Chs. 17-23 Review

A 45-year-old man with type 1 diabetes is found unresponsive. Which of the following questions is MOST important to ask his wife? A. "Did he take his insulin today?" B. "How long has he been a diabetic?" C. "Has he seen his physician recently?" D. "What kind of insulin does he take?"

Answer: A Rationale: All of these questions are important to ask the spouse of an unconscious diabetic. However, it is critical to ask if the patient took his insulin. This will help you differentiate hypoglycemic crisis from hyperglycemic crisis. For example, if the patient took his insulin and did not eat, or accidentally took too much insulin, you should suspect hypoglycemic crisis. If the patient did not take his insulin, you should suspect hyperglycemic crisis.

Which one of the following is NOT an appropriate treatment for EMTs to provide to a patient who has a hematologic disorder? A. Analgesics for pain B. Support of symptoms C. High-flow oxygen therapy at 12 to 15 L/min D. Rapid transport

Answer: A Rationale: Although analgesics would benefit a patient suffering from a hematologic disorder, the administration of such medications is not in the scope of practice for the EMT. ALS providers would have to be present to provide this emergency care.

The medical term for inflammation of the urinary bladder is: A. cystitis. B. nephritis. C. cholecystitis. D. diverticulitis.

Answer: A Rationale: Cystitis is the medical term for inflammation of the urinary bladder. Nephritis is inflammation of the kidney. Cholecystitis is inflammation of the gallbladder. Diverticulitis is a condition in which small pouches in the colon (large intestine) become inflamed.

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n): A. hemorrhagic stroke. B. acute ischemic stroke. C. severe migraine headache. D. transient ischemic attack.

Answer: A Rationale: Hemorrhagic strokes are typically preceded by a sudden, severe headache (signals the rupture of a cerebral artery), after which the patient becomes unresponsive due to bleeding within the brain. Ischemic strokes and transient ischemic attacks generally do not cause a sudden, severe headache, and migraine headaches typically do not cause a loss of consciousness.

If the cells do not receive glucose, they will begin to metabolize: A. fat. B. acid. C. sugar. D. ketones.

Answer: A Rationale: If the body's cells do not receive glucose, they will begin to metabolize the next most readily available substance—fat. Fat metabolism results in the production of ketoacids, which are released into the bloodstream (hence the term "ketoacidosis").

A 30-year-old male, who ingested an unknown substance, begins to vomit. You should: A. collect the vomitus and bring it to the hospital. B. apply a bag-valve mask. C. analyze the vomitus and try to identify the poison. D. suction his oropharynx for no longer than 30 seconds.

Answer: A Rationale: If the patient vomits, examine the contents for pill fragments. Ensure that you are wearing proper personal protective equipment for this activity. Note and document anything unusual that you see. You should try to collect the vomitus in a separate plastic bag so that it can be analyzed at the hospital.

A diabetic patient presents with a blood glucose level of 310 mg/dL and severe dehydration. The patient's dehydration is the result of: A. excretion of glucose and water from the kidneys. B. a deficiency of insulin that causes internal fluid loss. C. an infection that often accompanies hyperglycemia. D. an inability to produce energy because of insulin depletion.

Answer: A Rationale: In severe hyperglycemia, the kidneys excrete excess glucose from the body. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose, resulting in dehydration.

What is a wheal? A. A raised, swollen, well-defined area on the skin B. An area of localized swelling involving the lips, tongue, and larynx C. Generalized itching or burning that appears as multiple, small, raised areas on the skin D. An exaggerated immune response to any substance

Answer: A Rationale: Insect stings and bites can cause a wheal, which is a raised, swollen, well-defined area on the skin. There is no specific treatment for these injuries, although applying ice sometimes makes them less irritating.

A 34-year-old woman with a recent history of pelvic inflammatory disease presents with acute severe abdominal pain. Her abdomen is distended and diffusely tender to palpation. Based on your findings thus far, you should suspect: A. peritonitis. B. pancreatitis. C. appendicitis. D. cholecystitis.

Answer: A Rationale: Peritonitis—an inflammation of the thin membrane that lines the abdominal cavity—typically presents with acute abdominal pain. Causes of peritonitis include infection and blunt or penetrating abdominal trauma. The pain caused by peritonitis is typically diffuse (widespread), whereas appendicitis, pancreatitis, and cholecystitis (inflammation of the gallbladder) typically present with pain that is localized to a particular area.

Which of the following drugs is commonly used to facilitate sexual assault? A. Rohypnol B. Heroin C. Cocaine D. Marijuana

Answer: A Rationale: Rohypnol is a sedative that is used by criminals to facilitate sexual assault by depressing the victim's central nervous system.

Patients with diabetic ketoacidosis experience polydipsia because: A. they are dehydrated secondary to excessive urination. B. the cells of the body are starved due to a lack of glucose. C. fatty acids are being metabolized at the cellular level. D. hyperglycemia usually causes severe internal water loss.

Answer: A Rationale: Severe hyperglycemia—which leads to diabetic ketoacidosis—causes the body to excrete large amounts of glucose and water. As a result, the patient becomes severely dehydrated, which leads to excessive thirst (polydipsia).

A 70-year-old man presents with an acute onset of severe, tearing abdominal pain that radiates to his back. His BP is 88/66 mm Hg, pulse rate is 120 beats/min, and respirations are 26 breaths/min. Treatment for this patient should include: A. rapid transport to the hospital. B. firm palpation of the abdomen. C. placing him in a sitting position. D. oxygen at 4 L/min via nasal cannula.

Answer: A Rationale: Severe, tearing abdominal pain that radiates to the back is typical of an abdominal aortic aneurysm (AAA); it commonly occurs in older patients—especially those with hypertension. Treatment includes high-flow oxygen and rapid transport. If the patient has signs of shock, place him or her supine. Do not vigorously palpate the patient's abdomen; doing so may cause the aneurysm to rupture.

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: A. stridor. B. anxiety. C. cyanosis. D. wheezing.

Answer: A Rationale: Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling.

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score? A. 9 B. 8 C. 11 D. 12

Answer: A Rationale: The Glasgow Coma Scale gives a score of 3 to a patient who opens his or her eyes in response to speech. "Incomprehensible sounds" has a score of 2, and "withdraws to pain" has a score of 4. When added together, this patient's GCS score is 9.

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the: A. brain stem. B. hypothalamus. C. cerebrum. D. cerebellum.

Answer: A Rationale: The brain stem is responsible for functions such as breathing, blood pressure, and pupil constriction. Brain stem dysfunction would result in abnormal findings with these functions.

The mnemonic DUMBELS can be used to recall the signs and symptoms of a cholinergic drug poisoning. The "E" in DUMBELS stands for: A. emesis. B. erythema. C. ecchymosis. D. elevated blood pressure.

Answer: A Rationale: The mnemonic "DUMBELS," which can help you recall the signs and symptoms of cholinergic drug poisoning (ie, organophosphates), stands for excessive defecation, urination, miosis (pupillary constriction), bronchorrhea, emesis, lacrimation, and salivation.

Upon arrival at the residence of a young male with an apparent emotional crisis, a police officer tells you that the man is acting bizarrely. You find him sitting on his couch; he is conscious, but confused. He takes medications, but cannot remember why. His skin is pale and diaphoretic, and he has noticeable tremors to his hands. You should FIRST rule out (suspect): A. hypoglycemia. B. suicidal thoughts. C. severe depression. D. schizophrenia.

Answer: A Rationale: There are numerous physical problems that can cause bizarre behavior, such as hypoglycemia, hypoxemia, and brain tumors, among others. The EMT should rule out an underlying medical cause first. The patient's pallor, diaphoresis, and motor tremors suggest hypoglycemia. The EMT should assess the patient's blood glucose level, if trained to do so, and consider administering oral glucose. Psychiatric illnesses, such as clinical depression and schizophrenia, cannot be ruled in or out in the field.

Depression and schizophrenia are examples of: A. functional disorders. B. altered mental status. C. behavioral emergencies. D. organic brain syndrome.

Answer: A Rationale: Unlike an organic disorder, a functional disorder cannot be linked to any physical dysfunction or failure of an organ. Depression, schizophrenia, obsessive-compulsive disorder (OCD), and bipolar disorder are examples of functional disorders. They are usually caused by a chemical imbalance in the brain—not a structural or physical abnormality.

When physically restraining a violent patient, the EMT should: A. continually talk to the patient as he or she is being restrained. B. check circulation in all extremities only if the patient is prone. C. remove the restraints if the patient appears to be calming down. D. use additional force if the restrained patient begins to yell at the providers.

Answer: A Rationale: When physically restraining a violent patient, the EMT or his or her partner should continually talk to the patient throughout the process. Treat the patient with dignity and respect—regardless of the situation. Once restraints are placed, they should not be removed, even if the patient appears to be calm. Circulation in all extremities should be monitored, regardless of the position in which the patient is restrained.

A behavioral crisis is MOST accurately defined as: A. a severe, acute psychiatric condition in which the patient becomes violent and presents a safety threat to self or to others. B. any reaction to events that interferes with activities of daily living or has become unacceptable to the patient, family, or community. C. a normal response of a patient to a situation that causes an overwhelming amount of stress, such as the loss of a job or marital problems. D. a reaction to a stressful event that the patient feels is appropriate, but is considered inappropriate by the patient's family or the community.

Answer: B Rationale: A behavioral crisis is any reaction to events that interferes with the patient's activities of daily living or has become acceptable to the patient, his or her family, or the community. Not all patients with an emotional crisis are "psychotic," nor are all violent patients experiencing a psychiatric condition; these are common misconceptions. Various medical conditions can cause a behavioral crisis (eg, hypoglycemia, hypoxemia, brain tumors).

Most poisonings occur via the _________ route. A. injection B. ingestion C. inhalation D. absorption

Answer: B Rationale: Approximately 80% of all poisonings occur by ingestion.

You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still embedded in her skin. You should: A. leave the stingers in place. B. scrape the stingers from her skin. C. pull the stingers out with tweezers. D. cover the stings with tight dressings.

Answer: B Rationale: Because of the venom left in the sac located at the end of the stinger, you should not grab the stingers in an attempt to remove them. Instead, scrape them off with a rigid object such as a credit card.

What is the EMT's FIRST priority when dealing with a patient experiencing excessive vaginal bleeding? A. Determine the cause of the bleeding. B. Treat the patient for shock and transport. C. Determine if the bleeding is a result of sexual assault. D. Keep the patient warm and apply oxygen.

Answer: B Rationale: Determining the cause of the bleeding is less important than treating for shock and transporting the patient. EMTs can control the bleeding by using sanitary pads on the external genitalia. When treating for shock, the EMT must place the patient in the appropriate position, keep her warm, and apply oxygen.

The MOST important reason for promptly transporting a stroke patient to the hospital is: A. a transient ischemic attack can be ruled out. B. medications may be given to reverse the stroke. C. the clot in the coronary artery may be dissolved. D. he or she needs close blood pressure monitoring.

Answer: B Rationale: Fibrinolytic medications (clot busters) have been shown to reverse the symptoms of a stroke by dissolving the clot that is blocking the cerebral artery. However, for the patient to be eligible for this therapy, it must be initiated within 3 hours after the onset of symptoms. For this reason, prompt transport of the stroke patient is critical.

A 19-year-old diabetic male was found unresponsive on the couch by his roommate. After confirming that the patient is unresponsive, you should: A. suction his oropharynx. B. manually open his airway. C. administer high-flow oxygen. D. begin assisting his ventilations.

Answer: B Rationale: Immediately after determining that a patient is unresponsive, your first action should be to manually open his or her airway (eg, head tilt-chin lift, jaw-thrust). Use suction as needed to clear secretions from the patient's mouth. After manually opening the airway and ensuring it is clear of obstructions, insert a nasal airway adjunct and then assess the patient's breathing.

The onset of menstruation is called: A. menopause. B. menarche. C. ovulation. D. bleeding.

Answer: B Rationale: Menarche is the onset of menstruation, typically occurring between the ages of 11 and 16 years.

A 21-year-old male was found unconscious in an alley. Your initial assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. Further assessment reveals that his pupils are bilaterally constricted. His presentation is MOST consistent with an overdose of: A. cocaine. B. an opioid. C. a stimulant drug. D. methamphetamine.

Answer: B Rationale: Opioids are central nervous system depressant drugs; when taken in excess, they cause respiratory depression, bradycardia, and hypotension. Another common sign is miosis (constricted [pinpoint]) pupils. Cocaine, stimulant drugs (uppers), and methamphetamine have the opposite effect; they stimulate the central nervous system and cause tachycardia and hypertension.

Unlike an ischemic stroke, a transient ischemic attack is characterized by all of the following, EXCEPT: A. symptoms that resolve within 24 hours. B. symptoms that persist for longer than 24 hours. C. weakness or paralysis to one side of the body. D. an acute onset of confusion and slurred speech.

Answer: B Rationale: Signs and symptoms of a transient ischemic attack (TIA) are usually identical to those of an acute ischemic stroke (eg, hemiparesis, slurred speech, confusion, facial droop). Unlike the ischemic stroke, however, the symptoms of a TIA usually resolve within 24 hours.

Which of the following signs or symptoms would you be LEAST likely to find in a patient with an acute abdomen? A. Rapid, shallow breathing B. Soft, nondistended abdomen C. Tachycardia and restlessness D. Constipation or diarrhea

Answer: B Rationale: Signs and symptoms of an acute abdomen include, but are not limited to, rapid and shallow breathing, a tense and distended abdomen, tachycardia, restlessness, and constipation or diarrhea.

The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. A. 0.15, 0.3 B. 0.3, 0.15 C. 0.15, 0.5 D. 0.5, 0.2

Answer: B Rationale: The adult EpiPen system delivers 0.3 mg of epinephrine via an automatic needle and syringe system; the infant-child system delivers 0.15 mg.

What are the two main components of blood? A. Erythrocytes and hemoglobin B. Cells and plasma C. Leukocytes and white blood cells D. Platelets and neutrophils

Answer: B Rationale: The blood is made up of two main components: cells and plasma. The cells in the blood include red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. These cells are suspended in a straw-colored fluid called plasma.

Which combination of factors would MOST likely cause a hypoglycemic crisis in a diabetic patient? A. Eating a meal and taking insulin B. Skipping a meal and taking insulin C. Eating a meal and not taking insulin D. Skipping a meal and not taking insulin

Answer: B Rationale: The combination that would most likely cause a hypoglycemic crisis is skipping a meal and taking insulin. The patient will use up all available glucose in the bloodstream and become hypoglycemic. Left untreated, hypoglycemic crisis may cause permanent brain damage or even death.

What is the narrowest portion of the uterus? A. Vagina B. Cervix C. Fallopian tubes D. Ovaries

Answer: B Rationale: The ovaries are the primary female reproductive organ. The developing embryo travels into the uterus through the fallopian tube. The embryo attaches to the uterine wall and continues to grow. The narrowest portion of the uterus is the cervix, which opens into the vagina.

The ___________ lies in the retroperitoneal space. A. liver B. pancreas C. stomach D. small intestine

Answer: B Rationale: The pancreas, kidneys, and ovaries lie in the retroperitoneal space, which is behind the peritoneum, and are often the cause of acute abdominal pain. The liver, stomach, and small intestine are all found within the true (anterior) abdomen.

How much activated charcoal should you administer to a 55-pound child who swallowed a bottle of aspirin? A. 12.5 g B. 25 g C. 2 g/kg D. 50 g

Answer: B Rationale: The usual dose of activated charcoal for adults and children is 1 g of charcoal per kg of body weight. To convert a patient's weight from pounds to kilograms, simply divide the weight in pounds by 2.2. Therefore, a 55-pound child should receive 25 g of activated charcoal (55 [pounds] ÷ 2.2 = 25 [kg]). The average pediatric dosing range for activated charcoal is 12.5 to 25 g.

Type 1 diabetes is a condition in which: A. too much insulin is produced. B. glucose utilization is impaired. C. too much glucose enters the cell. D. the body does not produce glucose.

Answer: B Rationale: Type 1 diabetes is a disease in which the pancreas fails to produce enough insulin (or produces none at all). Insulin is a hormone that promotes the uptake of sugar from the bloodstream and into the cells. Without insulin, glucose utilization is impaired because it cannot enter the cell.

When administering epinephrine by auto-injector, the EMT should hold the injector in place for: A. 5 seconds. B. 10 seconds. C. 20 seconds. D. 30 seconds.

Answer: B Rationale: When administering epinephrine via auto-injector, push the injector firmly against the thigh until it activates. Hold the injector in place for 10 seconds to ensure that all the medication is injected.

Which of the following signs is LEAST indicative of a patient's potential for violence? A. The patient appears tense and "edgy." B. The patient is 6'5" tall and weighs 230 lb. C. The patient is loud and shouting obscenities. D. The patient is facing you with clenched fists.

Answer: B Rationale: When assessing a patient's potential for violence, you should observe for suggestive physical activity, such as clenching of the fists; glaring eyes; shouting obscenities; and rapid, disorganized speech. There is no correlation between a patient's physical size and his or her potential for violence.

General guidelines to follow when caring for a patient with a behavioral crisis include all of the following, EXCEPT: A. being honest and reassuring. B. rapidly transporting the patient. C. having a definite plan of action. D. avoiding arguing with the patient.

Answer: B Rationale: When caring for a patient with a behavioral crisis, the EMT must be prepared to spend extra time with the patient. It may take longer to assess and listen to the patient prior to transport.

When caring for a patient with a surface contact poisoning, it is important to remember to: A. prevent contamination of the patient. B. avoid contaminating yourself or others. C. let the hospital remove the surface poison. D. immediately flush dry chemicals with water.

Answer: B Response: Emergency care for a patient with a surface contact poisoning includes avoiding contaminating yourself and others and removing the irritating or corrosive substance from the patient as rapidly as possible. Dry chemicals must be brushed from the body prior to flushing with water.

After taking Vicodin for 2 years for chronic pain, a 40-year-old woman finds that her usual dosage is no longer effective and goes to the doctor to request a higher dosage. This is an example of: A. addiction. B. dependence. C. tolerance. D. drug abuse.

Answer: C Rationale: A person who takes a medication for a prolonged period of time often finds that higher doses of the medication are required to achieve the same effect. This is called tolerance.

If a hernia is incarcerated and the contents are so greatly compressed that circulation is compromised, the hernia is said to be: A. reducible. B. ruptured. C. strangulated. D. congenital.

Answer: C Rationale: A strangulated hernia occurs when a hernia is incarcerated and compressed by the surrounding tissues. It is a serious medical emergency and requires immediate surgery to repair the hernia, remove dead tissue, and return oxygen to the tissues. When the mass can be placed back into the body, it is considered reducible. Hernias are not at risk of rupturing. A congenital hernia is one that is present at birth and is usually present around the umbilicus.

The negative effects associated with anaphylactic shock are the result of: A. severe internal fluid loss. B. inadequate pumping of the heart. C. vasodilation and bronchoconstriction. D. the nervous system's release of adrenaline.

Answer: C Rationale: Anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases, anaphylaxis can rapidly result in death. One of the most common signs of anaphylaxis is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/bronchoconstriction and increased mucus production.

Food poisoning is almost always caused by eating food that contains: A. fungi. B. viruses. C. bacteria. D. protozoa.

Answer: C Rationale: Food poisoning is almost always caused by eating food that contains bacteria. Salmonella poisoning and botulism—two common forms of food poisoning—are both caused by bacteria.

When caring for a patient with an emotional crisis who is calm and not in need of immediate emergency care, your BEST course of action is to: A. advise the patient that he or she cannot refuse treatment. B. leave the patient with a trusted friend or family member. C. attempt to obtain consent from the patient to transport. D. apply soft restraints in case the patient becomes violent.

Answer: C Rationale: Just because a patient is experiencing an emotional crisis does not mean that he or she is "mentally incompetent" and cannot refuse EMS treatment and/or transport. You should attempt to obtain consent from any conscious patient unless he or she clearly does not have decision-making capacity (eg, underage, altered mental status, alcohol intoxication).

What breathing pattern would you MOST likely encounter in a patient with diabetic ketoacidosis (DKA)? A. Slow and shallow B. Shallow and irregular C. Rapid and deep D. Slow and irregular

Answer: C Rationale: Kussmaul respirations—a rapid and deep breathing pattern seen in patients with DKA—indicates that the body is attempting to eliminate ketones via the respiratory system. A fruity or acetone breath odor is usually present in patients with Kussmaul respirations.

What is the most common presenting sign of PID? A. Vomiting B. Vaginal discharge C. Lower abdominal pain D. Fever

Answer: C Rationale: Lower abdominal pain is the most common sign of pelvic inflammatory disease.

In which position do most patients with acute abdominal pain prefer to be transported? A. Sitting, with their head elevated 45° B. Supine, with their legs elevated 12 inches C. On their side, with their knees flexed D. Fowler's position, with their legs straight

Answer: C Rationale: Most patients with acute abdominal pain prefer to lie on their side with their knees flexed (and usually drawn up into their abdomen). This position takes pressure off the abdominal muscles and may afford them pain relief. The other positions do not allow the pressure to be relieved and may cause further discomfort.

Which of the following patients is at HIGHEST risk for suicide? A. A 24-year-old woman who is successfully being treated for depression B. A 29-year-old man who was recently promoted with a large pay increase C. A 33-year-old man who regularly consumes alcohol and purchased a gun D. A 45-year-old woman who recently found out her cancer is in full remission

Answer: C Rationale: Situations or indications that place a patient at high risk for suicide include, but are not limited to, recent diagnosis of a serious illness; financial setback; marital discord; death of a loved one; untreated psychiatric illness; recent acquisition of items that can cause death, such as a gun or knife; and chronic alcohol use.

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? A. Assist him in administering his epinephrine. B. Apply high-flow oxygen via nonrebreathing mask. C. Provide ventilatory assistance with a bag-valve mask. D. Elevate his legs and cover him with a warm blanket.

Answer: C Rationale: The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-valve mask. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.

You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): A. acute asthma attack. B. mild allergic reaction. C. anaphylactic reaction. D. moderate allergic reaction.

Answer: C Rationale: The patient's signs and symptoms indicate an anaphylactic reaction. Signs and symptoms of an anaphylactic reaction include difficulty breathing, urticaria (hives) over large parts of the body, and signs of shock (eg, tachycardia, hypotension). Certain foods, such as shellfish and nuts, may result in a relatively slow onset of symptoms, but the symptoms can become just as severe.

Which of the following are components of the Cincinnati Prehospital Stroke Scale? A. Arm drift, blood pressure, speech B. Speech, pupil response, arm drift C. Facial symmetry, speech, arm drift D. Pupil response, facial droop, speech

Answer: C Rationale: The three components of the Cincinnati Prehospital Stroke Scale are facial symmetry, speech, and arm drift. Both sides of the patient's face should move symmetrically (equally) when he or she smiles. The patient's speech should be easily understandable and without slurring. The patient should be able to hold both arms out in front of his or her body—with eyes closed and palms up—without one arm drifting down to his or her side.

What is the outermost cavity of a woman's reproductive system? A. Cervix B. Ovaries C. Vagina D. Uterus

Answer: C Rationale: The vagina is the outermost cavity of a woman's reproductive system.

If a patient complains of a severe migraine, how should she be transported? A. In a brightly lit ambulance so she can see while her vision is impaired B. With loud sirens so she can get to the hospital as soon as possible C. Without lights and sirens D. This patient should not be transported.

Answer: C Rationale: Treatment of a migraine headache is supportive; however, you should always assess the patient for other signs and symptoms that might indicate a more serious condition. Applying high-flow oxygen, if tolerated, may help ease the patient's condition. When possible, provide a darkened and quiet environment because patients are sensitive to light and sound. Do not use lights and sirens during transport.

You should discourage a rape or sexual assault victim from doing which of the following? A. Urinating B. Cleaning herself C. Changing clothes D. All of the above.

Answer: D Rationale: A victim of sexual assault or rape should be discouraged from showering, urinating, changing clothes, moving bowels, or rinsing out her mouth in order to preserve evidence.

A condition in which a person experiences a loss of appetite is called: A. ileus. B. colic. C. emesis. D. anorexia.

Answer: D Rationale: Anorexia is defined as a loss of appetite. It is a nonspecific symptom but is often associated with gastrointestinal diseases and abdominal pain. Ileus is the paralysis of the muscular contractions that normally propel material through the intestine. Colic is a severe, intermittent cramping pain. Emesis is the proper medical term for vomiting.

Which of the following questions is of LEAST pertinence for the EMT to ask a patient who intentionally overdosed on a medication? A. "How much do you weigh?" B. "How much did you ingest?" C. "What substance did you take?" D. "Why did you take the medication?"

Answer: D Rationale: Determining what the patient ingested, how much was ingested, and the patient's weight are all pertinent and have a direct impact on the care that is provided during the acute phase. Why the patient ingested the medication does not have a direct impact on acute care; therefore, it is the least pertinent question to ask.

Which of the following effects does drinking alcohol NOT produce? A. Induction of sleep B. Slowing of reflexes C. Inappropriate behavior D. Increased sense of awareness

Answer: D Rationale: Drinking alcohol (ethyl alcohol) is both a sedative (decreases activity and excitement) and a hypnotic (induces sleep). It dulls the sense of awareness, slows reflexes, and reduces reaction time. It may also cause aggressive or inappropriate behavior and lack of coordination.

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as: A. aphasia. B. dysphasia. C. dysphagia. D. dysarthria.

Answer: D Rationale: Dysarthria is defined as slurred, poorly articulated speech; it is common in stroke patients. Dysphasia is defined as difficulty speaking; the patient's speech may or may not be slurred. Aphasia is the inability to speak. Dysphagia is defined as difficulty swallowing.

The most common trigger of anaphylaxis is: A. plants. B. chemicals. C. medications. D. food.

Answer: D Rationale: Foods such as shellfish and peanuts are the most common triggers of anaphylaxis. These foods account for 30% of deaths from anaphylaxis, especially in adolescents and young adults.

A type of seizure that is characterized by severe twitching of all the body's muscles and lasts for several minutes or longer is called a(n): A. partial seizure. B. absence seizure. C. tonic-clonic seizure. D. generalized seizure.

Answer: D Rationale: Generalized seizures are characterized by generalized severe twitching of all of the body's muscles; they often last for several minutes or longer. An absence seizure is characterized by a blank stare; generalized muscle twitching is absent.

When dealing with hematologic disorders, the EMT must be familiar with the composition of blood. Which of the following is considered a hematologic disease? A. Sickle cell disease B. Hemophilia C. Lou Gehrig's disease D. Both A and B

Answer: D Rationale: Hematology is the study and prevention of blood-related diseases, such as sickle cell disease and hemophilia.

In contrast to a hyperglycemic crisis, a hypoglycemic crisis: A. rarely presents with seizures. B. presents over a period of hours to days. C. should not routinely be treated with glucose. D. usually responds immediately after treatment.

Answer: D Rationale: Hypoglycemic crisis usually responds immediately following treatment with glucose. Patients with hyperglycemic crisis generally respond to treatment gradually, within 6-12 hours following the appropriate treatment. Seizures can occur with both hyperglycemic crisis and hypoglycemic crisis, but are more common in patients with hypoglycemic crisis.

Reflective listening, an assessment technique used when caring for patients with an emotional crisis, involves: A. asking the patient to repeat his or her statements. B. simply listening to the patient, without speaking. C. asking the patient to repeat everything that you say. D. repeating, in question form, what the patient tells you.

Answer: D Rationale: Reflective listening—a technique in which you repeat, in question form, what the patient tells you—allows the patient to further expand on his or her thoughts; it also helps the EMT gain insight into the patient's situation.

The assessment of a patient with a hematologic disorder is the same as it is with all other patients an EMT will encounter. In addition to obtaining a SAMPLE history, EMTs should ask which of the following questions? A. Have you had a crisis before? B. When was the last time you had a crisis? C. How did your crisis resolve? D. All of the above.

Answer: D Rationale: SAMPLE is the mnemonic used in taking the history of all patients. In addition to asking the SAMPLE, EMTs should also ask about past crises.

MOST patients with an acute abdomen present with: A. dyspnea. B. diarrhea. C. hypotension. D. tachycardia.

Answer: D Rationale: Tachycardia (heart rate > 100 beats/min) is commonly seen in patients with an acute abdomen; it is usually the result of severe pain. Hypotension is not seen in all patients with an acute abdomen; if the patient is hypotensive, you should suspect internal bleeding or a severe infection (sepsis). Many patients with an acute abdomen have increased respirations (tachypnea); however, dyspnea (a feeling of shortness of breath) is not common.

A woman called EMS because her 12-year-old son, who had been experiencing excessive urination, thirst, and hunger for the past 36 hours, has an altered mental status and is breathing fast. You should be MOST suspicious for: A. low blood sugar. B. hypoglycemia. C. hypoglycemic crisis. D. hyperglycemic crisis.

Answer: D Rationale: The child is experiencing a hyperglycemic crisis secondary to severe hyperglycemia. Hyperglycemic crisis is characterized by a slow onset and excessive urination (polyuria), thirst (polydipsia), and hunger (polyphagia). Other signs include rapid, deep breathing with a fruity or acetone breath odor (Kussmaul respirations); a rapid, thready pulse; and an altered mental status.

Which of the following is NOT a solid organ? A. Liver B. Kidney C. Spleen D. Gallbladder

Answer: D Rationale: The gallbladder is a hollow organ that concentrates and stores bile, which is produced by the liver. Other hollow organs include the stomach and intestines. The liver, spleen, and kidney are all solid organs.

When assessing a patient with a behavioral crisis, your primary concern must be: A. allowing the patient to express himself or herself to you in his or her own words. B. setting your personal feelings aside and providing needed care. C. gathering the patient's belongings and taking them to the hospital. D. whether the patient will cause harm to you or your partner.

Answer: D Rationale: There are many things that you should be concerned with when assessing a patient with a behavioral crisis, including all of the items listed as answers to this question. Your primary concern, however, must be the safety of yourself and your partner.

An acute ischemic stroke is caused by: A. a ruptured cerebral artery. B. increased intracranial pressure. C. an acute rise in a person's blood pressure. D. a blocked cerebral artery.

Answer: D Rationale: There are two types of stroke—hemorrhagic and ischemic. A hemorrhagic stroke is caused by a ruptured cerebral artery (aneurysm), which causes bleeding within the brain and increased intracranial pressure. An ischemic stroke is caused by a blocked cerebral artery—either from a clot that grows locally (thrombus) or that travels to the brain from another part of the body (embolus).

When obtaining a SAMPLE history, which of the following pieces of information is important to obtain? A. Use of a birth control device or birth control pills B. The date of the patient's last menstrual period C. The possibility of pregnancy D. All of the above.

Answer: D Rationale: When obtaining a SAMPLE history, the EMT should inquire about the patient's medications. The EMT must ask about the use of birth control pills or birth control devices and ask specifically about the patient's last menstrual period. The EMT should also inquire about the possibility of sexually transmitted diseases and the possibility of pregnancy.

If fertilization has not occurred within about ___ days following ovulation, the lining of the uterus begins to separate and menstruation occurs. A. 8 B. 10 C. 12 D. 14

Answer: D Rationale: Women menstruate about 14 days following ovulation.

The signs and symptoms of an allergic reaction are caused by the release of: A. histamine. B. epinephrine. C. leukotrienes. D. both histamine and leukotrienes.

Answer: D Response: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenaline) is used to treat allergic reactions. Glucagon is a hormone secreted by the pancreas that helps control metabolism.

Which of the following can cause vaginal bleeding? A. Ectopic pregnancy B. Spontaneous abortion C. Trauma D. All of the above.

Answer: D Rationale: Ectopic pregnancy, spontaneous abortion, and trauma can cause vaginal bleeding and should not be overlooked.

A patient whose speech is slurred and difficult to understand is experiencing: Select one: A. aphasia. B. dysphagia. C. paraplegia. D. dysarthria.

Chapter 17, page 680, Stroke The correct answer is: dysarthria.

The left cerebral hemisphere controls: Select one: A. breathing and blood pressure. B. the right side of the face. C. the right side of the body. D. heart rate and pupil reaction.

Chapter 17, page 676, Anatomy and Physiology The correct answer is: the right side of the body.

Interruption of cerebral blood flow may result from all of the following, EXCEPT: Select one: A. a thrombus. B. an embolism. C. an acute arterial rupture. D. cerebral vasodilation.

Chapter 17, page 678, Stroke The correct answer is: cerebral vasodilation.

A patient with an altered mental status is: Select one: A. typically alert but is confused as to preceding events. B. not thinking clearly or is incapable of being aroused. C. usually able to be aroused with a painful stimulus. D. completely unresponsive to all forms of stimuli.

Chapter 17, page 685, Altered Mental Status The correct answer is: not thinking clearly or is incapable of being aroused.

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: Select one: A. is older than 60 years of age. B. has a GCS score that is less than 8. C. has bleeding within the brain. D. has had a prior heart attack.

Chapter 17, page 696, Emergency Medical Care The correct answer is: has bleeding within the brain.

During the primary assessment of a semiconscious 70-year-old female, you should: Select one: A. immediately determine the patient's blood glucose level. B. insert a nasopharyngeal airway and assist ventilations. C. ensure a patent airway and support ventilation as needed. D. ask family members if the patient has a history of stroke.

Chapter 17, pages 687-688, Patient Assessment The correct answer is: ensure a patent airway and support ventilation as needed.

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport? Select one: A. His wife states that this was his "usual" seizure B. He has experienced seizures since he was 20 C. His Glasgow Coma Scale (GCS) score is 15 D. He is currently not prescribed any medications

Chapter 17, pages 696-697, Emergency Medical Care The correct answer is: He is currently not prescribed any medications

Which of the following organs lies in the retroperitoneal space? Select one: A. Spleen B. Liver C. Pancreas D. Gallbladder

Chapter 18, page 705, Anatomy and Physiology The correct answer is: Pancreas

For a patient with a gastrointestinal complaint, it is MOST important for the EMT to _________. Select one: A. identify whether the patient requires rapid transport B. perform all interventions prior to transport C. determine the cause of the patient's complaint D. avoid transporting the patient if the condition is minor

Chapter 18, page 705, Introduction The correct answer is: identify whether the patient requires rapid transport

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain? Select one: A. Liver B. Pancreas C. Gallbladder D. Kidney

Chapter 18, page 709, Pathophysiology The correct answer is: Kidney

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale and she is tachycardic. The EMT should suspect: Select one: A. esophageal varices. B. Mallory-Weiss tear. C. esophagitis. D. acute pancreatitis.

Chapter 18, page 711, Pathophysiology The correct answer is: Mallory-Weiss tear.

A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should: Select one: A. request a paramedic unit to give the patient pain medication. B. administer oxygen and prepare for immediate transport. C. place the patient in a sitting position and transport at once. D. vigorously palpate the abdomen to establish pain severity.

Chapter 18, page 715, Patient Assessment The correct answer is: administer oxygen and prepare for immediate transport.

Most patients with abdominal pain prefer to: Select one: A. lie on their side with their knees drawn into the abdomen. B. lie in a supine position with their knees in a flexed position. C. sit in a semi-Fowler position with their knees slightly bent. D. sit fully upright because it helps relax the abdominal muscles.

Chapter 18, page 718, Patient Assessment The correct answer is: lie on their side with their knees drawn into the abdomen.

An important aspect in the treatment of a patient with severe abdominal pain is to: Select one: A. give 100% oxygen only if signs of shock are present. B. provide emotional support en route to the hospital. C. encourage the patient to remain in a supine position. D. administer analgesic medications to alleviate pain.

Chapter 18, page 718, Patient Assessment The correct answer is: provide emotional support en route to the hospital.

Excessive eating caused by cellular "hunger" is called: Select one: A. polyphagia. B. dysphasia. C. polydipsia. D. dyspepsia.

Chapter 19, page 731, Endocrine Emergencies The correct answer is: polyphagia.

A patient with an altered mental status; high blood glucose levels; and deep, rapid breathing may have a condition known as __________. Select one: A. hyperosmolar hyperglycemic nonketotic coma B. hypoglycemic crisis C. hyperglycemic crisis D. diabetic ketoacidosis

Chapter 19, page 732, Endocrine Emergencies The correct answer is: diabetic ketoacidosis

A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days' duration. Her blood glucose level reads 320 mg/dL. If this patient's condition is not promptly treated, she will MOST likely develop: Select one: A. acidosis and dehydration. B. irreversible renal failure. C. hypoxia and overhydration. D. severe insulin shock.

Chapter 19, page 733, Endocrine Emergencies The correct answer is: irreversible renal failure.

The EMT should assess for hypoglycemia in small children with a severe illness or injury because: Select one: A. children overproduce insulin during severe illness or injury. B. illness or injury causes the pancreas to produce less insulin. C. a child's cells do not uptake glucose as rapidly as adults' do. D. children cannot store excess glucose as effectively as adults.

Chapter 19, page 734, Endocrine Emergencies The correct answer is: children cannot store excess glucose as effectively as adults.

Classic signs and symptoms of hypoglycemia include: Select one: A. cool, clammy skin; weakness; tachycardia; and rapid respirations. B. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations. C. warm, dry skin; irritability; bradycardia; and rapid respirations. D. warm, dry skin; hunger; abdominal pain; and deep, slow respirations.

Chapter 19, page 734, Endocrine Emergencies The correct answer is: cool, clammy skin; weakness; tachycardia; and rapid respirations.

A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing: Select one: A. hypoglycemia. B. a heart attack. C. hyperglycemia. D. an acute stroke.

Chapter 19, page 735, Patient Assessment of Diabetes The correct answer is: a heart attack.

Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT: Select one: A. requesting permission from medical control. B. assessing the patient's mental status. C. ensuring the absence of a gag reflex. D. checking the medication's expiration date.

Chapter 19, pages 738-739, Emergency Medical Care for Diabetic Emergencies The correct answer is: ensuring the absence of a gag reflex.

The goal of invaders such as bacteria and viruses is to __________. Select one: A. use a human body as a home B. kill their human host C. cause an immune response D. spread disease and destruction

Chapter 20, page 753, Anatomy and Physiology The correct answer is: use a human body as a home

Urticaria is the medical term for: Select one: A. hives. B. a wheal. C. swelling. D. burning.

Chapter 20, page 753, Pathophysiology The correct answer is: hives.

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. Select one: A. quickly, within 30 minutes. B. quickly, within 30 seconds. C. slowly, over several hours. D. slowly, over more than 30 minutes.

Chapter 20, page 756, Common Allergens The correct answer is: quickly, within 30 minutes.

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction? Select one: A. The patient's general physical appearance B. The environment in which the patient is found C. The patient's family history D. The time of year in which the exposure occurred

Chapter 20, page 756, Patient Assessment of an Immunologic Emergency The correct answer is: The environment in which the patient is found

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction? Select one: A. Flushed, itching, or burning skin B. A sense of impending doom C. Tightness in the chest or throat D. All of these answers are correct.

Chapter 20, page 758, Patient Assessment of an Immunologic Emergency The correct answer is: Tightness in the chest or throat

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg. Select one: A. 0.1; 0.01 B. 0.3; 0.15 C. 0.03; 0.3 D. 0.01; 0.1

Chapter 20, page 761, Emergency Medical Care of Immunologic Emergencies The correct answer is: 0.3; 0.15

How do poisons typically act to harm the body? Select one: A. By causing burns and damage to either external or internal organs B. By changing the normal metabolism of cells or by destroying them C. By causing a slowing of nearly all bodily functions D. By interfering with normal neurologic function

Chapter 21, page 745, Identifying the Patient and the Poison The correct answer is: By changing the normal metabolism of cells or by destroying them

As you enter the residence of a patient who has possibly overdosed, you should: Select one: A. look for drug paraphernalia. B. be alert for personal hazards. C. quickly gain access to the patient. D. observe the scene for drug bottles.

Chapter 21, page 753, Patient Assessment The correct answer is: be alert for personal hazards.

Activated charcoal is given to patients who have ingested certain substances because it: Select one: A. is a direct antidote for many toxic substances. B. induces vomiting and empties the stomach. C. binds to the substance and prevents absorption. D. decreases absorption of poisons into the lungs.

Chapter 21, page 755, Emergency Medical Care The correct answer is: binds to the substance and prevents absorption.

A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing: Select one: A. addiction. B. dependence. C. withdrawal. D. tolerance.

Chapter 21, page 756, Specific Poisons The correct answer is: tolerance.

A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is MOST likely experiencing: Select one: A. acute hypovolemia. B. alcohol intoxication. C. delirium tremens. D. acute schizophrenia.

Chapter 21, page 758, Specific Poisons The correct answer is: delirium tremens.

Heroin is an example of a(n): Select one: A. hypnotic. B. opioid. C. cholinergic. D. sympathomimetic.

Chapter 21, page 758, Specific Poisons The correct answer is: opioid.

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause: Select one: A. kidney failure. B. liver failure. C. gastric ulcers. D. CNS depression.

Chapter 21, page 764, Specific Poisons The correct answer is: liver failure.

Why might EMTs encounter a larger proportion of violent patients than the population at large? Select one: A. EMTs respond to patients who, by definition, are having an emergency. B. EMTs respond with law enforcement. C. EMTs have to restrain patients. D. It is a common misperception; EMTs do NOT encounter a larger proportion of violent patients than the population at large.

Chapter 22, page 803, Myth and Reality The correct answer is: EMTs respond to patients who, by definition, are having an emergency.

Everyone exhibits some signs and symptoms of mental illness at some point in life ____________. Select one: A. and should be physically restrained for their own safety and the safety of the EMT B. because mental illness affects everyone C. and needs medication administered to control them D. but that does not mean a person is mentally ill

Chapter 22, page 803, Myth and Reality The correct answer is: but that does not mean a person is mentally ill

From a mental health standpoint, an abnormal or disturbing pattern of behavior is a matter of concern if it lasts for at least: Select one: A. 3 weeks. B. 1 week. C. 1 month. D. 2 weeks.

Chapter 22, page 804, Defining a Behavioral Crisis The correct answer is: 1 month.

A behavioral crisis interferes with which of the following? Select one: A. Activities of daily living B. Behavior that is acceptable to the community C. Dressing, eating, or bathing D. All of these answers are correct.

Chapter 22, page 804, Defining a Behavioral Crisis The correct answer is: All of these answers are correct.

A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a towel around his wrist and a moderate amount of blood has soaked through it. You should: Select one: A. calmly identify yourself to the patient. B. quickly tend to the bleeding wound. C. approach the patient with caution. D. tell the patient that you want to help.

Chapter 22, page 806, Safe Approach to a Behavioral Crisis The correct answer is: calmly identify yourself to the patient.

A general impression of the patient is formed by an EMT: Select one: A. speaking with family members or bystanders first. B. at a distance when the patient is first seen. C. speaking privately with the patient. D. when the patient is in the ambulance.

Chapter 22, page 807, Patient Assessment The correct answer is: at a distance when the patient is first seen.

Which of the following terms applies to a state of delusion in which the patient is out of touch with reality? Select one: A. Psychosis B. Suicidal C. Schizophrenia D. Agitated delirium

Chapter 22, page 810, Acute Psychosis The correct answer is: Psychosis

You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation? Select one: A. Encourage the patient to remain quiet during transport. B. Leave the scene and have a neighbor check in on her. C. Ask the patient if she has developed a suicidal plan. D. Have law enforcement place her in protective custody.

Chapter 22, page 817, Suicide The correct answer is: Ask the patient if she has developed a suicidal plan.

A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to: Select one: A. restrain the patient with appropriate force in order to treat his injuries. B. request that the police officers arrest him and take him to the hospital. C. try to gain the patient's trust by telling him that you see the vampires too. D. approach the patient and calm him by placing your hand on his shoulder.

Chapter 22, pages 811-812, Restraint The correct answer is: restrain the patient with appropriate force in order to treat his injuries.

You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient's potential for violence? Select one: A. His large body size B. His clenched fists C. The broken window D. His shouting of obscenities

Chapter 22, pages 815-816, The Potentially Violent Patient The correct answer is: His large body size

You are attending to a 32-year-old male patient. The patient's wife tells you that he returned from Afghanistan last year. While he initially seemed fine, lately he has become withdrawn and distanced himself from his family and friends. He does not talk about it, but she knows that he has been having terrible nightmares that wake him up. The most appropriate question to ask regarding his experience in Afghanistan is: Select one: A. Can you tell me about your experience? B. Have you ever been diagnosed with PTSD? C. Were you in combat? D. Were you shot at or under fire?

Chapter 22, pages 818-820, Posttraumatic Stress Disorder and Returning Combat Veterans The correct answer is: Were you shot at or under fire?

You are attending to a 27-year-old patient with a history of depression. The patient's family tells you that she has been openly talking about harming herself and suicide, and they got scared when she tried to overdose on some medications. The patient did not take the pills and is alert and oriented. Despite all of your best efforts to convince her, the patient refuses to go to hospital for treatment. Based on this information, you should: Select one: A. stay with the patient while you arrange for other transport options as a potentially life-threatening emergency exists. B. call for the police to attend the scene and, once they arrive, release responsibility for patient transport to them C. restrain the patient and transport her to the hospital as she represents a threat to her safety. D. ensure that the patient is competent and completes the required documentation, and leave her in the care of her family.

Chapter 22, pages 820-821, Medicolegal Considerations The correct answer is: ensure that the patient is competent and completes the required documentation, and leave her in the care of her family.

In anticipation of receiving a fertilized ovum, the lining of the uterine wall: Select one: A. diverts blood flow to the vagina. B. thins and begins to separate. C. becomes engorged with blood. D. sheds and is expelled externally.

Chapter 23, page 830, Anatomy and Physiology The correct answer is: becomes engorged with blood.

A patient with pelvic inflammatory disease will typically complain of _________. Select one: A. abdominal pain associated with menstruation B. nausea and vomiting associated with intercourse C. aches and fever associated with urination D. bleeding associated with stress

Chapter 23, page 831, Pathophysiology The correct answer is: abdominal pain associated with menstruation

Causes of vaginal bleeding include which of the following? Select one: A. Ectopic pregnancy B. Vaginal trauma C. Spontaneous abortion D. All of these answers are correct.

Chapter 23, page 832, Pathophysiology The correct answer is: All of these answers are correct.

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: Select one: A. may be relatively painless. B. can be controlled in the field. C. often presents with acute pain. D. is typically not as severe.

Chapter 23, page 832, Pathophysiology The correct answer is: may be relatively painless.

In cases of sexual assault, it is important to ensure that you do which of the following? Select one: A. Immediately write down your observations of the scene before assessing the patient. B. Call for a female EMT or ALS care provider. C. Discuss with law enforcement any suspicions that you may have about the perpetrator. D. All of these answers are correct.

Chapter 23, page 835, Patient Assessment The correct answer is: Call for a female EMT or ALS care provider.

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: Select one: A. assist her ventilations with a bag-valve mask, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport. B. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. C. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. D. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport.

Chapter 23, page 836, Emergency Medical Care The correct answer is: administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

During gynecologic emergencies, in addition to the standard SAMPLE questions, the EMT should attempt to determine which of the following? Select one: A. The amount of time since of the patent's last menstrual cycle B. The possibility that the patient may be pregnant C. If the patient is sexually active D. All of these answers are correct.

Chapter 23, pages 833-834, Patient Assessment The correct answer is: All of these answers are correct.

Signs of excited delirium include: Select one: A. slurred speech, bradycardia, and a high fever. B. diaphoresis, tachycardia, and hallucinations. C. subdued behavior, crying, and suicidal thoughts. D. pallor, hypotension, and constricted pupils.

The correct answer is: diaphoresis, tachycardia, and hallucinations.