EMT - Chapter 36: Patients With Special Challenges

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

A. Conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy.

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

A. avoid placing him in a supine position if possible and administer oxygen.

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

A. brain.

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

A. chronic seizure disorders.

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

A. colostomy.

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

A. have extreme difficulty with complex tasks that require many steps.

Which of the following does NOT usually contribute to or cause obesity? A. rapid metabolism B. high caloric intake C. low metabolic rate D. genetic predisposition

A. rapid metabolism

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

A. regulates the patient's heart rate if it falls below a preset value.

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

A. report exactly what the patient signs and not to add any commentary.

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

A. secretions can build up in and around the tube.

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

A. shunt.

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

A. teeth are misaligned and they have a large tongue.

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

A. vena cava.

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

B. Patients with developmental disabilities are susceptible to the same disease processes as other patients.

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

B. a birth defect caused by incomplete closure of the spinal column.

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

B. a round head with a flat occiput.

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

B. all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

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

B. as a bridge to heart transplantation while a donor heart is being located

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

B. be observant for signs of fear or reluctance from the patient.

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

B. disconnect the ventilator and use a bag-mask device.

For which of the following conditions would you MOST likely encounter a ventricular peritoneum shunt? A. heart failure B. hydrocephalus C. cerebral palsy D. subdural hematoma

B. hydrocephalus

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

B. is sick.

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

B. nerve damage.

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

B. removing the tube if the area around it appears to be infected.

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

B. spastic limb movement.

When caring for patients with cerebral palsy, it is important to remember that: A. they are unable to walk and are totally dependent upon you. B. their limbs are often underdeveloped and are prone to injury. C. hearing aids are usually ineffective for patients with hearing loss. D. most patients have the ability to walk, but have an unsteady gait.

B. their limbs are often underdeveloped and are prone to injury.

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

B. using a piece of paper and writing utensil to ask questions

A person is said to be obese when he or she is ________ over his or her ideal weight. A. 5% to 10% B. 10% to 15% C. 20% to 30% D. 40% to 50%

C. 20% to 30%

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

C. Check the mechanical ventilator for malfunction.

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

C. Hearing aids cannot restore hearing to normal levels.

Which of the following statements regarding autism is correct? A. Autism affects females four times greater than males. B. The majority of patients with autism do not speak at all. C. Most cases of autism are diagnosed by 3 years of age. D. Impairment of motor activity is a classic sign of autism.

C. Most cases of autism are diagnosed by 3 years of age.

Which of the following conditions would MOST likely cause a patient to slur words, speak very slowly, or speak in a monotone? A. advanced age B. cerebral palsy C. Parkinson disease D. visual impairment

C. Parkinson disease

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

C. Patients with a gastrostomy tube may still be at risk for aspiration.

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

C. a triplication of chromosome 21.

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

C. ask your team members to wait until you can establish a rapport with the patient.

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

C. attempt to use the patient's suction device first because it is probably already sized correctly.

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

C. body

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

C. has recognized a change in the patient's health status.

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

C. lower the pitch of your voice.

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

C. try repositioning the hearing aid or remove it and turn down the volume.

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

D. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

A significant number of patients with cerebral palsy also have: A. paralysis. B. brain tumors. C. type 2 diabetes. D. a seizure disorder.

D. a seizure disorder.

Two thirds of children born with Down syndrome have: A. diabetes mellitus. B. intracranial bleeding. C. unilateral paralysis. D. congenital heart disease.

D. congenital heart disease.

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

D. establish his or her chief complaint and then communicate your plan to help.

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

D. harness.

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

D. open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct.

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

D. pervasive developmental disorder characterized by impairment of social interaction.

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

D. positioning yourself approximately 18″ directly in front of the patient.

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

D. prevent excess cerebrospinal fluid from accumulating in the brain.

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

D. rupture of a central vein.

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

D. speaking with the patient and family to establish what is considered normal for the patient.

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

D. tell him or her what is happening, identify noises, and describe the situation and surroundings.

You receive a call to a residence for an apneic 2-month-old male. When you arrive at the scene, the infant's mother tells you that her son was born prematurely and that his apnea monitor has alarmed 4 times in the past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98% on room air. You should: A. request an ALS ambulance to transport the infant to the hospital. B. advise the mother to observe her son and call 9-1-1 again if necessary. C. administer high-flow oxygen and observe for a drop in oxygen saturation. D. transport the infant to the hospital and bring the apnea monitor with you.

D. transport the infant to the hospital and bring the apnea monitor with you.