging change contributes most?

    1. A. Increased kidney mass with age
    2. B. Reduced kidney filtration that slows drug clearance
    3. C. Faster liver metabolism of drugs
    4. D. Larger total body water that dilutes the drugs in blood
    Show answer

    Answer: B. Reduced kidney filtration that slows drug clearance

    Older adults lose nephrons and filtration, so renally cleared drugs (for example, digoxin, lithium, and some anticoagulants) build up, especially with dehydration. Kidney mass shrinks rather than grows, liver metabolism slows, and total body water falls, so drug concentrations rise.

30. Bladder changes in older adults include:

    1. A. Stronger sphincters and better control
    2. B. Increased capacity and less frequency
    3. C. No meaningful change in function
    4. D. Lower capacity and weaker muscles
    Show answer

    Answer: D. Lower capacity and weaker muscles

    Falls at night. This causes frequency and incontinence, and night trips raise fall risk.

31. Prostate enlargement in older men:

    1. A. Rarely causes any urinary symptoms
    2. B. Is almost always due to cancer
    3. C. Is common and may cause retention
    4. D. Is rare before about age 80
    Show answer

    Answer: C. Is common and may cause retention

    This is benign prostatic hyperplasia; it can cause urinary retention.

32. Gastrointestinal changes in older adults include:

    1. A. Better absorption of most nutrients
    2. B. Faster motility and more stomach acid
    3. C. Slower motility
    4. D. No meaningful change in digestion
    Show answer

    Answer: C. Slower motility

    Constipation and malnutrition. Acid production also falls; constipation and malnutrition result.

33. Liver changes in older adults include:

    1. A. Improved clearance of most drugs
    2. B. Smaller size, slowing drug metabolism
    3. C. Increased size and faster metabolism
    4. D. No meaningful change in liver function
    Show answer

    Answer: B. Smaller size, slowing drug metabolism

    Reduced size and blood flow slow drug metabolism and cause drug accumulation.

34. Endocrine changes in older adults include:

    1. A. Higher hormone levels from most of the endocrine glands
    2. B. No meaningful change in hormone function
    3. C. Lower insulin sensitivity, thyroid changes
    4. D. Tighter regulation of blood glucose
    Show answer

    Answer: C. Lower insulin sensitivity, thyroid changes

    Diabetes is common.

35. During a heat wave, an 86-year-old living without air conditioning is found confused and hot. Why are older adults at high risk?

    1. A. Older adults sweat more than younger people do in the heat
    2. B. Less sweating and a blunted sense of temperature
    3. C. Their thirst sensation is stronger
    4. D. They have more insulating fat
    Show answer

    Answer: B. Less sweating and a blunted sense of temperature

    Aging reduces sweating, blunts thirst and temperature perception, and limits cardiovascular reserve. Many older adults also take medications that impair heat loss (diuretics, anticholinergics, beta blockers). They sweat less and feel less thirst, and subcutaneous fat decreases with age.

36. Older adults may not develop fever with infection because:

    1. A. Their immune and thermal responses are blunted
    2. B. They get fewer bacterial infections overall
    3. C. Antipyretics are almost always on board
    4. D. They usually clear infections before a fever can develop
    Show answer

    Answer: A. Their immune and thermal responses are blunted

    Absence of fever does not exclude infection.

37. Immune changes in older adults include:

    1. A. Stronger immunity from lifelong exposure
    2. B. Weaker response to infection and vaccines
    3. C. An exaggerated, overactive reaction to most vaccines
    4. D. No meaningful change in immune function
    Show answer

    Answer: B. Weaker response to infection and vaccines

    This is immunosenescence.

38. When removing ECG electrodes from a 90-year-old, you notice a skin tear. Why does this happen?

    1. A. Aging skin is thicker and stiffer
    2. B. Older adults heal skin wounds faster
    3. C. Extra subcutaneous fat makes aging skin shear easily
    4. D. Aging skin is thinner, drier, and less elastic
    Show answer

    Answer: D. Aging skin is thinner, drier, and less elastic

    Aging thins the epidermis, flattens the dermal-epidermal junction, and reduces collagen and elasticity, so skin tears with minor shearing. Remove adhesives slowly and pad pressure points. Skin thins with age rather than thickening, subcutaneous fat decreases rather than increases, and healing slows.

39. Subcutaneous fat in older adults:

    1. A. Increases, adding insulation
    2. B. Decreases, reducing cushioning
    3. C. Stays the same throughout life
    4. D. Shifts entirely to the extremities
    Show answer

    Answer: B. Decreases, reducing cushioning

    Pressure injuries. Insulation is also reduced; pressure injuries are a risk.

40. Bone changes in older adults include:

    1. A. Stronger bones from decades of weight bearing
    2. B. No meaningful change in bone mass
    3. C. Lost density and higher fracture risk
    4. D. Increased density and strength
    Show answer

    Answer: C. Lost density and higher fracture risk

    Hip fractures are common.

41. Hip fracture in older adults:

    1. A. Carries high mortality within a year
    2. B. Is usually a minor injury
    3. C. Is uncommon after age 80
    4. D. Usually heals without lasting effect
    Show answer

    Answer: A. Carries high mortality within a year

    Hip fracture often leads to loss of independence.

42. Muscle changes in older adults include:

    1. A. Increased muscle mass
    2. B. Hypertrophy
    3. C. Sarcopenia
    4. D. Myositis
    Show answer

    Answer: C. Sarcopenia

    Resistance training helps. Sarcopenia is the loss of muscle mass and strength; resistance training helps.

43. Joint changes in older adults include:

    1. A. Improved flexibility and range
    2. B. Cartilage loss
    3. C. No meaningful change in joints
    4. D. Increased joint lubrication
    Show answer

    Answer: B. Cartilage loss

    Cartilage loss reduces range of motion; osteoarthritis is common.

44. Height loss in older adults results from:

    1. A. Vertebral compression and disc thinning
    2. B. Weight gain compressing the knee and hip joints
    3. C. Loss of muscle mass in the legs
    4. D. Loss of subcutaneous fat stores
    Show answer

    Answer: A. Vertebral compression and disc thinning

    Kyphosis also results.

45. A 79-year-old takes longer to answer questions but answers correctly and is oriented. How should you interpret this?

    1. A. Slowed processing from normal aging; allow time
    2. B. Acute delirium that needs emergency treatment right away
    3. C. Severe dementia, so ask family instead
    4. D. Intoxication until proven otherwise
    Show answer

    Answer: A. Slowed processing from normal aging; allow time

    Normal aging slows nerve conduction and processing speed without impairing orientation or judgment. Give extra time and do not interrupt. Delirium causes acute, fluctuating confusion and inattention, and dementia involves memory and functional loss. A correct, oriented patient should not be bypassed or labeled.

46. An 84-year-old taking apixaban hit her head in a fall 3 days ago and is now increasingly confused. Why can symptoms appear this late?

    1. A. Brain atrophy leaves room for a slow subdural bleed
    2. B. The confusion is most likely just part of normal aging
    3. C. Anticoagulants prevent bleeding from head trauma
    4. D. Head injuries always cause symptoms right away
    Show answer

    Answer: A. Brain atrophy leaves room for a slow subdural bleed

    With age the brain shrinks, which stretches the bridging veins and leaves more space inside the skull, so a subdural hematoma can grow for days before it raises intracranial pressure. Anticoagulants make bleeding more likely, not less. New confusion is never just normal aging, and delayed symptoms are typical of subdurals. She needs CT evaluation.

47. Reaction time in older adults:

    1. A. Speeds up when the person is alert
    2. B. Stays the same as in middle age
    3. C. Slows
    4. D. Improves with years of experience
    Show answer

    Answer: C. Slows

    Slower reaction time affects driving safety and fall prevention.

48. Memory changes in normal aging include:

    1. A. Severe loss of daily function
    2. B. Complete loss of recent memory
    3. C. No change at all in memory or recall ability
    4. D. Slower recall, not loss of function
    Show answer

    Answer: D. Slower recall, not loss of function

    Dementia is not normal aging. Recall of names and details slows; dementia is not normal aging.

49. Dementia prevalence in older adults:

    1. A. Affects nearly all older adults
    2. B. Is unrelated to age
    3. C. Is low even after age 85
    4. D. Rises with age, high after 85
    Show answer

    Answer: D. Rises with age, high after 85

    It affects a significant share of adults over 85. Alzheimer disease is the most common type.

50. A 79-year-old with mild dementia became acutely agitated and inattentive overnight, and his symptoms fluctuate. What is most likely?

    1. A. Delirium from an underlying cause such as infection
    2. B. Sudden progression of his dementia overnight
    3. C. Normal sundowning that needs no evaluation
    4. D. A new psychiatric disorder such as late-onset schizophrenia
    Show answer

    Answer: A. Delirium from an underlying cause such as infection

    Acute onset, inattention, and a fluctuating course define delirium, which is often superimposed on dementia and triggered by infection, drugs, hypoxia, hypoglycemia, or urinary retention. Dementia progresses over months, not overnight. Labeling it sundowning risks missing a treatable cause. New psychosis late in life is rare and is diagnosed only after medical causes are excluded.

51. An older adult fails to notice a gas leak in his kitchen. Which aging change contributes?

    1. A. Presbyopia from a stiffer lens
    2. B. Reduced thirst sensation
    3. C. Thinner, more fragile skin
    4. D. Reduced sense of smell
    Show answer

    Answer: D. Reduced sense of smell

    Smell and taste decline with age, so older adults may miss smoke, gas, or spoiled food; working smoke and gas detectors help. Presbyopia, reduced thirst, and thinner skin are also common aging changes, but none of them affects the ability to detect an odor.

52. Vision changes in older adults include:

    1. A. Improved acuity and color perception
    2. B. Cataracts, glaucoma, and macular degeneration
    3. C. Better vision in dim or low light
    4. D. No meaningful change in eyesight
    Show answer

    Answer: B. Cataracts, glaucoma, and macular degeneration

    Fall risk in dim light. Night vision also declines, raising fall risk in dim light.

53. Hearing loss in older adults:

    1. A. Rarely affects assessment
    2. B. Is common and adds to isolation
    3. C. Is rare and usually mild
    4. D. Is nearly always corrected with aids
    Show answer

    Answer: B. Is common and adds to isolation

    Check for hearing aids. It can be mistaken for confusion; check for hearing aids.

54. Reduced sense of smell in older adults matters because:

    1. A. It improves the sense of taste
    2. B. It reduces appetite only slightly
    3. C. They may miss gas leaks or smoke
    4. D. It rarely affects daily safety
    Show answer

    Answer: C. They may miss gas leaks or smoke

    It is a safety hazard; spoiled food may also go unnoticed.

55. Reduced pain sensation in older adults means:

    1. A. Serious illness may hurt less than expected
    2. B. Pain perception is unchanged with age
    3. C. Serious illness always causes severe, well-localized pain
    4. D. Pain is felt far more intensely
    Show answer

    Answer: A. Serious illness may hurt less than expected

    Silent MI is one example.

56. Atypical MI presentation in older adults includes:

    1. A. Dyspnea, weakness, confusion, or syncope
    2. B. Pain limited to the left arm only
    3. C. Classic crushing substernal chest pain
    4. D. No symptoms of any kind
    Show answer

    Answer: A. Dyspnea, weakness, confusion, or syncope

    Maintain suspicion. These may occur without chest pain; maintain suspicion.

57. A 90-year-old nursing home resident is 'not herself': more tired, not eating, and has fallen twice today. Her temperature is 37.2 C. What should you suspect?

    1. A. Normal aging, since she has no fever to explain her change
    2. B. A serious illness, such as infection, despite no fever
    3. C. Simple tiredness from a poor night of sleep
    4. D. A behavioral problem that staff can manage alone
    Show answer

    Answer: B. A serious illness, such as infection, despite no fever

    Older adults often present atypically: infection, MI, or other serious illness may show only as functional decline, falls, or confusion, and fever may be absent because the response is blunted. Assess fully (glucose, SpO2, 12-lead, signs of sepsis) and transport. This is not normal aging, tiredness, or a behavior problem until proven otherwise.

58. Atypical abdominal presentation in older adults includes:

    1. A. Less pain and guarding despite serious disease
    2. B. Classic rebound tenderness on exam
    3. C. Board-like rigidity in every case
    4. D. Pain far out of proportion to the physical exam findings
    Show answer

    Answer: A. Less pain and guarding despite serious disease

    Perforation may occur without rigidity.

59. An 81-year-old taking 12 medications has new confusion and falls. Which problem should you consider first?

    1. A. Normal aging, which commonly causes both falls and confusion
    2. B. Vitamin B12 deficiency from a poor diet
    3. C. A fever, since only infections cause confusion
    4. D. Adverse drug effects or interactions from her medicines
    Show answer

    Answer: D. Adverse drug effects or interactions from her medicines

    Polypharmacy, often defined as five or more drugs, raises the risk of interactions, sedation, orthostasis, hypoglycemia, and delirium, so medications are a leading cause of falls and confusion in older adults. New confusion is never just normal aging, and infection is only one of many causes. B12 deficiency develops slowly and is a far less likely cause of new confusion than her medicines. Bring the medication list.

60. Beers criteria identify:

    1. A. Drugs required for all patients over 65
    2. B. Drugs safe at any dose for older adults
    3. C. Low-cost generic substitutes for brand-name prescriptions
    4. D. Drugs potentially inappropriate in the elderly
    Show answer

    Answer: D. Drugs potentially inappropriate in the elderly

    Benzodiazepines and anticholinergics are examples.

61. Anticoagulant use in older adults means:

    1. A. Bleeding risk is lower than in younger adults
    2. B. Bleeding risk is unchanged by age
    3. C. Minor trauma may cause serious bleeding
    4. D. Head injuries need no special concern
    Show answer

    Answer: C. Minor trauma may cause serious bleeding

    Transport head injuries. Intracranial bleeding is the main concern; transport head injuries.

62. Beta blockers in older adults may:

    1. A. Have no effect on vital signs
    2. B. Increase the resting heart rate
    3. C. Mask tachycardia in shock
    4. D. Cause reflex tachycardia in shock
    Show answer

    Answer: C. Mask tachycardia in shock

    A normal heart rate does not mean the patient is stable.

63. An 80-year-old fell from standing and says she is fine. Why should you assess her carefully anyway?

    1. A. Falls from standing never injure older adults
    2. B. Falls are a leading cause of injury death in older adults
    3. C. Older adults always report injuries accurately
    4. D. Ground-level falls are only dangerous in very young children
    Show answer

    Answer: B. Falls are a leading cause of injury death in older adults

    Falls are the leading cause of injury death in adults 65 and older. Even ground-level falls can cause hip fractures and intracranial bleeding, especially with anticoagulants, and older patients often minimize symptoms. Look for the cause of the fall (syncope, dysrhythmia, medications) as well as injuries.

64. Fall risk factors include:

    1. A. Young age and regular exercise
    2. B. Good lighting and handrails at home
    3. C. High dietary protein intake
    4. D. Drugs, poor vision, and weakness
    Show answer

    Answer: D. Drugs, poor vision, and weakness

    Multifactorial. Environmental hazards and prior falls also count; risk is multifactorial.

65. A fall from standing in an older adult can cause:

    1. A. No injury if the floor is carpeted
    2. B. Skin tears but no deeper injury
    3. C. Hip fracture or subdural hematoma
    4. D. Minor bruising and nothing more
    Show answer

    Answer: C. Hip fracture or subdural hematoma

    Low mechanism, high injury. Head injury is also common; low mechanism, high injury.

66. Elder abuse includes:

    1. A. Neglect by paid caregivers only
    2. B. Physical harm such as hitting or restraint only
    3. C. Financial exploitation by family members only
    4. D. Physical, emotional, sexual, financial abuse, or neglect
    Show answer

    Answer: D. Physical, emotional, sexual, financial abuse, or neglect

    Abuse can be physical, emotional, sexual, or financial, and neglect also counts. Reporting is mandatory.

67. Signs of elder neglect include:

    1. A. Clean clothes and a full refrigerator
    2. B. Good hygiene but missed appointments
    3. C. Frequent visits from family members
    4. D. Poor hygiene, malnutrition, untreated illness
    Show answer

    Answer: D. Poor hygiene, malnutrition, untreated illness

    Document objectively. Unsafe living conditions are another sign; document objectively.

68. Social isolation in older adults:

    1. A. Benefits most older adults
    2. B. Is rare in modern communities
    3. C. Is harmless if the patient is content
    4. D. Raises mortality and depression
    Show answer

    Answer: D. Raises mortality and depression

    Ask about support systems.

69. A widowed 78-year-old man has stopped eating and says, 'Nobody would miss me.' What is the most appropriate action?

    1. A. Reassure him that feeling sad is normal at his age
    2. B. Leave, since he has capacity and has no injuries
    3. C. Ask his neighbor to check on him again tomorrow
    4. D. Ask directly about suicidal thoughts; arrange care
    Show answer

    Answer: D. Ask directly about suicidal thoughts; arrange care

    Depression is common but not normal in older adults and is often missed. Older men have the highest suicide rates. Hopeless statements, withdrawal, and recent loss call for direct questions about suicidal thoughts and a plan, and for transport or evaluation. Dismissing it or leaving without a safety plan risks a fatal outcome.

70. Suicide in older adults:

    1. A. Is rare after age 65
    2. B. Is almost always prevented by family
    3. C. Mainly affects older women
    4. D. Has high rates, especially in older men
    Show answer

    Answer: D. Has high rates, especially in older men

    Ask directly about suicidal thoughts.

71. Integrity versus despair refers to:

    1. A. Looking back with acceptance or regret
    2. B. Contributing to the next generation
    3. C. Forming close, intimate relationships
    4. D. Establishing a stable sense of identity
    Show answer

    Answer: A. Looking back with acceptance or regret

    This is Erikson's final stage.

72. Retirement affects health through:

    1. A. No measurable change in health
    2. B. Physical activity only, through less movement
    3. C. Lost structure and identity, or new freedom
    4. D. Finances only, through lost income
    Show answer

    Answer: C. Lost structure and identity, or new freedom

    Varies by individual. Loss of income or reduced stress also play a role; effects vary.

73. Loss of a spouse in late adulthood:

    1. A. Is rare after the age of 70
    2. B. Rarely affects physical health
    3. C. Mainly affects household finances, not health
    4. D. Raises mortality in the months after
    Show answer

    Answer: D. Raises mortality in the months after

    Bereavement affects health.

74. Older adults' functional status is assessed by:

    1. A. Body mass index and weight trend
    2. B. Chronological age in years
    3. C. Vital signs alone
    4. D. Daily living activities
    Show answer

    Answer: D. Daily living activities

    ADLs and instrumental ADLs. ADLs include bathing, dressing, and eating; instrumental ADLs are also assessed.

75. Frailty in older adults refers to:

    1. A. Low body weight alone
    2. B. Advanced chronological age
    3. C. Loss of height with age
    4. D. Reduced reserve against stress
    Show answer

    Answer: D. Reduced reserve against stress

    Frailty predicts poor outcomes.

76. Communication with older adults should:

    1. A. Go mainly through family members
    2. B. Be quick to keep the call efficient
    3. C. Face them and speak clearly
    4. D. Use a loud voice and simple words
    Show answer

    Answer: C. Face them and speak clearly

    Do not assume confusion. Confirm understanding; do not assume confusion.

77. Assessment of an older adult should include:

    1. A. The chief complaint and nothing more
    2. B. Baseline function, meds, and caregiver input
    3. C. A rapid trauma survey only
    4. D. Vital signs and a quick look
    Show answer

    Answer: B. Baseline function, meds, and caregiver input

    Ask what is normal for them.

78. Vital signs in older adults:

    1. A. Are always reliable indicators
    2. B. May look normal despite illness
    3. C. Are usually abnormal at rest
    4. D. Are irrelevant to assessment
    Show answer

    Answer: B. May look normal despite illness

    Trust the overall picture. Responses are blunted; trust the overall picture.

79. Hypothermia in older adults can result from:

    1. A. Mild cold exposure
    2. B. Extreme cold only
    3. C. Winter weather only
    4. D. Outdoor exposure only
    Show answer

    Answer: A. Mild cold exposure

    Indoor hypothermia. Thermoregulation is impaired, so indoor hypothermia occurs.

80. Older adults in heat waves:

    1. A. Cope better than younger adults do
    2. B. Are at highest risk of heat illness
    3. C. Are protected by reduced sweating
    4. D. Are at low risk if they stay indoors
    Show answer

    Answer: B. Are at highest risk of heat illness

    Wellness checks are important.

81. Positioning older adults:

    1. A. Is no different from younger adults
    2. B. Needs padding and room for kyphosis
    3. C. Is routine and simple
    4. D. Should always be supine and flat
    Show answer

    Answer: B. Needs padding and room for kyphosis

    Skin and comfort. Contractures also need accommodation; protect skin and comfort.

82. Spinal immobilization in older adults:

    1. A. Is identical to that of younger adults
    2. B. May need padding for spinal curvature
    3. C. Is always contraindicated after age 75
    4. D. Is never needed after a ground-level fall
    Show answer

    Answer: B. May need padding for spinal curvature

    Avoid forcing alignment.

83. Dignity in older adult care:

    1. A. Matters less than speed and efficiency
    2. B. Is essential; include them in decisions
    3. C. Is automatic and needs no special effort
    4. D. Is mainly a concern for the family
    Show answer

    Answer: B. Is essential; include them in decisions

    They are adults. Address them respectfully; they are adults.

84. Advance directives in older adults:

    1. A. Are already on file for nearly every older adult
    2. B. Should be asked about and honored
    3. C. Can be ignored in emergencies
    4. D. Are rare and seldom relevant
    Show answer

    Answer: B. Should be asked about and honored

    Ask early.

85. Older adults' capacity to make decisions:

    1. A. Is presumed unless shown otherwise
    2. B. Should be decided by family members
    3. C. Is irrelevant during emergencies
    4. D. Is generally impaired after age 75
    Show answer

    Answer: A. Is presumed unless shown otherwise

    Age is not incapacity.

86. Which older adult finding is most concerning?

    1. A. Needing reading glasses
    2. B. Slow walking speed
    3. C. Acute change in mental status
    4. D. Graying or thinning hair
    Show answer

    Answer: C. Acute change in mental status

    Change from baseline. Acute change in function also matters; compare to baseline.

87. Healthy aging is supported by:

    1. A. Rest, minimal physical exertion, and avoiding stress
    2. B. Favorable genetics alone
    3. C. Activity, social ties, and nutrition
    4. D. Medication adherence alone
    Show answer

    Answer: C. Activity, social ties, and nutrition

    Preventive care also matters; many factors are modifiable.

88. Which statement about aging is accurate?

    1. A. Most older adults are confused
    2. B. Most older adults are frail
    3. C. Aging varies; age doesn't set function
    4. D. Aging follows one uniform pattern
    Show answer

    Answer: C. Aging varies; age doesn't set function

    Treat the individual. Chronologic age does not determine function; treat the individual.

89. Centenarians are:

    1. A. Mostly institutionalized
    2. B. Rare and declining
    3. C. Increasing in number
    4. D. Mostly men, who tend to live longer
    Show answer

    Answer: C. Increasing in number

    Longevity is rising, and centenarians are a fast-growing group. Most are women, since women tend to live longer, and many live in the community rather than in institutions.

90. End-of-life care in older adults should:

    1. A. Be decided by family alone
    2. B. Reflect the patient's wishes
    3. C. Be withheld after age 85
    4. D. Always be fully aggressive, regardless of prognosis
    Show answer

    Answer: B. Reflect the patient's wishes

    Ask what they want. Follow documented wishes; ask what they want.