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Flashcards in Paramedic Exam 1 Deck (77)
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1
Q

During the initial phase of an acute stress reaction, which of the following physiological responses will occur?

A. normal vital signs that remain unchanged
B. increased vital signs that quickly return to normal
C. increased pulse rate and pupillary dilation
D. lowered pulse rate and pupillary constriction

A

C
Both good stress (eustress) and bad stress (distress) will initially cause sympathetic stimulation such as increased heart and respiratory rate, bronchodilation, dilated pupils, and increased blood flow to the skeletal muscles.

2
Q

Which root word means blue?

A. cyan-
B. melan-
C. buce-
D. hyster-

A

A.

The root word cyan- means, blue, as in cyanosis

3
Q

The ABC’s of initial patient assessment should be performed before anything else in which of the following situations?

A. during cardiac arrest at a swimming pool
B. when the patient is in a toxic environment
C. when the scene is not yet secured by law enforcement
D. during a recue from a fully involved structure fire

A

A.

Before assessing airway, breathing, and circulation, it is necessary to remove the patient (and yourself) to a place of relative safety.

4
Q

The focused history and physical examination of a patient begins after you have:

A. controlled immediate threats to the patient’s life.
B. transported the patient to the hospital
C. secured the scene and gained access tot he patient
D. contacted medical control for direction

A

A.

The purpose of the focused history and physical is to detect additional problems after you have controlled immediate threats to the patient’s life. The on-going assessment is typically performed during transport. Medical control may be consulted anytime during the call when you feel it is appropriate or whenever your protocols and standing orders require it.

5
Q

You arrive on the scene and find an elderly male complaining of severe abdominal and back pain. Upon further questioning, he states that the pain is “all over the left side.” On palpation you feel a pulsating mass in the abdomen.

This patient is most likely suffering from:
A. pulsating diaphragm lesions
B. acute arterial occlusion
C. acute pulmonary embolism
D. abdominal aortic aneurysm
A

D.

This patient is exhibiting the classic signs and symptoms of an abdominal aortic aneurysm. Further palpation may cause the aneurysm to rupture so be every careful in assessing this patient. The other choices will not cause abdominal pulsations to occur.

6
Q

You arrive on the scene and find an elderly male complaining of severe abdominal and back pain. Upon further questioning, he states that the pain is “all over the left side.” On palpation you feel a pulsating mass in the abdomen.

This patient’s vital signs have been worsening steadily throughout the time he has been under your care. Treatment for this patient should include:

A. cardiac monitoring
B. two liters of crystalloid solution
C. dopamine administration
D. PASG/MAST application

A

A.

Cardiac monitoring should always be performed when you suspect an aneurysm is present. Rapid infusion of crystalloid solution is often indicated in the treatment of shock, but the fluid must be titrated to patient response. Dopamine is indicated for cardiogenic shock. Shock in this patient would be due to hypovolemia. Dopamine is contraindicated in the presence of uncorrected hypovolemia. PASG/MAST may be indicated for treatment of AAA in some jurisdiction; however, it is not a standardized treatment

7
Q

Rales are best described as:

A. coarse, wet sounds
B. high-pitched whistles
C. fine crackling sounds
D. gasping sounds

A

c.

Rales, or crakles, indicate fluid in the lower lung tissues (bronchioles and alveoli) that is causing minor obstruction. The sound generated is often described as fine and crackling

8
Q

The posterior tibial pulse is assessed on your patient with palpation of you fingertips near the:

A. arch of the foot
B. medial ankle bone
C. posterior knee
D. top of the foot

A

B.

The posterior tibial pulse is assessed just below and posterior to where the ankle bone protrudes medially. The pulse located on the top of the foot is the dorsalis pedis. The popliteal pulse is located behind the knee.

9
Q

Which question would you ask to assess the P part of the SAMPLE acronym?

A. “Are you taking any prescription medicines?”
B. “What have you had to eat in the past 24 hours?”
C. “Have you recently been sick or had any surgery?”
D. “What were you doing when your felt sick?”

A

C.

The P in SAMPLE acronym stand for past and pertinent medical problems.  The other letters are:
S= signs and symptoms
A= allergies
M= medications
L= last oral intake
E= events leading up to the 911 call
10
Q

Which patient should be transported immediately, with minimal on-scene care and any attempts at stabilization performed en route to the hospital?

A. female, age 45, pulse 132, systolic BP 78
B. male, age 60, pulse 115, respiratory rate 12
C. female, age 28, systolic BP 96, respiratory rate 18
D. male, age 18, pulse 98, diastolic BP 80

A

A. Indications for immediate transport include any signs or symptoms of shock; sustained pulse rate greater than 120 or less than 50, systolic BP less than 90, and respiratory rate less than 10 or greater than 29. Based only on these vital signs, the first patient appears to already by in shock.

11
Q

The collective change in vital signs associated with the late stages of increasing intracranial pressure consists of:

A. increasing pulse rate, shallow respirations, increasing blood pressure
B. slowing pulse rate, deep or erratic respirations, increasing blood pressure
C. rapid and shallow pulse, deep respirations, decreasing blood pressure
D. quickening pulse rate, shallow respirations, decreasing blood pressure

A

B. This change in vital signs comprises Cushing’s Reflex , a sign of incereasing intracranial pressure. Cushing’s Reflex is also sometimes called Cushing’s Triad or Cushing’s Response

12
Q

If your patient has an open abdominal wound with a loop of bowel obtruding, you should treat this with

A, a trauma dressing secured with triangular bandages
B. an occlusive dressing secured on only three sides
C. a wet sterile dressing and an occlusive dressing
D. a clean gauze dressing secured with sterile tape

A

C

The most appropriate dressing for an evisceration is the application of a wet sterile dressing (which keeps the organs moist) and an occlusive dressing (which provides a barrier against further contamination and heat loss).

13
Q

Which of the following patients is likely to be a candidate for rapid transport based solely upon their age and injuries?

A. a 86-year-od female with a fractured clavicle
B. a 28-year-old male with a fractured femur
C. a 43-year-old female with a fractured rib
D. a 56-year-old male with a pelvic fracture

A

D.

Each fracture has a potential blood loss of one or more units per fracture site. Because of its rind shape th pelvis frequently has two or more fractures present. In addition, nerve and blood vessel damage and injury to genitourinary organ injuries can complicate the severity of this injury. Patients with pelvis fractures are always considered high priority patients and should be rapidly stabilized and transported. If a patient has bilateral femur fractures they are also a high priority patient.

14
Q

An unconscious patient who has one dilated pupil that is reactive to light is showing early signs of

A. transient ischemic attacks
B. cerebral artery aneurysm
C. status epilepticus
D. increased intracranial pressure

A

D.

A unilaterally dilated pupil may be an early sign of increased intracranial pressure. As swelling increases in the brain it puts pressure on the optic nerve that is located near the area of swelling.

15
Q

Your patient converses with you and answers most questions appropriately but is unsure of where she is or who you are even though you keep telling her your name. Her mental status is best described as

A. unresponsive or unconscious
B. responsive to painful stimuli
C. responsive to verbal stimuli
D. awake and alert

A

C.

The patient is responsive to verbal stimuli but is not alert because she is not oriented to her surroundings. This patient would be reported as V, when using the AVPU acronym:
A= Alert
V= Verbal
P= Painful
U= unresponsive
You could use the additional scale of AAO or CAO to further characterize her mental level. AAO stands Awake, Alert, and Oriented. CAO stands for Conscious, Alert, and Oriented. Both are medically acceptable terms. You then judge if the patient is oriented to person, place, time, and sometimes a 4th factor, event. You would report your finding as one of the following AAOx3, AAOx4, CAOx3 or CAOx4, depending on whether three or four factors were considered.

16
Q

You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.

Based on the mechanism described which of the following injuries would you expect to find?

A. calcaneus fracture
B. sternum fracture
C. clavicle fracture
D. humerus fracture

A

A.

Based on the mechanism of injury, you would expect the force of the energy from a feet first landing to travel up both legs, through the hips, and into the lower back. Any of the bones along this pathway may be fractured by the forces applied in this fall, including the calcaneus (heel).

17
Q

You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.

Because the victim first landed on his feet, the force of the fall might result in compression fractures of the

A. lumbar vertebrae
B. cervical vertebrae
C. thoracic vertebrae
D. coccyx vertebrae

A

A.

The lumbar spine is especially prone to compression fractures because it supports the entire weight of the upper body.

18
Q

You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.

After landing on his feet the patient then fell forward. Which of the following injuries would you expect from this part of the fall?

A. pelvis fracture
B. scapula fracture
C. rib fracture
D. wrist fracture

A

D.

As patients fall forward, they often brace against the landing by extending their arms, resulting in fractures or dislocation of the bones and joints of the upper extremities.

19
Q

You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.

Because this was a 25-foot fall, another possible life-threating injury you should suspect is:

A. hollow organ rupture
B. hemopneumothorax
C. aortic tear
D. splenic rupture

A

C. Although any of these injuries are technically possible with a fall more than three times greater than a patient’s height, the mechanism of injury described here suggests you should be particularly suspicious of an aortic tear. The impact from rapid vertical deceleration causes the heart to pull downward with such force that the aorta can shear off from the heart.

20
Q

You respond to a construction site to treat a 28-year-old male who fell approximately twenty-five feet from a scaffolding and landed feet first onto concrete.

Treatment for this patient should include:

A. micro-drip IV titrated to effect
B. morphine sulfate for pain
C. on-scene fracture management
D. ECG monitoring for dysrhythmia

A

D.

Because you cannot easily determine myocardial insult in the prehospital setting, ECG monitoring should occur for any trauma patient with significant mechanism of injury. The IV should be macrodrip in case you need to run it at a fast rate. Morphine use for pain control is indicated for single, isolated fractures and injuries but for this patient its use may mask (hide) pain and the resultant respiratory depression caused by the use of morphine may be very detrimental to this patient. This patient is also a candidate for rapid transport, so the long board should be used to splint long bone fractures until the patient is loaded for transport. Once transport is begun then splinting of fractures may be done, provided the crew is not managing a threat to the ABC’s.

21
Q

What does a positive tilt test suggest for a patient with acute abdominal pain?

A. The patient has appendicitis
B. The patient is hypovolemic
C. The patient has peritonitis
D. The patient is a diabetic

A

B

A positive tilt test in a patient with acute abdominal pain suggests that the patient is hypovolemic and may have impending shock.

22
Q

A patient with an acute abdomen who shows no signs of hemorrhage and has stable vital signs should be positioned

A. in whatever position is most comfortable for the patient
B. in supine position on a padded long backboard
C. in shock position with both lower legs elevated
D. sitting upright in a High Fowler’s position

A

A.

Medical patients who are stable should be in a position of comfort

23
Q

Forced examination of the abdomen of a patient who is complaining of abdominal pain should consist of :

A. percussion on the entire abdomen
B. auscultation of the area of discomfort
C. gentle palpation of the entire abdomen
D. repeated tests for rebound tenderness

A

C.

Use only gentle palpation in the field. Properly performed auscultation for bowel sounds takes several minutes and is of little value to your overall treatment regimen. Correctly performed percussion requires a relatively quiet environment and experienced hand to be of any diagnostic value. Continued assessment for rebound tenderness will aggravate the patient’s discomfort and is unnecessary once you have determined the patient has abdominal distress.

24
Q

Your patient is a 28-year-old diver who has been using scuba equipment. His diving partner states he was unconscious when he surfaced after a dive. You should suspect:

A. Type I decompression sickness
B. Type II decompression sickness
C. air embolism
D. pneumomediastinum

A

C.

Air embolism presents as neurological deficit (including unconsciousness) during or after ascent from a dive, or a sharp pain in the chest.

25
Q

Drug dosages are lower in elderly patients than in young adults primarily because elderly patients:

A. weigh less on average than younger patients
B. have a slower rate of elimination of drugs
C. forget they took their medication and overdose
D. do not respond to drugs as well as the young

A

B.

The dosage of many common medications is up to 50 percent lower in elderly adults primarily because of the decreased rate of elimination of the drug by the liver and kidneys.

26
Q

Which statement about the pain that accompanies a myocardial infarction is incorrect?

A. Patients often describe the pain as “crushing”
B. The pain is present only during exertion of stress
C. The pain is relieved by sublingual nitroglycerin
D. Pain due to AMI radiates like angina pain

A

C.

The pain of MI is not generally relieved by sublingual nitroglycerin and intravenous morphine or nitroglycerin is usually necessary. It may have all of the same characteristics of angina, making a diagnosis by EMS providers relatively difficult.

27
Q

Which set of vital signs is consistent with left heart failure?

A. BP 100/60, P 48 and regular, R 8 and shallow
B. BP 130/80, P 68 and irregular, R 14 and normal
C. BP 160/100, P 108 and irregular, R 26 and labored
D. BP 170/110, P 76 and irregular, R 22 and shallow

A

C.

A patient with left heart failure will present with elevated blood pressure, elevated and sometimes irregular pulse, and labored respirations

28
Q

Which of the following is an example of an open-ended question?

A. What kinds of things make you feel sad?
B. Do you feel sad or angry right now?
C. Do you want to go to the hospital today?
D. Would you like your wife to ride with us?

A

A.

Open-ended questions cannot be answered by a simple “yes” or “no”; such questions help keep lines of communication open.

29
Q

Which of the following signs or symptoms requires immediate corrective action in the prehospital setting?

A. decreased level of consciousness
B. night sweating in an AIDS patient
C. a pulse of 106 in a child
D. resting heart rate of 56 in an athlete

A

A. Decreased level of consciousness can cause airway compromise and is an early sign of many medical and trauma conditions, including decreased tissue perfusion.

30
Q

You are called to the home of an elderly female who is having difficulty breathing. She has a history of chronic congestive heart failure.

Which vital-sign pattern is most likely for this patient?

A. shallow rapid respirations, decreased pulse rate, cool clammy skin
B. deep labored respirations, decreased pulse rate, hot dry skin
C. shallow rapid respirations, increased pulse rate, cool clammy skin
D. increased respiratory rate, decreased pulse rate, flushed dry skin

A

C.

The vital signs given in this choice are most likely for a patient with CHF who is complaining of difficulty breathing.

31
Q

You are called to the home of an elderly female who is having difficulty breathing. She has a history of chronic congestive heart failure.

Which of the following are common medications associated with patients with chronic CHF?

A. thiamine, nitroglycerine, and albuterol
B. cortisone, digoxin, and theophylline
C. furosemide, calcium, and nitroglycerine
D. diuretics, potassium, and digoxin

A

D.

Diuretics, potassium, and digoxin are the common medications used to treat CHF.

32
Q

You are called to the home of an elderly female who is having difficulty breathing. She has a history of chronic congestive heart failure

You auscultate the patient’s chest. What lung sounds would you expect to hear from this patient?

A. basilar wheezes in all lung fields bilaterally
B. rales and/or rhonchi mainly in the lower lobes
C. clear but diminished sounds in the upper lobes
D. rubs with chest wall expansion in the bases

A

B.

The pulmonary edema associated with CHF commonly results in rales and/or rhonchi, especially in the lower lobes

33
Q

You are called to the home of an elderly female who is having difficulty breathing. She has a history of chronic congestive heart failure

Which of the following best describes the pathophysiology of CHF?

A. cardiac muscle failure resulting in pulmonary edema
B. aortic valve failure resulting in pulmonary edema
C. pneumonia resulting in pulmonary edema
D. superior vena cava failure resulting in pulmonary edema

A

A.

CHF results from the cardiac muscle’s inability to pump efficiently

34
Q

What I the purpose of performing the Sellick’s maneuver?

A. to visualize the upper airway structures during BVM
B. to prevent the tongue from blocking the airway
C. to protect a patient with possible spinal injury
D. to prevent vomiting during attempts at intubation

A

D.

Sellick’s maneuver is used to prevent patients from vomiting during intubation

35
Q

In order to maintain adequate oxygenation, any attempt to intubate a patient should last no longer than how many seconds?

A. 10
B. 15
C. 30
D. 45

A

C.

Tube placement should take no longer than 30 seconds; if it does, hyperventilate the patient again before the next attempt

36
Q

To ensure proper placement of the endotracheal tube, you should,

A. confirm placement of the tube by two different methods
B. suction the end of the tube and observe for vomitus or blood
C. check breath sounds in the chest before and after placement
D. visualize the open glottis and remove stylet before tube placement.

A

A.

To ensure proper placement, always confirm by two different methods; after watching the tube pass through the vocal cords, assess the chest for breath sounds in numerous locations and chest expansion, then check the proximal end of the tube for breath condensation. You may use one of several commercial confirmation devices that monitor end-tidal CO2 or provide an audible whistling sound to confirm air movement

37
Q

The digital intubation method is used for patients who

A. have short anterior cords
B. are very old or very young
C. have arthritis in the neck
D. have suspected spinal injury

A

D.

Because the digital method does not require hyper-extending the patient’s neck, it is used for patients with suspected spinal or cervical injury

38
Q

When should nasotracheal intubation not be attempted in a patient?

A. if the patient is very obese with a short fat neck
B. if you suspect the patient has a basilar skull fracture
C. if the patient has recently undergone oral surgery
D. if the patient is suspected of having a spinal injury

A

B.

Nasal intubation is not recommended in patients who have suspected nasal fracture, nasal obstruction, or basilar skull fracture as perforation through the area of fracture may result in introducing the tube directly into the brain tissue.

39
Q

When suctioning a patient, you should always

A. begin suctioning after the catheter is placed in the airway
B. limit suctioning attempts to no more than 45 seconds each
C. hyperventilate the patient after every three suction attempts
D. insert the catheter while the suctioning apparatus is turned on

A

A.

Attempts at suctioning should be limited to no more than 5-10 seconds (depending upon the level of consciousness). You should ventilate the patient after each attempt, and you should not turn on the apparatus until the catheter is placed properly. In the case of a suction catheter that has a hole in the system that allows you to control if suction is being applied or not upon withdrawal. This system may remain turned on at all times as long as you monitor closely when suction is actually being applied to the patient.

40
Q

Your patient exhibits cold, clammy skin, air hunger, distended neck veins tracheal displacement, and absent breath sounds on one side.
You should suspect:

A. tension pneumothorax
B. flail chest
C. massive hemothorax
D. pericardial tamponade

A

A.

The signs and symptoms of tension pneumothorax, the presence of air in the pleural space and medialstinal shifting, are listed.

41
Q

What are the signs of circulatory overload in a patient who is receiving IV fluids?

A. dyspnea, rales, and shonchi
B. agitation and clammy skin
C. falling blood pressure
D. Trauma Score lower than 10

A

A.

Dyspnea, rales, and rhonchi are classic signs of fluid overload which is usually first manifested as pulmonary edema.

42
Q

What is your first action for an adult patient who is conscious but who has a complete airway obstruction?

A. deliver rapid abdominal thrusts until cleared or unconsciousness results
B. use the jaw-thrust/chin lift technique to confirm the obstruction
C. pinch the patient’s nostrils and attempt to give two ventilations
D. ask the patient to lie down on the ground and attempt finger sweeps.

A

A.

For the conscious patient, your first action would b abdominal thrusts.

43
Q

What is the treatment for someone who is suffering an exacerbation of either emphysema or chronic bronchitis who is not too hypoxic?

A. transport this patient to the hospital rapidly, as there is little care that can be rendered for this condition
B. administer high-flow oxygen, establish an IV lifeline, place the patient on an EKG monitor, and administer bronchodilators
C. establish an airway, position the patient seated or semi-seated, administer low-flow oxygen, establish an IV lifeline, and transport
D. establish an airway, administer oxygen at the highest possible concentration, establish an IV lifeline, and transport rapidly.

A

C.

Low-flow oxygen is appropriate for this patient if he or she is not too hypoxic. If a patient with emphysema or chronic bronchitis it hypoxic, he or she needs more oxygen.

44
Q

What is the most commonly used drug in the prehospital setting for patients with asthma?

A. IV or IM corticosteroid
B. nebulized or SC epinephrine
C. inhaled or nebulized albuterol
D. IM or IV terbutaline

A

C.

Albuterol, a bronchodilator sold under the trade names Proventil and Ventolin, is frequently given via inhaler or nebulizer in the field.

45
Q

What is a recommended way to measure respiratory rate?

A. use a Wright Meter to determine peak expiratory flow rate
B. tell the patient to remain quiet while you count his or her respirations
C. carry on a conversation with the patient to distract him or her while you count
D. place your hand on the patient’s wrist as if you were measuring his or her pulse.

A

D.

Place your hand on the patient’s wrist as if you were measuring his or her pulse and count for 30 seconds. This will prevent the patient from consciously changing the respiratory rate. Placing the wrist and hand over the patient’s chest wall is called the pledge of allegiance method.

46
Q

You respond to a college fraternity where you encounter a 19-year-old male with a partially obstructed airway. According to witnesses, he was eating pizza and drinking beer when he began to cough and grab his throat. The patient is able to speak in a hoarse whisper only, and he has been coughing repeatedly for about 20 minutes.

A. What is the best treatment for this patient?
B. back blows and chest thrusts
C. urge him to continue coughing
D. obstruction removal with forceps

A

C.

AHA standards dictate that a conscious patient with a partial obstructed airway should be dealt with by encouraging coughing and continuous monitoring of patient status. Interventions like the Heimlich maneuver are considered counter-productive as they may actually worsen the obstruction.

47
Q

You respond to a college fraternity where you encounter a 19-year-old male with a partially obstructed airway. According to witnesses, he was eating pizza and drinking beer when he began to cough and grab his throat. The patient is able to speak in a hoarse whisper only, and he has been coughing repeatedly for about 20 minutes.

Should this patient suddenly become unable to cough or speak, treatment would then include:

A. abdominal thrusts without back blows
B. back blows and chest thrusts
C. urging him to continue coughing
D. obstruction removal with forceps

A

A.

AHA standards dictate that a conscious adult with airway obstruction should be given abdominal thrusts.

48
Q

You respond to a college fraternity where you encounter a 19-year-old male with a partially obstructed airway. According to witnesses, he was eating pizza and drinking beer when he began to cough and grab his throat. The patient is able to speak in a hoarse whisper only, and he has been coughing repeatedly for about 20 minutes.

Should this patient become unconscious, you should initially add which of the following treatments?

A. chest thrusts and back blows
B. back blows without chest thrusts
C. surgical crychothyriodotomy
D. laryngoscope and McGill forceps

A

D..

AHA standards do not include back blows for an adult chocking victim. Surgical intervention in the prehospital setting is not the first treatment and in many jurisdictions would require on-line consultation and medical direction. Laryngoscopy is your best choice.

49
Q

You respond to a college fraternity where you encounter a 19-year-old male with a partially obstructed airway. According to witnesses, he was eating pizza and drinking beer when he began to cough and grab his throat. The patient is able to speak in a hoarse whisper only, and he has been coughing repeatedly for about 20 minutes.

A. Should the obstruction be relieved and the patient become conscious, which of the following treatments should be performed?

A. encourage the patient to seek private medical attention without further delay
B. have the patient’s friends monitor him and, if necessary, drive him to the ER
C. utilize direct laryngoscopy to ensure that the airway is free of any debris
D. strongly urge transport of this patient to the emergency room for evaluation.

A

D.

Because portion of the obstruction may be retained, transport to an ER for chest X-rays and observation is essential.

50
Q

One breathing pattern is characterized by periods of apnea followed by periods in which respirations first increase then decrease in both depth and frequency. This pattern is called:

A. central neurogenic hyperventilation
B. apneustic respiration
C. Cheyne-Stokes breathing
D. diaphragmatic respiration

A

C.

Cheyne-Stokes respirations are characterized by periods of apnea lasting 10-60 seconds, followed by periods in which respirations gradually decrease, then increase, in depth and rate.

51
Q

What condition is the pathophysiological result of near drowning in sea water?

A. ventricular fibrillation
B. pulmonary edema
C. pulmonary embolism
D. metabolic alkalosis

A

B.

Because sea water is hypertonic, fluid is drawn from the blood stream into the alveoli, causing pulmonary edema. Because of this, all near drowning patients should be hospitalized and monitored for a short time.

52
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

What would account for the patient’s level of consciousness.
A. she has heat drug overdose resulting in unconsciousness.
B. she has heat stroke from the hot environment
C. she is suffering from carbon monoxide poisoning
D. she is suffering from carbon dioxide poisoning

A

C.

This victim of smoke inhalation is exhibiting the classic signs and symptoms of carbon monoxide poisoning.

53
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

Pulse oximetry reading should be scrutinized closely because elevated

A. carbon monoxide levels can cause an inaccurately high reading of the percentage of oxygen saturation
B. carbon monoxide levels can cause an inaccurately low reading of the percentage of oxygen saturation
C. carbon dioxide levels can cause an inaccurately high reading of the percentage of oxygen saturation
D. carbon dioxide levels can cause an inaccurately low reading of the percentage of oxygen saturation

A

A.

This is a common finding with the use of pulse oximetry in carbon monoxide poisoning. The CO molecule, which has a high affinity for hemoglobin, is bound to the molecule and is present for detection as “oxygen” in blood passing through the capillary beds resulting in fairly normal pulse oximetry readings. However, little if any of the oxygen is off-loaded from the hemoglobin molecule for use by the tissues.

54
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

Treatment for this type of toxic exposure should include which of the following?

A. nasal cannula (low-flow) oxygen
B. IV drip of sodium bicarbonate
C. transport to a hyperbaric facility
D. position of comfort transport

A

C.

If a hyperbaric chamber is available this patient should be transported there immediately for “diving”. Hyperbaric oxygen can dramatically improve outcomes for CO poisoning by reducing the time it takes for the CO molecule to unbinding from the hemoglobin molecule. Low flow oxygen and sodium bicarbonate are not indicated for carbon monoxide poisoning. The patient is unconscious, so position of comfort is not an issue. If you suspect the possibility of spinal injury you should immobilize this patient to the long back board.

55
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

Other signs of this type of exposure include all of the following except:

A. cyanotic skin
B. cherry-red skin
C. chest pain
D. hyperactivity

A

D.

Hyperactivity is not a sign of carbon monoxide exposure. Generally, patients are lethargic due to being hypoxic.

56
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

Which of the following is a common source of the toxin that is responsible for this patient’s condition?

A. engine exhaust
B. cellular respiration
C, cellular metabolism
D. well-ventilated space heater

A

A.

Engine exhaust is a common source of carbon monoxide. Improperly ventilated space heaters are another source. Cellular metabolism and cellular respiration result in the formation of carbon dioxide.

57
Q

You respond along with fire units to the scene of a structure fire. Firefighters have rescued a 25-year-old female who is unconscious and unresponsive to verbal or painful stimuli. The victim was located in a smoke-filled bedroom on the floor above the actual fire. A physical exam reveals cherry-red mucous membranes. Vital signs are: blood pressure 146/80: pulse 128, strong and regular; and respiratory rate is 40. The ECG monitor shows sinus tachycardia. Auscultation reveals generally clear lung sounds and mild expiratory wheezing, You note no burns injuries to the skin or clothing.

Which of the following best describes the difficulty the rescuer faces in reversing this patient’s condition?

A. Compared to oxygen, carbon monoxide has 200 times greater affinity for hemoglobin
B. Compared to oxygen, carbon dioxide has a 200 times greater affinity for hemoglobin
C. Carbon monoxide is weakly associated with hemoglobin and is difficult to remove from the blood
D. Carbon dioxide is weakly associated with hemoglobin and is difficult to remove from the blood.

A

A.

Choice a provides the reason it is so difficult to reverse carbon monoxide poisoning. As previously stated, carbon monoxide has a strong bond to hemoglobin that is difficult to break.

58
Q

Which of the following is a disease that is associated with cigarette smoking and is related to, but distinct from, emphysema?

A. Chronic bronchitis
B. Congestive heart failure
C. simple pneumothorax
D. hemopneumothorax

A

A

In addition to emphysema, chronic bronchitis is associated with cigarette smoking. Either condition can lead to CHF. A simple pneumothorax can be caused by cigarette smoking, especially in young and thin males, but the disease process is unrelated to emphysema.

59
Q

What is the primary drug for the management of acute anaphylaxis?

A. diphenhydramine HCL
B. methylprednisolone
C. Terbutaline
D. epinephrine

A

D

To manage acute anaphylaxis, epinephrine is the first medication used, followed by diphenhydramine. Epinephrine is a potent antihistamine and immediately reverses the physiological effects of the reaction (vasodilation, bronchoconstriction and airway swelling) while diphenhydramine slows and stops the reaction itself.

60
Q

You have just started an IV lifeline, but the fluid is not flowing properly. What is the first thing you should do to troubleshoot this situation?

A. remove the cannula and try another site.
B. make sure the constricting band has been removed
C. ensure that the right size drip-set is attached
D. lower the IV bag below the level of the patient’s arm

A

B.

Proper flow cannot be achieved if the constricting band (tourniquet) is not removed.

61
Q

Which of the following patients would benefit most from the application of the PASG/MAST?

A. 10-year-old male, suspected spinal fracture, no blood loss
B. 72-year-old female, suspected cardiogenic shock, no blood loss
C. 40-year-old male, suspected lower extremity fracture, low blood pressure
D. 67-year-old female, suspected ankle sprain, high blood pressure

A

C

Indications for use of the PASG are to control bleeding, stabilize fractures, and raise blood pressure. Although its use is currently controversial, of the choices listed, c has the indications called for if PASG is to be used.

62
Q

Care for the patient with cardiac contusion is similar to care for the patient with which of the following condition?

A. closed abdominal trauma
B. pericardial tamponade
C. tension pneumothorax
D. myocardial infarction

A

D

Patients with cardiac contusion can present with the symptoms of myocardial infarction, including life-threatening dysrhythmias. Care is similar to care of any cardiac patient.

63
Q

Which statement about use of Nitronox in the field is correct?

A. Nitronox is a short-acting agent that is administered via inhalation
B. Nitronox is used to manage pain in patients with COPD and asthma
C. Nitronox may be given to patients with acute abdominal distension
D. Nitronox may be safely used for patients with head injury

A

A.

Nitronox is a short-acting agent that the patient self-administers by mask. Its use is limited to patients who so not have the potential for having air filled spaces within their tissues, thus eliminating patients with COPD, pnuemothoracies, or air-filled abdominal organs.

64
Q

What does the Seldinger technique allow you to do?

A. calculate the amount of fluid replacement needed for shock patients
B. pass a large-gauge catheter into a peripheral vein by using a dilator
C. infuse fluids quickly using a pressure infuser placed at head level
D. palpate several veins simultaneously for possible catheter placement

A

B

The Seldinger technique uses a wire dilator to allow you to place a large catheter into a vein you have punctured with a small catheter.

65
Q

Which treatment for the care of a patient who is suffering from complications of dialysis is correct?

A. If possible, obtain a blood pressure reading on the arm on which the shunt is located.
B. Watch for narrow complex tachycardia to develop as the patient becomes hypoxic
C. Monitoring for dysrhythmias is frequently unnecessary in a hemodialysis patient.
D. To prevent exacerbation of the problem, start an IV only if ordered by medical control

A

D.

Fluid administration in dialysis patients should be under the direct authority of medical control. Dysrhythmias are common and it present, are generally caused by electrolyte imbalances. To prevent accidental damage to the shunt, a BP should never be assessed on the arm with the shunt.

66
Q

What is the leading cause of death in the elderly?

A. respiratory insufficiency
B. cerebral vascular accident
C. colon and skin cancer
D. cardiovascular disease

A

D

Cardiovascular disease is the leading cause of death in the elderly

67
Q

A single lead ECG tracing is useful for obtaining information about the heart. Which of the following can be determined from a single-lead ECG tracing?

A. mechanical response of ventricles
B. cardiac output and stroke volume
C. timing of electrical impulse travel
D. the presence of a myocardial infarct

A

C

A single-lead ECG, used for routine monitoring, can be used to determine the heart rate, regularity, and the length of time it takes for the impulse to travel through the heart. It tells you nothing about the mechanical response of the heart, of which stroke volume is a part. You need additional lead views to verify the presence of an MI.

68
Q

What does the actual drawing of the QRS complex on an ECG tracing show?

A. it shows you only ventricular repolarization
B. ventricular depolarization and atrial repolarization
C. ventricular repolarization and atrial depolarization
D. impulse travel through the atrioventricular junction

A

B

The QRS complex reflects the underlying ventricular depolarization and buried within it is the atrial repolarization

69
Q

A QRS complex is considered abnormal if it lasts longer than how many seconds?

A. 0.04 seconds
B. 0.08 seconds
C. 0.10 seconds
D. 0.12 seconds

A

D

The QRS complex normally lasts 0.04 to 0.12 seconds; anything longer than 0.12 seconds is considered to be abnormal

70
Q

What does the treatment for a patient whose ECG shows premature atrial contractions include?

A. observation only as long as the patient remains asymptomatic
B. vagal maneuvers and 6 mg adenosine rapid IV push over 1-3 seconds
C. 1-1.5mg/kg Lidocaine via slow IV push and consider sedation
D. immediate synchronized cardioversion with 50-100 joules

A

A

If the patient is asymptomatic, this arrhythmia requires observation only. Other treatments described are for patients with varying degrees of supraventricular tachycardia.

71
Q

What does the term bradycardia refer to?

A. a sinus origin heart rate > 60 beats per minute
B. a sinus origin heart rate > 150 beats per minutes
C. cardiogenic shock caused by congestive heart failure
D. a smaller than average heart size in an adult patient

A

A

Bradycardia refers to a sinus node origin heart rate slower than 60 beats per minute in a non-stressed adult patient.

72
Q

What is the clinical significance of a first-degree AV block?

A. it signals the onset of rapid cardiovascular decompensation?
B. it indicate that the heart rate may drop if action is not taken
C. it can lead to syncope and angina if not corrected quickly
D. it may foreshadow development of a more advanced dysrhythmia

A

D

First-degree AV block in itself calls for observation only; however, it may indicate the development of a more advanced heart block.

73
Q

Wolff-Parkinson-White (WPW) syndrome is characterized by which of the following wave form abnormalities?

A. QRS complex shorter than 0.12 seconds
B. short P-R interval and long QRS complex
C. lengthened and bizarre QRS complex
D. inverted P waves and normal QRS complex

A

B

Wolff-Parkinson-White, pre-excitation syndrome, is characterized by a short P-R interval and lengthened QRS complex. Often a delta wave is present as well. This condition occurs in 3 of 1000 individuals.

74
Q

In which situation would you consider having the patient perform a Valsalva maneuver to slow the heart rate?

A. male, age 34, paroxysmal junctional tachycardia
B. male, age 68, idioventricular escape rhythm
C. female, age 74, premature ventricular contraction
D. female, age 39, ventricular tachycardia

A

A

When PJT is caused by stress or excessive caffeine intake in a patient with no history of heart disease, the Valsalva maneuver can be successful at slowing the heart rate.

75
Q

Which rhythm is likely to foreshadow the development of other, more serious dysrhythmias?

A. atrial fibrillation
B. isolated premature atrial contractions
C. accelerated junctional rhythm
D. sinus dysrhythmia

A

C

Because the underlying cause is usually ischemia, accelerated junctional rhythm can deteriorate into more serious dysrhythmias.

76
Q

What does a prolonged sinus tachycardia accompanying an acute myocardial infarction suggests?

A. cardiogenic shock may develop
B. damage to the heart is minimal
C. hypervolemia is the underlying cause
D. the diagnosis of MI is incorrect

A

A

In a patient with acute MI, sinus tachycardia suggests that cardiogenic shock may develop.

77
Q

How should you position the patient to check for jugular vein distention?

A. lying flat on his or her back
B. sitting upright near 90 degrees
C. standing up in anatomical position
D. seated at a 45-degree angle

A

D

Check for jugular vein distension with the patient elevated at a 45-degree angle. Most patients will have observable jugular veins when supine.