Ch 37 Patients With Special Challenges

35. You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your most immediate action should be to: A) avoid placing him in a supine position if possible and administer oxygen. B) notify the receiving facility and advise them of the patient's weight and status. C) perform a secondary assessment, focusing on his respiratory system and back. D) ask a member of your team to locate the best route to move him to the ambulance.

ANS: A Complexity: Difficult Ahead: Bariatric Patients Subject: Chapter 37, Page 1403 Title: Patients With Special Challenges Feedback: See Bariatric Patients Taxonomy: Application Objective: 37-8 Explain the special patient care considerations required when providing emergency medical care to bariatric patients; include the best way to move bariatric patients.

54. EMTs are dispatched for a patient in cardiac arrest. When they arrive, they find that the patient is pulseless, apneic, and wearing an external defibrillator vest. In this situation, the EMTs should: A) perform CPR and leave the vest in place. B) quickly remove the vest and perform CPR. C) apply the AED pads over the vests' pads. D) wait 5 minutes prior to using the AED.

ANS: A Complexity: Difficult Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1409 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including an external defibrillator vest.

3. Patients with autism: A) have extreme difficulty with complex tasks that require many steps. B) prefer to maintain eye contact with whomever is talking with them. C) often speak with speech patterns that alternate in tone and speed. D) use and understand nonverbal means of communicating messages.

ANS: A Complexity: Easy Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

44. The tip of a central venous catheter rests in the: A) vena cava. B) left atrium. C) right ventricle. D) pulmonary vein.

ANS: A Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a central venous catheter.

50. A surgical procedure that creates an opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n): A) colostomy. B) gastrostomy. C) gastric stoma. D) intestinal shunt.

ANS: A Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1410 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a colostomy bag, ileostomy bag, or urostomy bag.

49. Vagus nerve stimulators may be an alternative treatment to medication for patients with: A) chronic seizure disorders. B) inherently slow heart rates. C) certain psychiatric conditions. D) chronic muscle pain and fatigue.

ANS: A Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1410 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a vagus nerve stimulator.

31. A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a: A) shunt. B) G-tube. C) CS tube. D) cerebral bypass.

ANS: A Complexity: Easy Ahead: Physical Disabilities Subject: Chapter 37, Page 1401 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

32. Which of the following does not usually contribute to or cause obesity? A) Rapid metabolism B) High caloric intake C) Low metabolic rate D) Genetic predisposition

ANS: A Complexity: Moderate Ahead: Bariatric Patients Subject: Chapter 37, Page 1402 Title: Patients With Special Challenges Feedback: See Bariatric Patients Taxonomy: Recall Objective: 37-7 Define obesity.

8. Airway management can be challenging in patients with Down syndrome because their: A) teeth are misaligned, and they have a large tongue. B) occiput is round, which causes flexion of the neck. C) tongue is relatively small and falls back in the throat. D) mandible is large, which inhibits a mask-to-face seal.

ANS: A Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Application Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

36. Because a tracheostomy tube bypasses the nose and mouth: A) secretions can build up in and around the tube. B) the risk of a local infection is significantly high. C) bleeding or air leakage might occur around the tube. D) severe swelling of the trachea and bronchi can occur.

ANS: A Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1403 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Analysis Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a tracheostomy tube.

42. In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker: A) regulates the patient's heart rate if it falls below a preset value. B) delivers a shock to the heart if the rate becomes exceedingly fast. C) is implanted under the skin in the left upper abdominal quadrant. D) will only activate if it detects rhythms such as ventricular fibrillation.

ANS: A Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including an internal cardiac pacemaker.

25. Cerebral palsy is a condition that results from damage or injury to the: A) brain. B) spinal cord. C) voluntary muscles. D) peripheral nervous system.

ANS: A Complexity: Moderate Ahead: Physical Disabilities Subject: Chapter 37, Page 1400 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

26. Which of the following statements regarding cerebral palsy is correct? A) Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy. B) Most cases of cerebral palsy develop within the first 10 years of life and are typically caused by meningitis. C) Approximately 25% of patients with cerebral palsy possess some varying degrees of developmental delay. D) A key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the patient to a ventilator.

ANS: A Complexity: Moderate Ahead: Physical Disabilities Subject: Chapter 37, Page 1400 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

20. When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to: A) report exactly what the patient signs and not to add any commentary. B) voice what he or she is signing while communicating with the patient. C) document the answers to the questions that the patient has responded to. D) avoid any kind of lip movement while he or she is signing with the patient.

ANS: A Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1397 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.

55. EMTs are dispatched for a patient whose central venous catheter is malfunctioning. When they arrive and assess the patient, they find bleeding from the tubing attached to the line. The EMTs should: A) carefully remove the catheter and transport. B) apply direct pressure to the tubing and transport. C) request an ALS ambulance to clamp the tubing. D) gently manipulate the catheter to reduce the bleeding.

ANS: B Complexity: Difficult Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a central venous catheter.

40. A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning, and the child has increasing respiratory distress. You should: A) attempt to troubleshoot the mechanical ventilator problem. B) disconnect the ventilator and apply a tracheostomy collar. C) place a call to the home health agency treating this patient. D) reset the ventilator by unplugging it for 30 to 60 seconds.

ANS: B Complexity: Difficult Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1405 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a mechanical ventilator.

21. By placing one hand on your head and the other hand over your abdomen, you are asking a hearing-impaired patient if he or she: A) is hurt. B) is sick. C) needs help. D) is nauseated.

ANS: B Complexity: Difficult Ahead: Sensory Disabilities Subject: Chapter 37, Page 1398 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.

1. Which of the following statements regarding patients with intellectual disabilities is correct? A) Speaking with the patient's family is the least effective way to determine how much the patient understands. B) Patients with intellectual disabilities are susceptible to the same disease processes as other patients. C) An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality. D) Most patients with intellectual disabilities have normal cognitive function but abnormal physical features.

ANS: B Complexity: Easy Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-1 Give examples of patients with special challenges EMTs may encounter during a medical emergency.

43. Under what circumstances is a left ventricular assist device used? A) To permanently replace the function of one or both of the ventricles B) As a bridge to heart transplantation while a donor heart is being located C) To reduce ventricular pumping force in patients with aortic aneurysms D) To ensure that the ventricles contract at an adequate and consistent rate

ANS: B Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a left ventricular assist device (LVAD).

29. Spina bifida is defined as: A) congenital inflammation of the spinal cord, usually in the neck. B) a birth defect caused by incomplete closure of the spinal column. C) a birth defect in which the child is born without spinal vertebrae. D) chronic pressure on the brain caused by excess cerebrospinal fluid.

ANS: B Complexity: Easy Ahead: Physical Disabilities Subject: Chapter 37, Page 1401 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

17. Which of the following would be the most practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located? A) Attempting to use body language to determine the problem B) Using a piece of paper and writing utensil to ask questions C) Using a high-pitched voice while speaking directly into the ear D) Contacting dispatch and requesting a sign language interpreter

ANS: B Complexity: Easy Ahead: Sensory Disabilities Subject: Chapter 37, Page 1397 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.

6. Characteristic anatomic features of Down syndrome include: A) a proportionately small tongue. B) a round head with a flat occiput. C) bulging eyes and a large face. D) long hands with wide fingers.

ANS: B Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

11. When assessing or providing care to a patient with an intellectual disability, you should: A) explain procedures while in the process of performing them. B) be observant for signs of fear or reluctance from the patient. C) move swiftly and deliberately to quickly accomplish the task. D) frequently reassure him or her that everything will be okay.

ANS: B Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

38. General care for a patient with a tracheostomy tube includes all of the following, except: A) ensuring adequate oxygenation and ventilation at all times. B) removing the tube if the area around it appears infected. C) suctioning the tube as needed to clear a thick mucous plug. D) maintaining the patient in a position of comfort when possible.

ANS: B Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a tracheostomy tube.

47. For which of the following conditions would you most likely encounter a ventricular peritoneum shunt? A) Epidural hematoma B) Hydrocephalus C) Cerebral palsy D) Subdural hematoma

ANS: B Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1410 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a ventricular peritoneal shunt.

28. When caring for patients with cerebral palsy, it is important to remember that: A) they cannot walk and are totally dependent upon you. B) their limbs are often underdeveloped and prone to injury. C) hearing aids are usually ineffective for patients with hearing loss. D) most patients can walk but have an unsteady gait.

ANS: B Complexity: Moderate Ahead: Physical Disabilities Subject: Chapter 37, Page 1401 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

30. Common associated conditions in patients with spina bifida include all of the following, except: A) hydrocephalus. B) spastic limb movement. C) extreme latex allergy. D) loss of bladder control.

ANS: B Complexity: Moderate Ahead: Physical Disabilities Subject: Chapter 37, Page 1401 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

53. According to the Emergency Medical Treatment and Active Labor Act (EMTALA): A) all healthcare facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured. B) all healthcare facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay. C) a healthcare facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical. D) a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.

ANS: B Complexity: Moderate Ahead: Poverty and Homelessness Subject: Chapter 37, Page 1412 Title: Patients With Special Challenges Feedback: See Poverty and Homelessness Taxonomy: Recall Objective: 37-13 Discuss the issues of poverty and homelessness in the United States, their negative effects on a person's health, and the role of EMTs as patient advocates.

16. In contrast to conductive hearing loss, sensorineural hearing loss is caused by: A) barotrauma. B) nerve damage. C) earwax accumulation. D) eardrum perforation.

ANS: B Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1397 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.

15. EMTs are dispatched for a fall. The patient, a 16-year-old female with Down syndrome, is experiencing difficulty walking and says that her fingers "feel like needles." The EMTs should suspect: A) a seizure. B) an intracranial hemorrhage. C) a cervical spine injury. D) hydrocephalus.

ANS: C Complexity: Difficult Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Analysis Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

37. According to the "E" in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube? A) Look for blood or other secretions in the tube. B) Attempt to pass a suction catheter into the tube. C) Check the mechanical ventilator for malfunction. D) Listen to breath sounds to assess for a pneumothorax.

ANS: C Complexity: Difficult Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a tracheostomy tube.

23. A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should: A) recognize that the batteries in his hearing aids are probably depleted. B) remove his hearing aids, turn up the volume, and replace them in his ears. C) try repositioning the hearing aid or remove it and turn down the volume. D) remove both of his hearing aids and use pencil and paper to communicate.

ANS: C Complexity: Difficult Ahead: Sensory Disabilities Subject: Chapter 37, Page 1400 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Application Objective: 37-5 Describe the various types of hearing aids worn by patients; include strategies to troubleshoot a hearing aid that is not working.

33. An obese person is ________ over ideal weight. A) 10% or more B) 15% or more C) 30% or more D) 50% or more

ANS: C Complexity: Easy Ahead: Bariatric Patients Subject: Chapter 37, Page 1402 Title: Patients With Special Challenges Feedback: See Bariatric Patients Taxonomy: Recall Objective: 37-7 Define obesity.

4. The rate of autism in the US population is about 1 in: A) 5. B) 27. C) 40. D) 100.

ANS: C Complexity: Easy Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

39. If suctioning of the tracheostomy tube is necessary, the EMT should: A) attach a bag-valve mask to the tracheostomy tube and hyperventilate the patient for 2 minutes. B) instill 20 mL of saline into the tracheostomy tube and suction for no longer than 20 seconds. C) attempt to use the patient's suction device first because it is probably already sized correctly. D) insert the suction catheter to a depth of no more than 15 cm and set the suction unit to 140 mm Hg.

ANS: C Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a tracheostomy tube.

46. Which of the following statements regarding gastrostomy (gastric) tubes is correct? A) Gastrostomy tubes are placed directly into the small intestine. B) Most gastrostomy tubes are temporary and are not sutured in place. C) Patients with a gastrostomy tube might still be at risk for aspiration. D) Gastrostomy tubes are used for patients who cannot digest food.

ANS: C Complexity: Easy Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1409 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a gastrostomy tube.

24. Cerebral palsy is characterized by poorly controlled ________ movement. A) eye B) neck C) body D) extremity

ANS: C Complexity: Easy Ahead: Physical Disabilities Subject: Chapter 37, Page 1400 Title: Patients With Special Challenges Feedback: See Physical Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

5. Down syndrome is a genetic defect that occurs as the result of: A) an extra pair of chromosomes. B) a separation of chromosome 21. C) a triplication of chromosome 21. D) a sperm that contains 24 chromosomes.

ANS: C Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

10. When interacting with an intellectually disabled patient, the best approach is to: A) speak primarily with the patient's family to establish the degree of disability. B) approach the patient as a team to reassure him or her that you are there to help. C) ask your team members to wait until you can establish a rapport with the patient. D) position yourself slightly above the patient's level to reduce his or her anxiety.

ANS: C Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

52. EMS personnel would most likely be called to the residence of a patient receiving home health care when the home care provider: A) needs simple assistance in providing patient care. B) must confirm that a specific intervention is required. C) has recognized a change in the patient's health status. D) has a question that is specific to the patient's condition.

ANS: C Complexity: Moderate Ahead: Home Care Subject: Chapter 37, Page 1411 Title: Patients With Special Challenges Feedback: See Home Care Taxonomy: Recall Objective: 37-10 Describe home care, the types of patients it serves, and the services it encompasses.

19. Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to: A) try basic sign language first. B) speak in a monotone voice. C) lower the pitch of your voice. D) increase the pitch of your voice.

ANS: C Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1398 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Application Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.

22. Which of the following statements regarding hearing aids is correct? A) Over time, hearing aids can restore normal hearing. B) In-the-canal hearing aids fit in the outer part of the ear. C) Hearing aids cannot restore hearing to normal levels. D) A whistling sound indicates correct hearing aid placement.

ANS: C Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1398 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-5 Describe the various types of hearing aids worn by patients; include strategies to troubleshoot a hearing aid that is not working.

9. You respond to a residence for a 9-year-old female with Down syndrome who is sick. When you arrive at the scene and assess the patient, you determine that she is unresponsive and has gurgling respirations. You should: A) insert an oropharyngeal airway and begin assisting her ventilations with a bag-valve mask. B) open her airway with the jaw-thrust maneuver and assess the rate and depth of her breathing. C) immediately apply high-flow oxygen via a nonrebreathing mask and then assess her pulse rate. D) open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

ANS: D Complexity: Difficult Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Application Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

41. You receive a call to a residence for an apneic 2-month-old male. When you arrive at the scene, the infant's mother tells you that her son was born prematurely and that his apnea monitor has alarmed four times in the past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98% on room air. You should: A) request an ALS ambulance to transport the infant to the hospital. B) advise the mother to observe her son and call 9-1-1 again if necessary. C) administer high-flow oxygen and observe for a drop in oxygen saturation. D) transport the infant to the hospital and bring the apnea monitor with you.

ANS: D Complexity: Difficult Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1404 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Application Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including an apnea monitor.

2. Autism is defined as a: A) psychiatric condition related to an imbalance of serotonin in the brain. B) mental disability caused by insufficient cognitive development of the brain. C) congenital condition caused by factors such as malnutrition or birth complications. D) pervasive developmental disorder characterized by impairment of social interaction.

ANS: D Complexity: Easy Ahead: Developmental Disability Subject: Chapter 37, Page 1394 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

13. A service dog is easily identified by its: A) size. B) breed. C) color. D) harness.

ANS: D Complexity: Easy Ahead: Sensory Disabilities Subject: Chapter 37, Page 1397 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-3 Describe the different types of visual impairments and the special patient care considerations required when providing emergency medical care for visually impaired patients, depending on the level of their disability.

34. When caring for a morbidly obese patient, you should: A) leave him or her in a supine position, as this often facilitates breathing. B) ask the patient if he or she knows what led to his or her obesity problem. C) call for ALS backup because obese patients are at high risk for heart attack. D) establish his or her chief complaint and then communicate your plan to help.

ANS: D Complexity: Moderate Ahead: Bariatric Patients Subject: Chapter 37, Pages 1402-1403 Title: Patients With Special Challenges Feedback: See Bariatric Patients Taxonomy: Recall Objective: 37-8 Explain the special patient care considerations required when providing emergency medical care to bariatric patients; include the best way to move bariatric patients.

7. As many as 40% of patients with Down syndrome have: A) diabetes mellitus. B) intracranial bleeding. C) unilateral paralysis. D) a heart condition.

ANS: D Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1395 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

12. An important aspect in the assessment of a patient who experienced a previous brain injury involves: A) presuming that he or she has cognitive impairment until proven otherwise. B) contacting the patient's physician to determine the extent of the brain injury. C) recalling that most patients with a brain injury have other organ dysfunction. D) speaking with the patient and family to establish what is considered normal for the patient.

ANS: D Complexity: Moderate Ahead: Developmental Disability Subject: Chapter 37, Page 1396 Title: Patients With Special Challenges Feedback: See Developmental Disability Taxonomy: Recall Objective: 37-2 Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries.

51. Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct? A) In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver. B) Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition. C) In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness. D) Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

ANS: D Complexity: Moderate Ahead: Patient Assessment Guidelines Subject: Chapter 37, Page 1411 Title: Patients With Special Challenges Feedback: See Patient Assessment Guidelines Taxonomy: Recall Objective: 37-10 Describe home care, the types of patients it serves, and the services it encompasses.

45. Common complications associated with central venous catheters include all of the following, except: A) a local infection. B) clotting of the line. C) bleeding around the line. D) rupture of a central vein.

ANS: D Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1407 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a central venous catheter.

48. The purpose of a ventricular peritoneum shunt is to: A) divert excess cerebrospinal fluid to the ventricles of the brain. B) monitor pressure within the skull in patients with a head injury. C) remove fluid from the abdomen of patients with right-sided heart failure. D) prevent excess cerebrospinal fluid from accumulating in the brain.

ANS: D Complexity: Moderate Ahead: Patients With Medical Technology Assistance Subject: Chapter 37, Page 1410 Title: Patients With Special Challenges Feedback: See Patients With Medical Technology Assistance Taxonomy: Recall Objective: 37-9 Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including a ventricular peritoneal shunt.

27. Which of the following conditions would most likely be encountered in a patient with cerebral palsy? A) Paralysis B) Brain tumors C) Type 2 diabetes D) Seizure disorder

ANS: D Complexity: Moderate Ahead: Physical Disabilities Subject: Chapter 37, Page 1401 Title: Patients With Special Challenges Feedback: See Physical 00Disabilities Taxonomy: Recall Objective: 37-6 Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis.

14. When caring for a patient who is visually impaired, it is important to: A) allow a service dog to remain with the patient at all times, even if the patient is critically ill. B) stand to the side of the patient when speaking if his or her peripheral vision is impaired. C) leave items such as canes and walkers at the residence if the patient will be carried on a gurney. D) tell him or her what is happening, identify noises, and describe the situation and surroundings.

ANS: D Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1396 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-3 Describe the different types of visual impairments and the special patient care considerations required when providing emergency medical care for visually impaired patients, depending on the level of their disability.

18. General techniques for communicating with hearing-impaired patients include: A) exaggerating your lip movements to ensure the patient understands. B) speaking directly into the patient's ear with an increased voice pitch. C) removing any hearing aids and using pen and paper to ask questions. D) positioning yourself approximately 18″ directly in front of the patient.

ANS: D Complexity: Moderate Ahead: Sensory Disabilities Subject: Chapter 37, Page 1397 Title: Patients With Special Challenges Feedback: See Sensory Disabilities Taxonomy: Recall Objective: 37-4 Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips for effective communication.