EMS Chapter 15
31) When in shock, the body has a slightly delayed compensation mechanism that utilizes: A) Hyperventilation B) Vasodilation C) Nerve stimulation D) The release of hormones
D
14) A patient has just gone into cardiac arrest. His heart is most likely in which rhythm? A) Ventricular fibrillation B) Ventricular asystole C) Ventricular tachycardia D) Ventricular PEA
A
49) You are transporting a patient in cardiac arrest. The AED is being used and a shock has been advised. Prior to administering the shock, what should you do? A) Ensure that no rescuer is touching the stretcher B) Move the patient from the metal stretcher to a nonmetal surface C) Withhold all shocks because metal will conduct the shock into the ambulance D) Stop the ambulance and have all rescuers exit prior to shocking the patient with the AED
A
59) Which of these condition(s) is (are) as the most probable cause of cardiogenic shock? A) Myocardial infarction B) Severe vomiting and diarrhea C) Gastrointestinal bleed D) Systemic infection
A
67) You are assessing an elderly patient with a decreased level of consciousness. Your assessment reveals the patient to have a patent airway, labored respirations, and weak, rapid pulses. The skin is pale, cool, and cyanotic in the extremities. You also observe diaphoresis and a delayed capillary refill. Vital signs for this patient are heart rate, 136 beats/min; blood pressure, 66/40 mmHg; and respirations, 40 and shallow. Auscultation of the lungs reveals profound rales located throughout each lung. The patient's temperature is 99°F and there is obvious jugular vein distention and pedal edema. Additionally, family states that the patient has an extensive cardiac and diabetic history. Based on this information, you should suspect which kind of shock? A) Cardiogenic B) Hypovolemic C) Hypotensive D) Obstructive
A
71) When performing the primary assessment, which sign or symptom best indicates that the patient is in hypovolemic shock? A) Cool and diaphoretic skin B) Radial pulse of 72 beats/min C) Crackles heard in both lungs D) Constricted pupils
A
8) The AED should never be applied to a patient who is not in cardiac arrest because some patients in: A) Ventricular tachycardia may still have a pulse B) Ventricular fibrillation may still be conscious and alert C) Ventricular fibrillation may still have a pulse D) Asystole may still have a pulse
A
80) Which of these remarks made by the patient best reinforces your suspicion that he is in the early stages of hypovolemic shock? A) "I have had diarrhea for the past four days." B) "I fell last night and think I hurt my belly; see the bruise?" C) "I must have fallen and hit my head. I am very confused and restless." D) "I have been coughing up green mucus and feel weak."
A
87) Which of these is most appropriate when two EMTs are performing CPR on an adult patient? A) At least 100 compressions per minute B) Airway reassessment after every 30 compressions C) Compression to ventilation rate of 15:2 D) Delivery of ventilations while compressions are being provided
A
9) Which of these is considered a benefit of the automated external defibrillator? A) The ease and speed with which it can be used B) Elimination of the need for a primary assessment C) Its ability to identify and confirm cardiac arrest D) The need for little-to-no CPR training to use the device
A
98) One of the benefits of utilizing an automated chest compression device is that: A) It frees up EMS providers to tend to other patient care tasks B) It provides a similar cardiac output as a spontaneously beating heart does C) It avoids the need to simultaneously ventilate the patient D) The survival rate when using automated chest compression devices is almost 90%
A
21) It is critical that the EMT never apply the AED to a person who is not in cardiac arrest because an accidental shock could: A) Cause the patient extreme pain B) Cause the beating heart to go into cardiac arrest C) Cause the patient to lose his eyesight D) Produce full-thickness burns and lead to a deadly infection
B
4) You have been asked to describe the American Heart Association's Chain of Survival to a group of Emergency Medical Responder students. Which of these is the best description of this concept? A) A sequence of care that provides instructions on how to use an AED B) A sequence of events that, if enacted quickly, gives the patient the best chance of surviving cardiac arrest C) A treatment plan that helps to prevent and treat cardiac arrest in the general population D) A treatment plan, that if followed, almost guarantees the survival of a patient with cardiac arrest
B
41) You have been assigned to a football game to provide standby coverage. While taking a break, you decide to walk to a nearby concession stand for a soft drink. On the way, you come across a group of people standing around a male patient who collapsed and is on the ground. Your assessment reveals him to be unresponsive, not breathing, and pulseless. A bystander states that the patient just collapsed moments ago. An AED is located less than 1 minute from your location. The nearest EMT is 5 minutes from your location. What should you do immediately? A) Start CPR and wait for the AED B) Retrieve the nearby AED C) Call for assistance and start CPR, continuing it until the other EMT arrives D) Perform manual in-line spinal stabilization
B
2) Resuscitation, when started during which phase of cardiac arrest, provides the patient with the best chance of survival? A) Circulatory B) Metabolic C) Electrical D) Bradycardic
C
22) If a cardiac arrest patient were in asystole, which message would the AED provide? A) "Shock advised" B) "Check electrodes" C) "No shock advised" D) "Press analyze
C
24) A 7-year-old boy choked on a grape at school. By the time the obstruction was removed, assessment revealed him to be in cardiac arrest. When you arrive, teachers are performing CPR. The school nurse informs you that CPR has been in progress for 6 minutes. You have an AED, but do not have a pediatric conversion device that reduces the energy of defibrillation from that of an adult to that of a child. What should you do immediately? A) Perform five abdominal thrusts and then 1 minute of CPR before using the AED B) Continue CPR and transfer the boy to the stretcher for immediate transport C) Place the adult AED electrodes on the boy's chest and follow the AED's prompts D) Instruct the teachers to continue CPR for 2 additional minutes before applying the AED
C
6) Which cardiac arrest rhythm is the AED designed to shock? A) Asystole B) Pulseless electrical activity C) Ventricular fibrillation D) Bradycardia
C
16) A 47-year-old patient has been in cardiac arrest for 6 minutes. While you set up the AED, you would direct your partner to: A) Perform CPR at a ratio of 30 ventilations to 2 compressions B) Assist you in making sure that the AED is ready for application C) Perform a primary and secondary assessment D) Perform CPR until the AED is ready
D
27) You have been dispatched to a residence for a male patient with a cardiac history who is complaining of chest pain. On scene, you find a 52-year-old man sitting in a chair. He is alert and oriented. He states that his chest pain feels like the last time he had a heart attack. He reports that in the hospital his heart stopped and the health care personnel had to shock him twice before it restarted. He is breathing adequately and has a strong radial pulse. Which of these actions would be appropriate in the assessment and/or management of this patient? A) Apply the AED to the patient but do not turn it on B) Provide positive pressure ventilation with high-concentration oxygen C) Open the patient's airway using the head-tilt, chin-lift maneuver D) Obtain the patient's heart rate, respiratory rate, and blood pressure
D
12) Why is defibrillation in the first few minutes of cardiac arrest so critical? A) If cardiac arrest is not treated within the first few minutes, ventricular fibrillation will convert to asystole, a nonshockable heart rhythm B) Research has shown that a heart in cardiac arrest will continue to pump blood for a few minutes before cardiac output drops to zero C) In the first few minutes of cardiac arrest, the blood pressure is still normal, but will drop quickly, making successful defibrillation less likely D) In the first few minutes of cardiac arrest, the heart is still warm, but it begins to cool rapidly, which makes it less receptive to a defibrillatory shock
A
19) Your service has a new AED. During the in-service program on the new device, the instructor informs you that it is a semi-automated AED and uses a biphasic wave form, as opposed to the monophasic form used by the previous AED. As a knowledgeable EMT, you should recognize that: A) The new AED will defibrillate the patient with smaller amounts of electrical energy B) The EMT will not need to press a "shock" button to shock the patient C) The new AED will defibrillate the patient with larger amounts of electrical energy D) Less energy but more shocks will be needed to treat cardiac arrest
A
28) You have arrived at the residence of a 66-year-old female patient who is in cardiac arrest. In the living room, you find Emergency Medical Responders performing CPR on the patient. They quickly report that they found the patient in cardiac arrest and have been doing CPR for 5 minutes. Which of these statements should you make at this time? A) "Let's stop CPR so I can check the airway, breathing, and circulation." B) "Let's stop CPR so I can put the electrodes of the AED on her chest." C) "Let's continue CPR for another 2 minutes, and then I will put the AED on." D) "Let's continue CPR while I talk with the family to see if they want us to continue."
A
3) A patient arrests at 1313 hours. E-911 is activated and dispatches an ambulance at 1315 hours. The ambulance arrives on scene at 1319 hours, and the EMTs reach the patient's side and start care at 1321 hours. After transporting the patient, the patient is transferred to the ED staff at 1346 hours. Based on that information, which of these statements would be considered correct? A) Down time is 8 minutes B) Total down time is 31 minutes C) Down time is 25 minutes D) Total down time is 6 minutes
A
30) Which of these unresponsive patients would the EMT recognize as in cardiac arrest? A) A female who has an occasional gasp for a breath but no palpable carotid pulse B) A male with a heart rate of 16 beats/min and agonal respirations C) A female who is not breathing and has a heart rate of 24 beats/min D) A male with an absent radial pulse but breathing 20 times per minute
A
32) You have just applied the AED to a female patient in cardiac arrest and the machine is ready to analyze the heart rhythm. Which of these instructions is appropriate to give at this time? A) "Stop CPR and clear the patient." B) "Stop chest compressions but continue ventilation." C) "Continue CPR until we see if a shock is advised." D) "Stop CPR but continue to check for a pulse."
A
38) When should the EMT transport the patient with cardiac arrest? A) After three "no shock advised" messages are received B) Immediately upon determining that the patient is in cardiac arrest C) After one shock has been delivered and the patient remains in cardiac arrest D) Before delivering the first shock when a "shock advised" message is received
A
43) A patient in cardiac arrest has regained a pulse after two shocks, but is still apneic. Which action would be appropriate next? A) Transport the patient supine and secured to a long spine board as treatment is continued B) Remove the AED once it is determined that a pulse has returned and initiate transport C) Reanalyze the patient's heart rhythm with the AED every 5 minutes D) Cancel the ALS assistance request and proceed directly to the hospital
A
5) When presenting information on cardiac arrest and automated external defibrillation to a community group, a man asks why people should perform CPR prior to the arrival of EMS if the EMS responders will provide a shock after they arrive. Your response would be: A) "Immediate CPR can prolong the period in which the heart can be successfully shocked into a perfusing rhythm following cardiac arrest." B) "In many cases, CPR can reverse the cardiac arrest, making a shock by the AED unnecessary since the shock may further damage the heart." C) "In the American Heart Association's Chain of Survival, CPR is the most important link in surviving cardiac arrest that occurs outside the hospital." D) "CPR is needed to keep blood flowing through the body so the EMTs can give the patient IV medications when they arrive."
A
52) You are instructing a first-aid class at a local chemical plant. The course includes instruction regarding an AED that is to be placed in the plant. Which point would you emphasize to the employees to help them avoid the most common cause of AED failure? A) "The batteries must be checked regularly." B) "An extra set of electrodes should be kept in the AED." C) "The AED should be kept clean and undamaged." D) "Always check the electrode wires for cracks."
A
66) You are treating a patient with severe crushing chest pain. She has had two heart attacks in the past, and you believe that she is currently in cardiogenic shock. Blood pressure is 86/66 mmHg, respirations are 20 breaths/min, heart rate is 102 beats/min, and room-air pulse oximetry reading is 91%. Which intervention is the most appropriate next action in this case? A) Supplemental oxygen B) Application of the AED C) Administration of nitroglycerin D) Rapid transport with the patient supine
A
72) A patient fell 20 feet from a ladder, and is now confused and anxious. Which of these signs/symptoms suggests that the patient is in shock? A) Heart rate of 110 beats/min B) Deformity to the left arm C) Contusion to his head D) Constricted pupils
A
83) A 44-year-old male patient has been shot in the abdomen. Which assessment findings would lead you to believe that the patient is in compensated shock? A) Alert and anxious, pulse 102, BP 114/88 mmHg, pale and cool skin B) Slightly confused, pulse 116, BP 102/56 mmHg, warm skin that is flushed C) Confused and anxious, pulse 144, BP 82/palpation, cool skin that is mottled D) Confused, pulse 44, BP 110/68 mmHg, cool and cyanotic skin
A
85) At a continuing education seminar on shock, the presenter asks if there is a point where someone cannot recover from shock. Which statement made by an EMT is correct? A) "Even with treatment, if shock has reached the final stage when multiple organs start to fail, death will result." B) "If the pupils are dilated and pulse is rapid, the patient cannot recover." C) "The patient probably cannot recover if the radial pulse is weak, even if the carotid pulse remains strong." D) "To survive severe shock, the patient needs a large amount of IV fluids immediately or a blood transfusion at the hospital."
A
91) You are preparing to attach an AED when you notice that the patient has an implanted pacemaker. What should you do? A) Apply the AED, but avoid placing the electrodes over the pacemaker B) Call for ALS backup with a manual defibrillator C) Forego the AED and transport the patient immediately while continuing CPR D) Call medical command and request permission to perform a precordial thump
A
94) You arrive on the scene of an "unknown medical emergency." The local fire department EMRs arrive simultaneously, so you now have five providers at the scene to help. The on-scene police officer tells you the patient is an elderly man who has attempted suicide by shooting himself in the head. As you enter the patient's room, you see the male patient with an extensive skull injury. A large portion of his right temporal and parietal skull is gone, and there are blood splatter and brain tissue on the wall behind him. Given this information, what should you do? A) Withhold resuscitation B) Start CPR, since you have ample help to treat and transport the patient C) Do nothing until you get advice from online medical direction D) Start BLS care, but withhold ALS care
A
1) Immediately following the onset of cardiac arrest, brain cells begin to die after: A) 1 minute B) 5 minutes C) 10 minutes D) 15 minutes
B
13) Which of these statements about the heart rhythm of ventricular fibrillation is true? A) Ventricular fibrillation occurs when the heart rate is so slow and weak that a pulse cannot be felt B) When a patient's heart is in ventricular fibrillation, it is unable to pump blood throughout the body C) The most effective treatment for converting ventricular fibrillation to a normal heart rhythm is CPR D) The AED is designed to identify ventricular tachycardia and give a "no shock advised" message when it is present
B
17) Because of a shortage of paramedics at your ambulance service, it has been announced that there will be AEDs placed on every ambulance for use by EMT crews. Which of these statements indicates an understanding of how this policy will affect the EMTs? A) "Cardiopulmonary resuscitation will no longer be needed." B) "The AED will let us know whether to shock the patient." C) "EMTs will now be able to shock all patients in cardiac arrest." D) "EMTs will have to learn how to interpret ECG tracings."
B
18) Which of these statements about the AED and its use in the treatment of cardiac arrest is true? A) AEDs have simplified the treatment of cardiac arrest to the point where the EMT does not have to be worried about inappropriately shocking a patient B) Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator C) To use an AED, the EMT must be able to identify some basic cardiac arrest heart rhythms so that he or she can tell the AED to shock or not shock the patient D) The AED is advantageous in that it will determine if a patient is in cardiac arrest and whether or not to shock the patient
B
25) You have arrived at a residence where a 4-month-old baby was found in his crib in cardiac arrest. Emergency Medical Responders have been on scene for 5 minutes prior to arrival. They began CPR immediately on reaching the patient's side. You have an AED with adult pads with you, but not pediatric pads. After rechecking and confirming that the patient is in cardiac arrest, you would: A) Continue CPR and transfer the patient to the stretcher for transport B) Place the AED on the patient and follow all prompts C) Continue CPR for 2 more minutes before placing the AED on the patient D) Discuss with the parents whether they want to proceed with use of the AED
B
26) An unrestrained 37-year-old female patient is in cardiac arrest after her vehicle struck a tree head-on at a high rate of speed. Assessment reveals that the patient suffered massive blunt trauma to the chest and abdomen. The patient is quickly extricated from the vehicle and placed in a supine position on the ground. It is estimated that the patient has been in cardiac arrest for approximately 10 minutes, during which time CPR was not performed. At this time, the EMT would: A) Withhold CPR and perform a focused trauma assessment B) Perform CPR and contact medical command for permission to use the AED C) Administer CPR for 2 minutes prior to applying the AED D) Apply electrodes to the patient's chest and follow the AED's instructions
B
34) The AED has just been applied to a female patient in cardiac arrest. After analyzing the heart rhythm, it provides a "no shock advised" message. The EMT should immediately: A) Reanalyze the patient's heart rhythm B) Resume cardiopulmonary resuscitation C) Check the electrodes for proper placement D) Check the patient for a pulse and blood pressure
B
35) After you applied the AED to a patient in cardiac arrest, it delivered a shock. Immediately after the shock, what should you do next? A) Check the patient for a pulse and reanalyze the rhythm if no pulse is present B) Provide 2 minutes of CPR, and then check the patient for a pulse C) Check the patient for a pulse and start CPR if no pulse can be located D) Provide five cycles of single-rescuer CPR with a ratio of 15 compressions to 2 ventilations
B
36) Which of these statements made by your EMT partner regarding care for the adult patient in cardiac arrest is accurate? A) "It is important to always check for a pulse immediately after the AED has delivered a shock." B) "When using an AED, the machine should be turned on before applying the electrodes." C) "When checking for a patient's pulse, the EMT should take no more than 5 seconds." D) "If two EMTs are performing CPR, a ratio of 15 compressions to 2 ventilations can be used."
B
44) You are transporting an unresponsive 31-year-old female patient who suffered cardiac arrest. On scene, Emergency Medical Responders (EMRs) shocked the patient once with the AED and she regained a pulse. She remains unresponsive and has shallow respirations. Ventilation is being provided with a bag-valve mask. An EMR has agreed to ride to the hospital with you to provide assistance in caring for the patient. Which set of instructions given to the EMR next is most appropriate? A) "Place the patient in semi-Fowler's position so her airway is clear if she vomits." B) "Leave the AED on the patient, even though she is breathing and has a pulse." C) "Please check the patient's breathing and pulse every 5 minutes." D) "Place the patient on a nonrebreather mask with 15 liters per minute of oxygen."
B
53) The EMT realizes that the best means of preventing failure of the AED is to: A) Make sure that the AED is kept clean and free of damage B) Check the AED battery and its supplies at the beginning of each shift C) Check the electrodes monthly and replace them when expired D) Obtain a second set of batteries when the original set is no longer functional
B
58) A patient with a severe gastrointestinal bleeding is in shock. Which ALS or hospital interventions would best correct the patient's underlying problem? A) Intravenous fluids B) Blood replacement C) High-concentration oxygen via endotracheal tube D) Replacement of lost electrolytes by intravenous infusion
B
62) Which statement made by a patient's family member would cause the EMT to suspect that a patient is experiencing hypovolemic shock? A) "He has had a rash for the past three days." B) "He cannot stop throwing up." C) "He has been taking an antibiotic for a chest cold." D) "He got up this morning and was having a hard time breathing."
B
65) A patient in shock with abdominal pain indicates he noticed a lot of blood in the toilet after having a bowel movement this morning. The EMT should suspect which type of shock? A) Septic hypovolemic B) Hemorrhagic hypovolemic C) Hypoxic hypovolemic D) Nonhemorrhagic hypovolemic
B
76) A driver was ejected from his vehicle in a rollover-type collision. Assessment findings reveal the patient to be unresponsive, with bruising to the abdominal and pelvic areas as well as an open femur fracture. The patient has an open airway and is breathing 32 times per minute. When you listen to breath sounds, you find them to be absent over the alveolar areas of the lungs. The patient's skin is cool and clammy and the radial pulses weak. Manual spine motion restriction is being maintained. What should your next intervention be? A) Obtain a blood pressure B) Assist respirations C) Examine the fracture site D) Apply a cervical collar
B
78) While cleaning a gun, a 44-year-old patient accidentally shot himself in the abdomen. On arrival, you observe the patient on the floor lying on his side, with his legs drawn to his chest. His blood pressure and pulse oximetry reading are low, and his heart rate and respirations are high. Blood is evident on his shirt and pants. Which of these indicates the correct sequence of events when caring for this patient? A) Perform primary and secondary assessments, move the patient to the stretcher for immediate transport, start positive pressure ventilation en route to the hospital B) Perform the primary assessment, administer supplemental oxygen, perform a rapid secondary assessment, transfer the patient to the stretcher, provide rapid transport C) Transfer the patient to the ambulance, provide rapid transport, perform the primary assessment and oxygen therapy en route to the hospital D) Transfer the patient to the ambulance, perform the primary assessment and rapid secondary assessment, provide oxygen therapy, provide rapid transport
B
84) You are reassessing a young female who sustained blunt trauma to the chest in a motor vehicle collision. Which of these assessment findings best indicates that she is deteriorating and in the decompensatory phase of shock? A) Heart rate of 100 beats/min B) Blood pressure of 88/50 mmHg C) Blood continuing to ooze from an abdominal laceration D) Restless and confused mental status
B
89) You are by the side of an unresponsive 6-month-old child with a history of congenital heart disease. The patient's airway is patent, but he is not breathing. A heart rate of 24 beats/min is noted. At this time, it is essential that you: A) Apply the AED with pediatric pads B) Start cardiopulmonary resuscitation with compressions and ventilations C) Start positive pressure ventilation with high-concentration oxygen D) Place the patient on the stretcher for immediate and emergent transport
B
90) You are dispatched to a residence for an 82-year-old female who is not breathing. On arrival, the husband directs you to a second-floor bedroom. As you make patient contact, you note that she is rigored. What should your next step be? A) Start CPR B) Withhold CPR and contact medical command C) Start positive pressure ventilation with high-concentration oxygen D) Place the patient on the stretcher for immediate and emergent transport
B
96) What is the primary difference between the 2015 American Heart Association's "Chain of Survival" for the adult patient versus the pediatric patient? A) The adult chain allows the use of the AED, whereas use of this device is discouraged in the pediatric chain B) The pediatric chain emphasizes strategies for arrest prevention C) The pediatric chain emphasizes ALS treatment as the first link D) The adult chain includes a 30:2 compression/ventilation ratio, whereas the pediatric chain uses a 15:1 compression/ventilation ratio
B
open, and he is adequately breathing, 22 times per minute, with a pulse oximetry reading of 90%. He has a radial pulse of 92 beats/min, which is moderate in strength. Emergency Medical Responders are maintaining manual spine motion restriction. What should your next action be? A) Check the blood pressure and assess for injuries causing blood loss B) Administer supplemental oxygen C) Insert an oral airway and start positive pressure ventilation D) Complete spinal motion restriction interventions by placing the patient on a long spine board with a cervical collar applied, and then applying straps
B
10) Which link of the American Heart Association's Chain of Survival must occur first, if a patient is to survive cardiac arrest? A) Early CPR B) Early defibrillation C) Early activation D) Early advanced life support
C
11) A patient goes into cardiac arrest at 11:40 a.m. Which of these treatments gives the patient the best chance for recovery? A) CPR at 11:42 a.m. and advanced cardiac drugs at 11:48 a.m. B) Defibrillation at 11:46 a.m., followed by ALS (ACLS) at 11:51 a.m. C) CPR at 11:41 a.m. and defibrillation at 11:43 a.m. D) Defibrillation at 11:44 a.m., followed by CPR at 11:49 a.m.
C
15) Within 2 minutes of going into cardiac arrest, an AED is applied, the patient is shocked, and a pulse is restored. The EMT should recognize that the patient's heart was in: A) Ventricular fibrillation and now is in cardiac arrest B) Asystole and now is in an organized rhythm C) Ventricular fibrillation and now is in an organized rhythm D) Ventricular fibrillation and now is in asystole
C
20) As you arrive at a metal scrap yard for an unknown medical emergency, you observe a male supine on the ground with AED electrodes on his chest. The AED operator has just ordered coworkers to clear the patient because the AED is going to shock. Within seconds, the AED delivers a shock without the operator pressing a "shock" button. The EMT should recognize that which type of AED is being used? A) Semi-automated B) Manual C) Fully automated D) Biphasic
C
33) After analyzing the heart rhythm of a patient in cardiac arrest, the AED provides a "deliver shock" message. After clearing the patient, the EMT's next step should be to: A) Press the shock button, and then check for the return of a pulse B) Press the shock button, and then allow the AED to analyze the heart rhythm C) Press the shock button, and then perform CPR for 2 minutes D) Check for a pulse, and then press the shock button if a pulse is not present
C
39) A "no shock advised" message is provided by the AED. The EMT understands that this could mean: A) The patient is in ventricular fibrillation B) The electrodes may be loose C) The patient has regained a pulse D) CPR is no longer needed
C
40) After the AED gives a "no shock advised" message, it is determined that the patient has a weak pulse and slow and shallow respirations. You would immediately: A) Transfer the patient to the stretcher for transport B) Provide 2 minutes of CPR C) Start positive pressure ventilation D) Obtain a blood pressure
C
42) After two cardiac arrests occurred on its premises over the last 6 months, a large home improvement center has purchased a fully automated AED. You have been asked to provide education on its use. During an instructional session, a student asks you what will happen when the AED indicates that a shock is indicated. Your response should be: A) "The AED will prompt you to recheck the pulse." B) "You will need to reanalyze the heart rhythm." C) "The AED will automatically charge and shock the patient." D) "You will need to press the shock button after the system charges."
C
47) An EMT has just received a "shock advised" message from the AED. Just before delivering the shock, the EMT must: A) Press the analyze button once more B) Hold the patient's head to avoid injury when shocking C) Ensure that all rescuers are clear of the patient D) Remove the oral airway to prevent possible choking
C
50) Which of these actions performed by the EMT indicates appropriate care with the AED when treating a patient in cardiac arrest? A) The EMT places the AED pads 2 inches away from a transdermal medication patch on the patient's chest B) The EMT intentionally withholds a shock on a patient in cardiac arrest who has an implantable defibrillator C) The EMT places, then quickly removes, a set of electrodes in an attempt to remove excessive hair from a patient's chest D) The EMT applies one electrode over the top of the power source for a pacemaker located on the patient's chest
C
51) You have applied the AED's electrodes to an obese male patient in cardiac arrest. When you press the analyze button, the AED gives you a "check electrode" message. In looking at the patient, which of these factors would most likely be responsible for this message? A) Obese chest and abdomen B) History of asthma C) Hairy chest D) AED pads placed too far to the left
C
56) The owner of a day care center for adults with Alzheimer's disease calls you to ask about an AED at her facility. Specifically, she asks if she will need a physician to oversee the AED program. Your reply should be: A) "If you intend to use the AED on anyone younger than 50 years, a medical director will be needed." B) "A medical director is needed only if you are going to bill insurance companies for the provision of care; if you are not, a medical director is not needed." C) "You will need to have a physician medical director since the AED can be used only with his or her permission under his or her license." D) "If you get a semi-automated AED, you will need a physician medical director. Since fully automated AEDs are easier to use, a medical director is not needed."
C
60) When paramedics administer IV fluids as treatment for hemorrhagic shock, the fluids will: A) Stabilize the shock by restoring needed fluid and electrolytes to the intravascular volume B) Enable the lungs to better oxygenate the blood by increasing the hemoglobin level in the bloodstream C) Not be able to increase the oxygen-carrying capability of the blood D) Reverse the shock by increasing the blood pressure and inhibit anaerobic metabolism
C
64) Which of these conditions could be responsible for causing obstructive shock? A) Infection throughout the body B) Loss of blood in the urine C) Blood clots in the lungs D) Poor transfer of oxygen at the capillary level
C
68) As you approach a seemingly unresponsive patient, you observe a 1- to 2-inch circle of dark blood on his shirt. He also appears pale and diaphoretic. What should you do first? A) Apply oxygen B) Cut his shirt C) Assess his airway D) Treat for shock
C
69) You believe that a young male patient, who has been shot in the lower abdomen, is bleeding internally and is in the early stage of shock. Which of these descriptions includes appropriate prehospital care of this patient? A) Semi-Fowler's position and direct pressure over the injury site B) "Shock" position and administration of water by mouth C) Oxygen therapy and rapid transport to the hospital D) Oxygen therapy and warm packs to the abdomen
C
74) You suspect that a patient involved in a motor vehicle collision is in shock. Which sign or symptom of shock would you expect to see last? A) Tachycardia B) Increased respirations C) Decreased blood pressure D) Pale and diaphoretic skin
C
82) You have been called to transport a patient in septic shock from the emergency department of a local hospital to the critical care unit of another hospital. Two nurses will be accompanying you. As a knowledgeable EMT, you recognize that this state of shock has been caused by: A) Failing heart B) Blood loss C) Infection D) Fluid volume loss
C
86) When comparing the pediatric Chain of Survival to the adult Chain of Survival, the EMT would note that the pediatric version differs in which way? A) Emphasis on ventilations over compressions B) Less attention to post-resuscitation care C) Prevention of cardiac arrest D) Emphasis on ALS over BLS
C
92) Mechanical external compression devices are recommended: A) By AHA 2015 guidelines as a preferred substitute for manual CPR B) Because patient ventilation is not required C) When high-quality manual compressions are not possible D) For short-term use only
C
95) You are treating a 4-year-old child who sustained trauma after being ejected from a motor vehicle rollover. Your assessment has revealed a blood pressure of 72/52 mmHg, a heart rate of 118 beats/min, and respirations of 28 breaths/min and unlabored. The pulse oximetry reading on ambient air is 92%. How would you describe these findings? A) Acceptable vital signs for this age bracket B) Elevation of all vital signs C) Shock findings for this age D) Normal vital signs with an abnormally low pulse oximeter reading
C
23) When a 52-year-old male patient collapsed on his front porch, his family dialed 911. When you arrive, the daughter informs you that the patient has been down for approximately 8 minutes. Assessment reveals him to be in cardiac arrest. What should you do immediately? A) Contact medical direction for permission to use the AED given the down time B) Perform five cycles of CPR at a ratio of 15 compressions to 2 ventilations C) Withhold CPR so that the AED can be applied D) Start CPR while the AED is applied and readied for use
D
29) You have been called for an elderly male patient who suddenly collapsed. On scene, you find an 82-year-old man lying on the garage floor. Assessment reveals him to be unresponsive and not breathing. What should you do immediately? A) Determine the "down time" B) Apply the AED C) Start cardiopulmonary resuscitation D) Check for a carotid pulse
D
37) While using the AED to treat a patient in cardiac arrest, your partner informs you that he can feel a carotid pulse. What should you do immediately? A) Obtain a heart rate and blood pressure B) Reanalyze the patient's heart rhythm C) Insert an oropharyngeal airway and begin positive pressure ventilation D) Assess the patient's airway and breathing adequacy
D
45) You are transporting a 57-year-old male patient who went into cardiac arrest at home. After two shocks and CPR, he regained a pulse, but he remains unresponsive and in respiratory arrest. During transport, your reassessment reveals the absence of a carotid pulse. What should you do first? A) Reapply the AED and analyze the heart rhythm B) Provide five cycles of CPR prior to using the AED C) Start CPR and continue emergency transport D) Stop the ambulance and analyze the heart rhythm with the AED
D
46) A 51-year-old male patient who experienced cardiac arrest has regained a pulse after one shock from the AED. The dispatcher informs you that the paramedic unit you have requested for assistance is coming from the eastern end of the county and has a 20-minute ETA. The hospital is 15 minutes west of your location. Which action would be most appropriate given this situation? A) Load the patient and meet the paramedic unit at a halfway point B) Wait on scene for the paramedic unit to arrive C) Load the patient in the ambulance and wait on scene for the paramedic unit D) Start transport to the hospital and inform the ALS dispatcher of your intent
D
48) You have been called to a public pool for an unresponsive patient. On arrival, you find lifeguards performing CPR with a pocket mask and oxygen on a 67-year-old male swimmer. They report that the patient was in the water and was seen clutching his chest seconds before going unresponsive. He was immediately pulled from the water and CPR was initiated. The lifeguards estimate that CPR has been performed for 5 minutes. Assessment shows the man to be unresponsive, apneic, and pulseless. What should be your first response? A) "Stop CPR and let's apply the AED." B) "We need to quickly dry him from head to toe before applying the AED." C) "Let's start ventilation with a bag-valve mask and oxygen." D) "Resume CPR and let's take a towel and dry off his chest so we can apply the AED electrodes."
D
54) Which activity related to the use of an AED would a medical director carry out? A) Overseeing repairs to AEDs that are in need of service or repair B) Responding to calls in which the EMT is using the AED C) Obtaining funding for supplies such as batteries, razors, and electrodes D) Reviewing cases in which an AED was used but no shock was advised
D
55) Your ambulance service director has given you permission to replace an old fully automated AED with a new semi-automated AED produced by a different manufacturer. Before making the purchase, you must receive authorization to do so from the: A) Shift supervisor B) Old manufacturer C) American Heart Association D) EMS system's medical director
D
57) A patient in early shock informs the EMT that he has had severe diarrhea and vomiting over the past four days. Given this history, the EMT should recognize the pathophysiology of the shock as: A) Loss of red blood cells B) Decreased formed elements in the blood C) Leakage of the capillaries D) Loss of plasma volume
D
61) Which of these are some of the major categories of shock that the EMT will likely encounter? A) Hemorrhagic, distributive, anoxic, and obstructive B) Burn, hypovolemic, distributive, and hypoxic C) Hypoglycemic, obstructive, distributive, and hypovolemic D) Hypovolemic, cardiogenic, obstructive, and distributive
D
63) The underlying pathophysiology of distributive shock is: A) Poor fluid intake B) Loss of blood volume C) Damaged heart with poor contractility D) Dilation of the blood vessels
D
7) The EMT should request advanced life support (ALS) backup for a patient in cardiac arrest because: A) Paramedics must be present for the EMT to use the AED B) Patients with cardiac arrest must be transported by ALS personnel C) ALS care is superior to basic life support care, even when the AED is available D) ALS treatment decreases the possibility of the patient going back into cardiac arrest once successful defibrillation has occurred
D
70) When a person is in shock, what is occurring in the body? A) The cells are getting glucose and other nutrients, but not oxygen B) The amount of oxygen to the cells is adequate, but CO2 is not being eliminated C) The blood carries an adequate amount of oxygen, but not enough nutrients for cell survival D) The cells are not getting enough oxygen, and waste products are accumulating
D
75) Which of these statements made by your EMT partner best indicates an understanding of the prehospital role in caring for the patient in shock? A) "The job of the EMT is to recognize that a person is in shock and get him or her to the hospital so treatment can be started." B) "Because shock is a life-threatening condition, it is important that the EMT identify the exact cause so the proper care can be given." C) "If shock is in the compensatory or early stage, it is not yet life-threatening and the EMT can take his time in assessing and treating the patient." D) "Since shock is best treated in the hospital, the EMT should provide care to maintain perfusion to the vital organs and transport the patient."
D
77) A 28-year-old male patient was cutting limbs from a tree when he lost his footing and fell approximately 20 feet. He is unresponsive and has shallow breathing, with a rate of 28 breaths/min. His radial pulse is weak and thready, and his skin is cool to the touch. Emergency Medical Responders (EMRs) have placed him on a nonrebreather face mask and are holding manual spine motion restriction. His respirations are sonorous. Based on these assessment findings, which of these instructions would you next provide to the EMRs? A) "The patient has snoring respirations, so let's go ahead and open the airway with the head-tilt, chin-lift maneuver." B) "Do not cover the patient with a blanket, because that will cause his blood vessels to dilate and drop his BP." C) "Let's elevate the patient's legs 8 to 12 inches so more blood gets to his vital organs." D) "Let's take off the oxygen mask and try manually opening the airway."
D
79) A 66-year-old female patient has been struck by a car. Your assessment reveals gurgling respirations, rapid breathing, and cool, diaphoretic skin. You also note bruising to her chest and abdomen. What should you do immediately? A) Determine the blood pressure B) Administer supplemental oxygen C) Evaluate for shock D) Suction the airway
D
81) A patient has been involved in a very serious motor vehicle collision and is in shock. Assessment findings indicate that he sustained blunt trauma to the abdominal and pelvic areas. Which type of shock is the patient most likely suffering? A) Obstructive B) Cardiogenic C) Distributive D) Hypovolemic
D
88) Proper care of cardiac arrest for a 6-year-old pediatric patient when there are no available pediatric AED pads would include: A) Two EMTs providing a 15:1 ratio of compressions to ventilations B) CPR with no AED placement due to lack of pediatric pads C) Compressing the chest to a maximum depth of 1½ inches D) Placement and use of the adult pads with adult energy levels
D
93) When the body is in a shock state, which hormone released from the adrenal glands stimulates primarily alpha-1 and beta-1 receptors, but has no effects on beta-2 receptor sites? A) Biepinephrine B) Pseudoepinephrine C) Coepinephrine D) Norepinephrine
D
97) You are treating a pediatric patient in cardiac arrest. The patient has a long congenital cardiac history and had a pacemaker implanted a year ago. How will this information change the EMT's use of the AED during arrest management? A) In a pediatric patient, the use of an AED is contraindicated if the patient has an implanted pacemaker B) The AED can be used, with the adhesive pads being placed over, or beside, the implanted pacemaker C) The AED can be used, but only half of the normal pediatric energy level should be used during defibrillatory shocks D) The AED can be used, but the adhesive pad should not be placed directly over the pacemaker
D