EMT Chapter tests 14-17
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:
EMS system's medical director
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?
Ensure that no rescuer is touching the stretcher.
Which action is it essential that the EMT take prior to assisting the patient in taking his nitroglycerin tablet?
Evaluate the patients systolic blood pressure and heart rate
You are assisting a patient with her metered-dose inhaler (MDI). In an effort to determine the exact name of the medication, it would be best for the EMT to:
Find the medication name on the label of the MDI
One of the benefits of utilizing an automated chest compression device is that:
It frees up EMS providers to tend to other patient care tasks
After administering oral glucose to a patient with altered mental status, which of these findings best indicates a positive therapeutic effect or response to themedication?
Mental status that is now alert and oriented
A 64-year-old male patient presents with a blood pressure of 210/132 mmHg. Which of these statements made by this patient would you recognize as most concerning and most likely associated with the elevated blood pressure?
"I have a history of left-sided heart failure."
Which of these statements made by the patient should cause the EMT to suspect an abdominal aortic aneurysm?
"I have belly pain that I also feel in my back."
Which of these remarks made by the patient best reinforces your suspicion that he is in the early stages of hypovolemic shock?
"I have had diarrhea for the past four days."
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:
"Immediate CPR can prolong the period in which the heart can be shocked following cardiac arrest."
While you are obtaining a medical history for a patient with generalized weakness and fatigue, she hands you a list of all the medications she is currently taking. Which of these medications should the EMT recognize as a bronchodilator for which the EMT could assist in its administration?
Metaproterenol
You suspect a patient of being infected with pertussis. While performing the primary assessment, you note a deep cough with clear breath sounds. Her vital signs arepulse, 108; respirations, 16 breaths/min; and SpO2, 96% on room air. Given this scenario, which action by the EMT would be most appropriate?
Monitor the patient and transport
When assessing a 3-year-old male patient in respiratory distress, the EMT should recognize "see-saw" breathing when he observes:
Movement of the chest and abdomen in opposite directions
Which of these scene size-up observations would make you suspicious that a patient who complains of shortness of breath has congestive heart failure?
Multiple pillows stacked at the head of his bed
A 66-year-old male patient is complaining of chest pain. The EMT is considering assisting with the patient's prescribed nitroglycerin. Which of these statements made by the patient is most relevant to the EMT at this time?
My urologist just started treating me for problems I am having with sex.
Which of these medications may be administered by a mucosal atomizer device (MAD) by the EMT if the EMT has authorization from medical direction to do so?
Naloxone hydrochloride
A patient with chest pain has an SpO2 of 90% on room air. How would you start providing oxygen to this patient?
Nasal cannula 2 lpm
Which of these pieces of information would heighten the EMT's suspicion that a child with a persistent cough may have whooping cough?
Never had childhood immunizations
The EMT should most suspect a patient has angina when he takes which medication?
Nitroglycerin
What is the typical resting respiratory rate for an elderly patient?
20 bpm
When should the EMT transport the patient with cardiac arrest?
After three " No Shock Advised" messages are received
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?
Alert and anxious, pulse 102, BP 114/88 mmHg, pale and cool skin
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?
Oxygen therapy and rapid transport to the hospital
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:
Perform CPR until the AED is ready
As you enter a room for an unknown medical emergency, you find an unresponsive male with snoring respirations lying supine in bed. Which action should you takeimmediately?
Perform a head-tilt, chin-lift maneuver
You have been called to a residence for a patient with altered mental status and shortness of breath. On scene, an Emergency Medical Responder meets you and states that he believes the patient had a stroke and is unresponsive. As you enter the room, you see the patient lying in bed with snoring respirations. Oxygen at 15 liters per minute has been applied. Your immediate action when you reach the patient's side would be to:
Perform the head-tilt, chin-lift maneuver
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?
Perform the primary assessment, administer supplemental oxygen, perform the secondary assessment, transfer the patient to the stretcher, and provide rapid transport
What is the most reliable source of information about a medication?
Physicians Desk Reference PDR
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?
Start CPR while the AED is being prepared for use
When auscultating breath sounds, the EMT should recognize rhonchi when he hears which type of sound?
Rattling-like noises that decrease when the patient coughs
You are treating a patient who has a history of gout, hypertension, diabetes, emphysema, and high cholesterol. As you review his medications, you notice that one of his pill bottles has the name "levalbuterol" on its label. You would recognize this name as:
The generic name for Xopenex
You are transporting a patient with chest pain to the hospital emergency department. In regard to possible fibrinolytic therapy, what should you relay during your hospital report as a possible relative contraindication to this therapy?
Use of anticoagulant medication.
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 wasin:
Ventricular fibrillation and now is in an organized rhythm
Mechanical external compression devices are recommended:
When high-quality manual compressions are not possible
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 patientcontact, you note that she is rigored. What should your next step be?
Withhold CPR and contact medical command
Why would a patient with COPD have a higher percentage of red blood cells than a healthy person without COPD?
to carry additional oxygen to the cells
A 67-year-old male patient has chest pain. After you assist him with taking two of his nitroglycerin tablets, his chest pain remains 7 out of 10 and he is still diaphoretic. His vital signs are as follows: pulse, 72; respirations, 18 breaths/min and adequate; blood pressure, 82/60 mmHg; and SpO2, 97% on 2 lpm of oxygen. You should:
transfer the patient to the stretcher and begin transport
A patient has been diagnosed with high blood pressure. A medication that can effectively serve to lower this patient's blood pressure is one that:
dilates the arteries
A beta-2 medication benefits a patient by:
dilating the small airways
When administering albuterol to a patient with shortness of breath, the EMT realizes that the therapeutic effect of this medication is achieved by:
dilating the small airways
The underlying pathophysiology of distributive shock is:
dilation of the blood vessels
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:
loss of plasma volume
What is the most likely indication for the administration of oral glucose to a patient with diabetes?
low blood sugar
For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for:
massive internal bleeding
Which of these condition(s) is (are) as the most probable cause of cardiogenic shock?
myocardial infarction
Which of these is considered an early sign of inadequate breathing in children?
nasal flaring
Which structure of the neck would the EMT examine on a patient she believes to be in congestive heart failure?
neck veins
Which of these medications can be administered by the EMT only if the patient has a prescription for it?
nitroglycerin
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?
norepinephrine
When paramedics administer IV fluids as treatment for hemorrhagic shock, the fluids will:
not be able to increase the oxygen-carrying capability of the blood
An elderly patient with diabetes who experiences a silent MI will most likely:
not be awakened by a heart attack as he sleeps
Which of these medications is included in the EMT scope of practice?
oral glucose
A patient informs you that he has a hard time breathing when he lies in bed. You would best document this report as:
orthopnea
Which of these medications is included in the EMT scope of practice?1
oxygen
The EMT is correctly assessing a patient for subcutaneous emphysema when he:
palpates the anterior and posterior chest
When arrive on scene, a family member directs you to a bedroom where a 62-year-old male patient is in respiratory distress. During the scene size-up, which finding would most strongly suggest that the patient suffers from a chronic respiratory disease?
patient in a chair in tripod position and has a barrel shaped chest
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:
perform CPR and contact medical command for permission to use the AED.
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?
place the adult AED electrodes on the boy's chest and follow the AED's prompts
Proper care of cardiac arrest for a 6-year-old pediatric patient when there are no available pediatric AED pads would include:
placement and use of the adult pads with adult energy levels
In the blood, which component is largely responsible for the formation of blood clots?
platelets
An acute infectious disease caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation resulting in dyspnea is:
pneumonia
You are caring for an alert and oriented patient with chest pain. Emergency First Responders have initiated supplemental oxygen, and your EMT partner assisted in the administration of aspirin and two nitroglycerin tablets. Currently, the patient's vital signs are pulse, 76; respirations, 16 breaths/min; blood pressure, 110/56 mmHg; andSpO2, 95%. When transporting this patient on the stretcher, which position is best?
position of comfort
Which of these is considered a benefit of the automated external defibrillator?
the ease and speed with which it can be used
Which piece of information regarding drug administration by the EMT according to protocol is not necessary to document on the patient care report?
the family's reaction to the need for the medication to be administered
A "no shock advised" message is provided by the AED. The EMT understands that this could mean:
the patient has regained a pulse
When in shock, the body has a slightly delayed compensation mechanism that utilizes:
the release of hormones
You are transporting a 4-year-old female patient whom you found sitting in a chair with labored respirations, inspiratory stridor, and drooling. Which sign or symptom would warrant immediate reassessment?
the stridor ceases
You are interviewing a patient whom you suspect has an acute coronary syndrome. Which question is most appropriate initially?
"Are you having any chest discomfort?"
Which of these statements made by the patient should the EMT associate with the condition of congestive heart failure?
"I have a hard time breathing when I am lying down."
Medical direction has ordered you to administer 162 mg of aspirin to a patient with chest pain. Your best response to this order would be:
"Received. I will administer 162 mg of aspirin orally."
The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states:
"An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."
Which of these statements made by the EMT indicates a safe understanding of the administration of nitroglycerin in the prehospital setting?
"A total of three nitroglycerin tablets may be administered in the prehospital setting, and this includes what the patient takes prior to EMSarrival."
The EMT understands the ECG when he makes which of these statements about the waveform?
"An ECG represents the electrical activity of the heart."
After you assist a patient with use of his metered-dose inhaler, the patient's son asks why his father cannot take the medication in the form of a pill. Which of these responses would be most appropriate?
"By giving the medication directly to the lungs, the effect is more immediate."
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 iscorrect?
"Even with treatment, if shock has reached the irreversible stage, death will result."
Which statement made by a patient's family member would cause the EMT to suspect that a patient is experiencing hypovolemic shock?
"He cannot stop throwing up"
Assessment of a 67-year-old male patient reveals absent lung sounds to the right lung, accompanied by sharp chest pain to the same side. When obtaining a history, which of these statements made by the patient's wife would the EMT recognize as most important?
"He has emphysema."
You have been called for a 6-year-old male patient with shortness of breath. On scene, you find the patient with a runny nose and mucus coming from the right nare. Breath sounds are clear and his SpO2 is 99% on room air. When asked, the patient states that his throat is very sore. His vital signs are pulse, 124; respirations, 20breaths/min; and temperature, 98.9°F. There is no medical history, according to the mother. Which statement or instruction would be most appropriate for this situation?
"He is stable, but we will take him to the hospital. The danger lies in the infection spreading to the lungs."
You have arrived at a residence to help another crew with a 62-year-old woman who is complaining of fatigue, chest discomfort, and diaphoresis. The EMTs on scene report that she has a history of hypertension from atherosclerosis, for which she takes a blood pressure pill, and is also prescribed nitroglycerin. She reports an allergy to aspirin. Vital signs are pulse, 64; respirations, 16 breaths/min; blood pressure, 128/86 mmHg; and SpO2, 97% on room air. Which of these statements made by your EMT partner would require immediate correction on your part?
"I am going to put the patient on high concentration oxygen because she has chest discomfort"
A 71-year-old male patient with a cardiac history and lower abdominal and back pain has called 911 for help. On scene, you detect a large pulsatile mass in his abdomen. With the exception of skin that is diaphoretic, the primary assessment indicates no life threats to the airway, breathing, or circulation. The patient has a history of hypertension, high cholesterol, and diabetes, and is allergic to sulfa-based medications. Vital signs are pulse, 92/min; respirations, 20 breaths/min; bloodpressure, 130/66 mmHg; and SpO2, 95% on room air. Which of these statements made by the patient would make you intervene immediately?
"I am going to take my daily aspirin since I did not take it this morning."
A 71-year-old female patient complains of the sudden onset of shortness of breath and rapid breathing. She also states that she is experiencing some chest pain that seems to worsen when she takes a deep breath. The primary assessment shows her to be alert and oriented with a patent airway and rapid breathing that is adequate. Her pulse rate is 92 and her blood pressure is 116/68 mmHg. When obtaining a history, which of these statements made by the patient should raise your suspicion that the patient may be experiencing a pulmonary embolism?
"I had leg surgery five days ago"
You are transporting a patient who had an episode of chest pain. On scene, you assisted him in taking his nitroglycerin medication, which completely alleviated the chest pain. En route to the hospital, the patient asks you why the nitroglycerin took the chest pain away. Beyond telling the patient that nitroglycerin can increase coronary artery blood flow, you would add:
"It dilates the blood vessels, which decreases the workload of the heart."
You are approached by an EMR who informs you that last week, he was on a call in which a patient with chest pain and a known history of coronary artery disease was not given oxygen by the EMTs. You would reply:
"It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."
At a health fair, a patient informs you that she has just been prescribed a metered-dose inhaler (MDI) for her asthma. She is confused about how to take the medication when needed. Which of these statements about the MDI would be most appropriate for you to make?
"It is important to shake the inhaler vigorously before taking the medication."
When instructing a patient on how to use a small-volume nebulizer, which of these statements would be correct?
"It is really important to occasionally cough during the treatment."
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?
"Leave the AED on the patient , even though she is breathing and has a pulse.
Which instruction given by an EMT indicates the proper administration of nitroglycerin?
"Let this pill dissolve under your tongue."
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?
"Let's take off the oxygen mask and try manually opening the airway"
You are treating a patient who states that he has been short of breath for the past month. Tonight, his breathing just "got too bad" and he decided to call 911. The67-year-old male patient is alert and oriented and has a patent airway. He appears to have an adequate tidal volume. His pulse is strong and regular, and his skin is warm. Vital signs are pulse, 92; respirations, 22 breaths/min; blood pressure, 128/66 mmHg; and SpO2, 93% while on home oxygen at 2 lpm. Which instruction would you give to your partner regarding this patient's care?
"Lets try 4 lpm through a nasal cannula"
After administering a bronchodilator to a patient through a small-volume nebulizer, which of these statements made by the patient should be of most concern to anEMT?
"My chest feels heavy."
If a cardiac arrest patient were in asystole, which message would the AED provide?
"No shock advised"
The EMT indicates that he is properly assessing the patient's breath sounds when he gives which of these instructions to the patient?
"Please breathe through your mouth as I listen to your lungs."
Medical direction has ordered you to assist a patient in taking his metered-dose inhaler (MDI). After placing the patient's lips on the mouthpiece, which instruction would be most appropriate?
"Please inhale slowly and I will administer the medication."
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?
"Resume CPR and lets take a towel and dry off his chest so we can apply the AED electrodes"
You arrive on scene for a 9-year-old female patient with a severe cough. Her mother states that she has spoken to her pediatrician, who believes that the child may have whooping cough and should be taken to the hospital for evaluation. Her mother is unsure if her daughter has had all her immunizations. Which of these statements would be most appropriate in regard to the care of this patient?
"She is possibly contagious, so let's put a surgical mask on her"
Which of these statements made by your EMT partner best indicates an understanding of the prehospital role in caring for the patient in shock?
"Since shock is best treated in the hospital, the EMT should provide care to maintain perfusion to the vital organs and transport the patient."
Which of these statements made by another EMT, regarding chest pain and acute coronary syndrome, is correct?
"Some patients experiencing acute coronary syndrome do not have actual chest pain; rather, they experience a sensation of discomfort or pressure."
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?
"Stop CPR and clear the patient."
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:
"The AED will automatically charge and shock the patient."
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?
"The AED will let us know whether or not to shock the patient."
The EMT shows she understands the difference between a metered-dose inhaler (MDI) and a small-volume nebulizer (SVN) when she states:
"The MDI provides medication during one or two of the patient's breaths; the SVN provides a continuous flow of medication until gone."
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?
"The batteries must be checked regularly."
Which of these statements would the EMT expect from a patient with unstable angina?
"The chest pain awakens me from my nighttime sleep."
A patient has chest pain, and you have just assisted him in taking his nitroglycerin tablet. Which of these statements made by the patient is the cause for greatestconcern?
"The chest pain does not feel any different."
Following a call in which you treated a pediatric patient with croup, a new EMT who is in orientation asks you how you can differentiate croup from epiglottitis. Which of these responses would be most appropriate?
"The child with epiglottitis typically drools; the child with croup rarely, if ever drools.
A TV reporter has been assigned to your ambulance for a ride-along. He is doing a segment on the local EMS system for EMS Week. In your down time, the reporter tells you that his wife was diagnosed with atherosclerosis. He is unsure what this condition is and asks you to explain it to him. Your response would be:
"The coronary arteries become narrowed by fat deposits."
Regarding women and cardiac compromise, with which of these statements would you agree?
"The death rate for females suffering a heart attack is higher than for males"
You are treating a patient for mild chest pain but notice that his blood pressure is elevated. Which of these statements made by the patient would make you suspect he has acute hypertension?
"The doctor checks my blood pressure regularly and its not normally that high"
Within minutes of administering Proventil (albuterol) to a patient through her metered-dose inhaler (MDI), the patient is breathing easier and states that she feels much better. An Emergency Medical Responder on scene asks you how the medication in the MDI helped the patient. Which of these responses would be most appropriate?
"The medication in the inhaler relaxes and opens up the small airways in the lungs."
You have been called to a residence for an obese 52-year-old male patient who complains of chest pain. When obtaining a history from the patient, which of these statements made by the patient would you find most concerning?
"The pain came on suddenly when I was reading the paper."
Which of these statements, made by the EMT, shows an understanding of medication administration and drug dosages?
"The proper dose of a medicine should be administered unless medical direction orders otherwise."
Which of these statements from a patient should the EMT recognize as an absolute contraindication to the use of fibrinolytic medications in the emergencydepartment?
"Two months ago I had a stroke on the left side of my brain."
You are delivering positive pressure ventilations to a patient who is breathing poorly and has absent breath sounds in the right lung. Which of these instructions would you provide to those responders who are ventilating the patient?
"Use the minimal tidal volume possible, just enough to make the chest rise and fall."
A confused and cyanotic patient is breathing 8 times per minute with poor chest rise and fall. Which instruction would you give your partner about the respiratory care of this patient?
"Ventilate him at 10 times per minute"
When obtaining a medical history, which of these statements made by the patient seemingly indicates that he is suffering from classic angina?
"When I stopped cutting the grass, the pain went away."
Which of these statements about the heart rhythm of ventricular fibrillation is true?
"When a patient's heart is in ventricular fibrillation, it is unable to pump blood throughout the body."
While talking to your partner one day in between emergency calls, he tells you he has recently read a CE article on pulmonary embolisms. Which of these statements indicates that your partner understands the underlying pathophysiology of how a pulmonary emboli can cause hypoxia?
"When the pulmonary vasculature becomes blocked by an emboli, then blood cannot reach the alveoli for gas exchange, and hypoxia can result."
You are assisting a patient in taking her metered-dose inhaler for the first time. Which of these statements about the side effects of the medication would be mostappropriate?
"You may feel anxious and your heart rate may increase"
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:
"You will need to have a physician medical director since the AED can only be used with his or her permission under his or her license."
A new employee of your EMS system is about to take a protocol test in front of the EMS supervisor. As he is reviewing the protocol from memory, he gets confused about which amount of oxygen to administer to a patient with a suspected pulmonary embolism. How would you respond if he asks you for help?
"administer supplemental oxygen to the patient of sufficient amount to maintain the pulse oximeter reading at or greater than 94%"
A patient requires several doses of medication from her metered-dose inhaler. At a minimum, how long should the EMT wait between administrations?
2 minutes
Which of these descriptions on a patient care report best illustrates how the EMT should document the administration of a medication?
325 mg of aspirin administered orally at 1325 hours
The EMT shows she is correctly administering aspirin to a patient with chest pain when she provides:
325 mg of baby aspirin and instructs the patient to chew it
On room air, which of these patients requires supplemental oxygen?
47-year-old female; temperature 100.3°F; denies sob; SpO 2 91%
Immediately following the onset of cardiac arrest, brain cells begin to die after:
5 minutes
Which of these patients is most likely to suffer a silent MI?
55-year-old female with diabetes
Which of these unresponsive patients would the EMT recognize as in cardiac arrest?
A female who has an occasional gasp for a breath but no palpable carotid pulse
A patient has a medical problem characterized by an increase of interstitial fluid in and around his alveoli. This condition would disrupt normal oxygen and carbon dioxide exchange by creating which type of disturbance?
A gas exchange disturbance
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 sequence of events that, if enacted quickly, gives the best chance for surviving cardiac arrest
The EMT should request advanced life support (ALS) backup for a patient in cardiac arrest because:
ALS treatment decreases the possibility of the patient going back into cardiac arrest once successful defibrillation has occurred
You are administering a medication through a metered-dose inhaler (MDI) using a spacer. Which of these actions would be most appropriate?
Administer the medication into the spacer and then have the patient inhale
The mother of a 5-year-old female patient states that her daughter has been "sick" with a sore throat and fever for several days. The mother became concerned tonight and called 911 because the child was "making funny noises" and could not breathe well. Your assessment reveals a lethargic, well-developed child sitting upright and with high-pitched tracheal noises when she breathes in. What should be the priority action for the EMT?
Administering supplemental oxygen
You have just arrived by the side of a male patient who is in cardiac arrest. Emergency Medical Responders have been on scene for 6 minutes performing CPR. Advanced life support (ALS) has been contacted and is 1 minute out. What should you do immediately?
Apply and use the automated external defibrillator.
You are called to a motor vehicle collision. A 26-year-old female states that she was unrestrained and struck the steering column with her chest after the car she was driving hit another car from behind. She is somewhat confused, and complains of chest pain and difficult and painful breathing when she inhales. Her airway is patent and her breathing is adequate. Assessment of the radial pulse reveals it to be rapid and very irregular and weak. The patient has cyanosis in her nose and fingertips. Her breath sounds are clear and equal, and her skin is moist and pale. The patient informs you that she has asthma and has a metered-dose inhaler (MDI). What is your best initial action in treating this patient?
Apply supplemental oxygen if indicated
On scene, you are treating a 62-year-old female patient with chest pain, diaphoresis, and nausea. She has a history of heart problems as well as diabetes, for which she takes medications. She is allergic to penicillin and iodine. She is alert, oriented, and calm, and there are no threats to the airway, breathing, or circulation. The patient took 81 mg of aspirin this morning, as she always does. Her vital signs are pulse, 100; respirations, 16 breaths/min; blood pressure, 118/90 mmHg; and SpO2, 97% on room air. In overseeing the care of this patient, which of these actions would demand immediate and corrective intervention?
Applying oxygen through a nasal cannula
A 59-year-old male patient has summoned EMS for crushing chest pain. He states that he needs his nitroglycerin, but it is in his car in a nearby parking lot. A friend of the patient explains that he also takes nitroglycerin and hands you his bottle of nitroglycerin. The patient appears very ill, and he says that this chest pain is the worsthe's ever experienced. Given the patient's condition, your best action would be to:
Ask the friend to get the patient's nitroglycerin from his car quickly
When assessing a patient who complains of shortness of breath but has an open airway, which action should the EMT perform next?
Assess the adequacy of the patient's breathing
A confused, lethargic, and nonverbal 50-year-old female patient has altered mental status. You are told she has a history of chronic obstructive pulmonary disease(COPD). The primary assessment reveals a respiration rate of 6 breaths/min and cool, clammy skin with cyanosis around the lips. What should be your prioritymanagement?
Assist respirations with positive pressure ventilation.
A patient with chest pain tells you that he feels the same now as when he had a heart attack 2 years ago. He is diaphoretic, nauseated, and vomiting; he has a pulse of84, respirations of 16 breaths/min, and a blood pressure of 78/50 mmHg. The patient is allergic to aspirin. He asks you to assist him in taking one of his nitroglycerin pills because his arthritis makes it too hard for him to open the medication bottle. Which of the assessment findings represents a contraindication to the nitroglycerin?
Blood pressure of 78/50 mmHg
Which of these statements regarding contraction of the heart is true?
Both atria contract together just before both ventricles contract.
During a lecture you are attending that covers the pharmacology information often used by EMS providers, the lecturer references a drug source you know to be incorrectly stated. Which of these is a fictitious or incorrect name for an information source?
CDC Guide to Pharmacology
Pursed lip breathing is most commonly observed when a patient has:
COPD
An alert and distressed 72-year-old male patient with a history of pulmonary edema from heart failure is in severe respiratory distress, breathing 28 to 32 times per minute. His airway is patent, respirations are labored, crackles are heard in the bases of the lungs, and skin is found to be diaphoretic with a rapid radial pulse. Other vital signs are pulse, 136; blood pressure, 202/110 mmHg; and SpO2, 83%. Cyanosis is evident in the fingertips. The best treatment for this patient's breathing difficulty would be:
CPAP
A patient goes into cardiac arrest at 11:40 a.m. Which of these treatments gives the patient the best chance for recovery?
CPR at 11:41 A.M. and defibrillation at 11:43 A.M.
Which of these statements regarding cardiac compromise or acute coronary syndrome should the EMT recognize as true?
Cardiac compromise should be suspected for any patient with chest discomfort
It is critical that the EMT never apply the AED to a person who is not in cardiac arrest because an accidental shock could:
Cause the beating heart to go into cardiac arrest
A patient with a past medical history of angina is now complaining of chest discomfort. When assessing this patient, which sign or symptom should alert the EMT that the patient is probably experiencing an acute myocardial infarction and not an anginal attack?
Chest discomfort is not relieved by nitroglycerin
When assessing a patient in the prehospital setting, which of these does the EMT recognize as an indication for aspirin?
Chest discomfort that is suggestive of a heart attack
A mother has called 911 because her 6-year-old son told her he had chest pain. On scene, the mother informs you that her son suffers from a congenital heart defect called aortic coarctation. The boy admits to chest pain and appears distressed. His airway is patent, breathing adequate, and radial pulse present and regular. Vital signs are pulse, 108; respirations, 24 breaths/min; blood pressure, 148/92 mmHg; and SpO2, 98%. Your next action would be to:
Contact medical command for advice
You are by the side of an alert and oriented 56-year-old male patient who complains of generalized weakness and a pounding headache. His pulse is 104, respirations are 18 breaths/min, and blood pressure is 218/110 mmHg. He has a history of high blood pressure, for which he takes lisinopril. He states that he has not taken the Lisinopril for 2 weeks and hands you a container with the medication inside. You would:
Continue treatment and transport the patient to the hospital
You are assessing a patient in heart failure. Which sign or symptom seemingly indicates that the left ventricle is the cause of the heart failure?
Crackles in the bases of both lungs
During an asthma attack, three main pathological changes lead to hypoxia in the patient. Which of these changes is not one of these three?
Decreased alveolar perfusion
When administering aspirin to a patient with chest discomfort that is suggestive of a heart attack, the EMT recognizes that this medication will benefit the patient by:
Decreasing the ability of the platelets in the blood to form clots
A 911 call was placed for a 3-year-old child with difficulty breathing. On scene, you note that the child is upright with slight stridor upon inspiration. He is alert and breathing at a rate of 30 breaths/min. His skin is warm and dry, and his radial pulse strong and regular. His breath sounds are clear and equal. His mother states that he was fine all day until 15 minutes ago, when he was playing with friends in the playroom and suddenly started having difficulty breathing. As an EMT, you should suspect which condition?
Foreign body airway obstruction
You have been called for a 2-year-old male patient who is sick and having a difficult time breathing. On scene, you find the patient in his mother's arms. He appears to have labored breathing and skin that is warm to the touch. Which of these additional assessment findings would you recognize as the most serious?
Grunting noise heard as the child exhales
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?
Heart rate of 110 bpm
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?
Hemorrhagic hypovolemic
You are having a hard time getting the past medical history of a patient who is short of breath. Which piece of information would lead the EMT to believe that the patient has a history of chronic lung disease, such as emphysema or chronic bronchitis?
Her chest is "barrel" shaped.
You have been called to a residence for an 18-year-old female patient with shortness of breath and a history of cystic fibrosis. On scene, you find the patient to be very thin and sick looking. Her airway is patent and breathing adequate, although slightly labored. Her radial pulse is strong, and she has a constant cough, which occasionally produces green- and yellow-colored mucus. Auscultation of the lungs reveals rhonchi to the upper portion of both lungs. Vital signs are pulse, 108;respirations, 20 breaths/min; blood pressure, 98/56 mmHg; and SpO2, 92%. Based on these findings, appropriate care should include:
Humidified oxygen via nasal cannula starting at 2 liters per minute
Which of these are some of the major categories of shock that the EMT will likely encounter?
Hypovolemic, cardiogenic, obstructive, and distributive
Why is defibrillation in the first few minutes of cardiac arrest so critical?
If cardiac arrestis not treated within the first few minutes, ventricular fibrillation will convert to asystole, a non-shockable heart rhythm.
As an EMT, you may assist patients in taking which kind of prescribed medication?
Inhalers used for difficulty breathing
Which of these statements regarding ventilation in a healthy patient is true?
Inspiration is an active process that requires energy; expiration requires little to no energy.
You have arrived on scene to find a 32-year-old male patient who complains of rapid breathing, light-headedness, tachycardia, and numbness and tingling to his lips and hands. Family on scene report that he had just received bad advice from his attorney about a pending divorce when the symptoms started. The patient denies chest pain as well as any other past medical history. His pulse is 124, respirations are 52 breaths/min, and his blood pressure is 158/68 mmHg. What is your first course of action in treating this patient?
Instruct the patient to close his mouth and breathe through his nose
You have been called to an office building for a 47-year-old male patient complaining of chest pain. He is alert, oriented, and complaining of mild pain in his chest that came on suddenly about 15 minutes ago. Airway, breathing, and circulation are intact, and his skin is diaphoretic and cool. What should you do first?
Obtain a heart rate, respiratory rate, blood pressure, and SpO2 reading.
You are caring for a 62-year-old female patient with chest discomfort and shortness of breath. She is alert and oriented with an open airway. Her breathing is adequate and radial pulse strong. Her skin is warm and dry. What should you do next?
Obtain her heart rate and blood pressure
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?
Obtain the patient's heart rate, respiratory rate, and blood pressure.
You have administered Xopenex to a patient, using a small-volume nebulizer. You then notify medical direction that you have administered the drug. This is an example of which type of medical control?
Off-line
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:
Place the AED on the patient and follow all prompts
After you applied the AED to a patient in cardiac arrest, it delivered a shock. Immediately after the shock, what should you do next?
Provide 2 minutes of CPR, and then check the patient for a pulse
A patient with a cardiac history complains of chest pain. He already took four baby aspirins, and medical direction has given you permission to assist the patient with his nitroglycerin dose. After you administer nitroglycerin to the patient, he complains of a headache. What would be your most appropriate next step?
Realize that the headache is an undesirable side effect of the nitroglycerin and continue care
Which of these statements about the AED and its use in the treatment of cardiac arrest is true?
Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator
Which activity related to the use of an AED would a medical director carry out?
Reviewing cases in which an AED was used but no shock was advised.
A patient has pulmonary hypertension, which has increased the resistance in the pulmonary blood vessels. In response, what will most likely occur over a long period oftime?
Right side of the heart will weaken
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 theway, 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, notbreathing, 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?
Run to retrieve the nearby AED.
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:
Start cardiopulmonary resuscitation with compressions and ventilations
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?
Stop the ambulance and analyze the heart rhythm with the AED
You have been dispatched for a young child with difficulty breathing. As you enter the apartment, which scene size-up clue would best indicate that the patient is experiencing a problem in her upper airway?
Stridorous noises with inspiration
Which of these actions performed by the EMT indicates appropriate care with the AED when treating a patient in cardiac arrest?
The EMT places, then quickly removes, a set of electrodes in an attempt to remove hair from a patient's chest.
The EMT understands diastolic blood pressure when he defines it as:
The EMT understands diastolic blood pressure when he defines it as:
You have been called for a patient who complains of shortness of breath. On scene, you find the 41-year-old woman sitting upright in bed with nasal flaring and wheezing. A metered-dose inhaler (MDI) is lying on the nightstand next to her. To assist her with the MDI, which criteria must be met?
The MDI must be prescribed for the patient
A patient is very dizzy and has an altered mental status. Vital signs are pulse, 84; respirations, 16 breaths/min; blood pressure, 74/32 mmHg; and SpO2, 93%. Medical direction has ordered the paramedic to start an IV infusion of a medication that causes blood vessel constriction. You would recognize that the medication is benefiting the patient when you observe:
The blood pressure increase to 110/64 mmHg
If a clot occludes the blood flow through the coronary artery, what will be the detrimental effect?
The flow of oxygen-rich blood to the muscle of the left ventricle will be decreased.
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 waveform, as opposed to the monophasic form used by the previous AED. As a knowledgeable EMT, you should recognize that:
The new AED will defibrillate the patient with smaller amounts of electrical energy
Prior to administering nitroglycerin to a patient with chest pain, the EMT must ensure that:
The nitroglycerin is prescribed for the patient.
What is the primary difference between the 2015 American Heart Association's "Chain of Survival" for the adult patient versus the pediatric patient?
The pediatric chain emphasizes strategies for arrest prevention
What is the best reason why the EMT administers or assists with the administration of medications?
To help stabilize a patient's medical condition
You are by the side of a patient who complains of severe chest pain that radiates into his right arm and neck. He is alert and oriented, with an open airway and adequate breathing. His radial pulse is strong, and his skin is cool and diaphoretic. Your partner reports his pulse rate is 84, respirations are 18 breaths/min, blood pressure is 86/62 mmHg, and SpO2 is 98% on room air. You have obtained a medical history and performed the secondary assessment. The patient states that he has had two heart attacks in the past and is allergic to aspirin and sulfa medications. What should you do next?
Transfer him to the stretcher and transport.
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?
Withhold resuscitation
A patient with severe chest pain hands you a bottle of nitroglycerin. After reading the label, you determine that the prescribed dose is two pills when chest pain ispresent, but the medication expired almost a month ago. You should:
Withhold the medication and transport
When assessing an elderly patient with upper back pain, which of these assessment findings would make you very suspicious of a thoracic aortic dissection?
different blood pressure readings in each arm
A 26-year-old male patient has summoned EMS after lifting a heavy box and suddenly experiencing shortness of breath and sharp pain to the left side of his chest that worsens with deep inspiration. Given this description, you immediately become suspicious of a pneumothorax. Which action should you perform next to help confirm this suspicion?
auscultate breath sounds
Atrovent, if prescribed to the patient, is indicated for:
difficulty breathing
You have been dispatched to a home for a 16-year-old female patient with shortness of breath. On scene, you find the patient in bed with her mother at her side. Her mother states that her daughter has a fever with a past medical history of cystic fibrosis; she would like to have her daughter transported to the hospital for evaluation of possible pneumonia. As a knowledgeable EMT, you know that the underlying pathophysiology of cystic fibrosis is a:
a. condition in which excessive and thick mucous often plugs the airways.
When auscultating the lungs of an elderly patient, you note rhonchi-like noises in the upper regions of both lungs. As a knowledgeable EMT, you would recognize that this finding is caused by:
accumulation of mucus in the bronchi.
An alert and oriented 45-year-old female patient complains of shortness of breath. Although her respiratory volume and rate are satisfactory, you note cyanosis in her fingertips and you cannot get the pulse oximeter to show a reading. What should be your next action?
administer supplemental oxygen
You have been called to an industrial warehouse for a young adult male patient who was exposed to an unknown chemical gas. The patient was immediately removed from the environment and presents to you with a patent airway, burning to the throat with inspiration, and complaint of shortness of breath. His vital signs are pulse, 120; respirations, 28 breaths/min; blood pressure, 164/60 mmHg; and SpO2, 90%. In addition, you note bilateral wheezing to the lungs. What should be your first action in caring for this patient?
administer supplemental oxygen
The medication contained within a metered-dose inhaler is in which form?
aerosolized
A patient with difficulty breathing has a metered-dose inhaler (MDI). Which of these would be a likely type of medication contained in the MDI?
albuterol
Your medical director's written protocol instructs you to obtain on-line medical direction prior to assisting a patient with a metered-dose inhaler (MDI). Given thisprotocol, you must contact:
an emergency physician prior to assisting with the MDI.
Which of these therapies is the best option for definitively treating a known myocardial infarction (AMI)?
angioplasty
What is the best description of the purpose of the five rights of drug administration?
decreases the risk of a medication error
After being dispatched for a male patient experiencing dyspnea, you arrive to find the confused 67-year-old man sitting upright at his kitchen table in severe respiratory distress. You also note remarkable swelling to his lower legs and feet. He has an open airway, but cannot speak more than two to three words without attempting to breathe. His breathing is extremely labored, with inspiratory crackles heard upon auscultation. His skin is cool, diaphoretic, and dusky in color. A family member at the scene reports a history of hypertension, congestive heart failure, and angina, for which the patient takes nitroglycerin. The baseline vital signs are acceptable and theroom-air pulse oximeter reading is 45%. What is your immediate action in caring for this patient?
apply continuous positive airway pressure (CPAP).
You are caring for a 69-year-old male patient who is short of breath and in acute congestive heart failure. He is alert, anxious, and panicked, with an open airway and rapid shallow respirations. His heart rate is tachycardic, and his skin is cool and diaphoretic, with cyanosis noted to the lips and fingers. There are crackles noted in both lungs, as well as pedal edema in both feet. The patient denies chest pain or discomfort, but is having a difficult time speaking due to the shortness of breath. When caring for this patient, you should:
apply continuous positive airway pressure (CPAP)
You have been called for a 4-year-old female patient who told her mother that her chest hurts. On scene, the child is crying and points to her chest when asked if she has pain. Her airway is patent, respirations slightly labored, pulse rapid and regular, and skin warm and pale. Vital signs are pulse, 132; respirations, 28 breaths/min; blood pressure, 108/74 mmHg; and SpO2, 89%. The mother denies any medical history, medications, or allergies for her daughter. Your first action would be to:
apply oxygen
A 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he complained of a sore throat throughout the day, and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is very warm to the touch. Vital signs are pulse, 132; respirations, 28breaths/min; and SpO2, 90% on room air. Which is your first action in caring for this child?
apply supplemental oxygen
You are assessing a 73-year-old male patient who complains of altered mental status and shortness of breath. The patient is conscious, but confused. His pulse is rapid and weak, and his skin cool and diaphoretic. An Emergency Medical Responder provides you with the following vital signs: pulse, 136; respirations, 20breaths/min; blood pressure, 168/88 mmHg; and SpO2, 89%. A family member states that the patient has diabetes and takes insulin. He also has a history ofhypertension, colon cancer, irregular heartbeat, and transient ischemic attacks (TIA). Which action should the EMT take next?
apply supplemental oxygen
You are preparing to attach an AED when you notice that the patient has an implanted pacemaker. What should you do?
apply the AED, but avoid placing the electrodes over the pacemaker
For the EMT to administer aspirin in the prehospital setting, which of these criteria must be met?
approval from medical direction
Which of these is a generic drug name?
aspirin
Which of these medications would the EMT administer PO?
aspirin
A 67-year-old male patient with a history of coronary artery disease and COPD called 911 for chest discomfort and mild dyspnea. When you are at the patient's side, he states that the pain started when he was cleaning out his garage, but after a period of rest, the pain has resolved. His airway is patent, breathing adequate, radial pulseirregular, and skin warm and dry. He has a past medical history of atrial fibrillation (irregular heartbeat), coronary artery disease, and diabetes, for which he takes insulin. Vital signs are pulse, 68; respirations, 16 breaths/min; blood pressure, 148/88 mmHg; and SpO2, 97% on room air. The patient took 81 mg of aspirin as prescribed this morning on awakening. What should you do first?
assess breath sounds
As you enter the living room of an adult patient who called 911 for shortness of breath, you observe the patient sitting upright in a chair with a panicked look on herface, struggling to breathe, with obvious suprasternal retractions. Her breathing rate appears to be fast and her tidal volume poor. You can hear rhonchi from her lungs without the aid of a stethoscope. Once at her side, your initial care should be to:
assess her airway
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?
assess his airway
A patient informs you that he has a history of an abdominal aortic aneurysm. To best assess the status of this condition, you should:
assess the abdomen
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?
assess the patient airway and breathing adequacy
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?
assist respirations
Which of these is most appropriate when two EMTs are performing CPR on an adult patient?
at least 100 compressions per minute
The EMT is properly using a small-volume nebulizer when she:
attaches the nebulizer to oxygen at 8 to 10 lpm
An obstruction of the pulmonary artery will cause:
backup of blood in the right side of the heart
Which medical emergency would most likely be treated with the use of epinephrine by the EMT?
bee sting
A patient has a low platelet count. Based on this finding, which complication is he most at risk for?
bleeding
Which one of the following conditions could be responsible for causing obstructive shock?
blood clots in the lungs
During your reassessment of the respiratory system and oxygenation status of a patient with a chronic pulmonary condition, which of these would most likely not be part of this reassessment process?
blood glucose level
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?
blood pressure of 88/50 mmHg
A patient with a severe gastrointestinal bleeding is in shock. Which ALS or hospital interventions would best correct the patient's underlying problem?
blood replacement
When assessing an adult patient with difficulty breathing, which of these signs or symptoms would be of most immediate concern?
blue coloration to the lips
You have been called to a home for an 18-year-old male patient, who informs you that he experienced a sudden onset of shortness of breath and back pain while watching television. He has a history of spontaneous pneumothorax, and the current symptoms he is experiencing are identical to those he felt with a previous pneumothorax. Assessment reveals the patient to be slightly dyspneic with breath sounds clear and intact bilaterally. During transport, what is most critical to continually monitor on this patient?
breath sounds
Auscultation of breath sounds in a patient complaining of shortness of breath reveals wheezing. Which condition is responsible for this finding?
bronchiole constriction
A 67-year-old male patient complains of shortness of breath. The patient cannot remember how many times he used his inhaler prior to your arrival, but he knows it has been multiple times. He is tachypneic and tachycardic. After administering oxygen, what should be your next action?
call Medical direction for advice
You are assessing an elderly patient with a decreased level of consciousness. Your assessment reveals the patient to have a patent airway, labored respirations, andweak, 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 99degrees°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?
cardiogenic
All arteries:
carry blood away from the heart
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?
check for a carotid pulse
Immediately after assisting a patient with diabetes to take her nitroglycerin, she states that she feels weak, dizzy, and nauseated. What should the EMT do next?
check her blood pressure
You have just arrived by the side of a 68-year-old male patient who complains of chest pain. After determining his airway is patent and breathing adequate, it is imperative that you perform which action next?
check his radial pulse
The EMT realizes that the best means of preventing failure of the AED is to:
check the AED battery and its supplies at the beginning of each shift
A patient has fallen down a flight of stairs, and is now restless and confused. His airway is 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?
check the blood pressure and assess for injuries causing blood loss
You have been called for a patient with angina. On scene, the 67-year-old man reports that he has a history of angina and the pain started when he was moving firewood from the garage into his house. Unfortunately, the pain has yet to go away, despite three nitroglycerin tablets and 20 minutes of rest. Your next action should be to:
check the patients vital signs
A patient complains of chest pain that radiates into his neck and arms. The primary assessment reveals a patent airway, adequate breathing, and a strong, regular radial pulse. The patient's skin is warm and dry, and reveals no signs of inadequate perfusion. What should you do next?
check vital signs
The EMT is correctly accessing for accessory muscle use when he examines which part of the body?
chest
The EMT should consider aspirin for a patient with:
chest discomfort
The primary function of the heart is to:
circulate blood
A patient with a history of diabetes is confused and irritable. According to family members, he accidentally took too much insulin this morning and did not eat breakfast. Since he is conscious with an intact gag reflex, medical direction orders you to administer oral glucose. Which component of this situation best represents the indication for the medication?
confusion and irritability
An alert and oriented patient presents with shortness of breath, crackles in both lungs, jugular venous distention, and edema to the feet and ankles. Her pulse is 132, respirations 26 breaths/min, blood pressure 160/86 mmHg, and SpO2 at 88%. Based on these findings, the EMT should suspect:
congestive heart failure
A patient who is short of breath and has a history of right arm paralysis from a stroke has asked you to help him use his metered-dose inhaler containing albuterol. Since your medical director requires on-line authorization for albuterol, you would:
contact medical direction for authorization
The label on a patient's prescribed metered-dose inhaler reads as follows: "Administer three puffs as needed for shortness of breath." Your protocols state that you can assist with only two puffs without medical direction consultation. The patient is extremely short of breath. What should you do?
contact medical direction for orders to administer three puffs
On an ECG, the QRS represents:
contraction of the ventricles
When performing the primary assessment, which sign or symptom best indicates that the patient is in hypovolemic shock?
cool and diaphoretic skin
Which sign or symptom would the EMT typically associate with congestive heart failure?
crackles in both lungs
A patient with chest pain and shortness of breath informs you that the last time he had a heart attack, he went into heart failure. When performing your secondaryassessment, which sign or symptom is most indicative that the patient is in heart failure again?
crackles in the lungs
You are treating a 67-year-old male patient with chest pain and a history of prior heart attacks as well as diabetes and hypertension. The patient has taken three nitroglycerin tablets, which have decreased his pain from 7/10 to 4/10; however, the pain persists. Initially, his SpO2 was 91% on room air. Oxygen was applied by nasal cannula and now, on 3 lpm O2, his SpO2 is 97%. How would you address the oxygen administration, given that the patient still has chest pain?
decrease the oxygen flow to 2 lpm
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?
decreased blood pressure
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?
down time is 8 minutes
A patient with a history of COPD is breathing 32 times a minute. Her vital signs are pulse, 140; blood pressure, 168/102 mmHg; and SpO2, 98% on room air. You would classify this patient's condition as:
dyspnea
Which link of the American Heart Association's Chain of Survival must occur first, if a patient is to survive cardiac arrest?
early activation
You suspect that a patient with a history of chronic obstructive pulmonary disease (COPD) is has right ventricular failure. In your assessment, which finding would reinforce this suspicion?
edema to the feet
Resuscitation, when started during which phase of cardiac arrest, provides the patient with the best chance of survival?
electrical
An EMT has just received a "shock advised" message from the AED. Just before delivering the shock, the EMT must:
ensure that all rescuers are clear of the patient
Which of these actions would be most important when administering aspirin to a patient with chest pain?
ensuring that the patient can follow directions and has an intact gag reflex
As compared to an adult, how would you describe the respiratory rate of an infant?
faster than an adults rate
What are the protein strands that strengthen a clot called?
fibrin
The tricuspid valve prevents blood from:
flowing from the right ventricle into the right atrium
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?
fully automated
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?
hairy chest
A 6-year-old female patient is in acute respiratory distress and is still breathing adequately but will not keep the nonrebreather face mask on her face. In this situation, the EMT should:
have the mother hold the mask near her daughters face
The primary control or automaticity of the heart rate originates in the:
heart
The three primary components of the cardiovascular system are best described as:
heart, blood vessels and blood
After you administer a medication through a metered-dose inhaler (MDI) and the patient has inhaled the medication, it is important that the patient:
hold her breath for several seconds
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?
hypovolemic
A 36-year-old patient has overdosed on an unknown drug and is unresponsive. His breathing is shallow, with a rate of 6 breaths/min. He has cyanosis around his lips and to his fingertips. His skin is cool to the touch, and his radial pulse is rapid. His breath sounds are diminished but clear. The EMT should recognize which respiratory condition from this assessment?
hypoxia
A 48-year-old male patient is short of breath and confused. His airway is open, and his breathing is fast. A radial pulse is easily palpated. His skin is warm to cool and dry. Your partner reports the following vital signs: pulse, 124; respirations, 24 breaths/min; blood pressure, 158/86 mmHg; and SpO2, 89% on room air. The patient's lung sounds indicate slight wheezing. Based on this information, which of these conditions poses the most immediate threat to this patient's well-being?
hypoxia
The pathophysiology of heart failure that causes the common signs and symptoms of cardiogenic shock is:
inadequate ejection of blood from the left ventricle
When a child starts to become hypoxic, the pulse will initially:
increase
A paramedic administers a medication to decrease the effect of the parasympathetic nervous system on the heart. In response to this treatment, the EMT would expect which vital sign change?
increase in heart rate
Sympathetic nervous system stimulation will cause the heart to:
increase the heart rate
You are treating a patient who complains of altered mental status, shortness of breath, and chest pain. A paramedic has just administered a medication that causes the sympathetic nervous system to increase its influence in the body. Which finding should you anticipate after this treatment?
increased heart rate
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:
infection
You are assisting a paramedic in the transport of a patient from a community hospital emergency department to a large medical center. The patient was diagnosed with an acute myocardial infarction and received fibrinolytic therapy in the ED. Currently, you are transporting the patient with the fibrinolytic medication infusing through an IV. In regard to the fibrinolytic therapy, you know that during this transport, you will need to closely monitor the patient for which complication?
internal bleeding
The route by which the EMT would administer epinephrine is:
intramuscular
Dysfunction of the heart's electrical conduction cells from ischemia or infarction may cause:
irregular heartbeats
A patient in respiratory distress is exhibiting pursed lip breathing. You realize that he is doing this to:
keep the small airways open
You are starting to assess a patient's breath sounds and have just listened to the upper right back. You would next listen to the:
left upper back
Chronic and untreated hypertension will affect which part of the heart first?
left ventricle
Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back up into the alveoli?
left ventricle
A 44-year-old male patient is experiencing chest pain. He has a history of angina and is prescribed nitroglycerin, which he has not taken yet. He is also taking another medication. Which of these medications is a contraindication to the administration of nitroglycerin?
levitra
You are at an extended care facility for the elderly to assess and transport a patient suspected of having pneumonia to the hospital for evaluation. During your pulmonary assessment, which breath sound would you expect to hear that would be most specific to pneumonia versus other pulmonary conditions?
localized wheezing to one side of the chest
A 71-year-old female patient is lying in bed and complaining of respiratory distress. She exhibits moderate dyspnea, crackles in both lungs, and edema to the abdomen and lower extremities. Supplemental oxygen is being provided to the patient by Emergency Medical Responders. Her vital signs are as follows: pulse, 132; respirations, 18 breaths/min; blood pressure, 138/86 mmHg; and SpO2, 95%. Which of these actions would be of the most immediate benefit to the patient?
position the patient in a sitting upright position
A patient with an unknown medical problem is responsive to painful stimuli and breathing poorly at a rate of 8 breaths/min. The airway is patent and the skin warm and moist. The patient's radial pulse is strong and irregular. Breath sounds are absent over the bases of the lungs. Vital signs are pulse, 84; blood pressure, 256/120mmHg; and SpO2, 81%. The best treatment for this patient's breathing difficulty would be:
positive pressure ventilation.
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:
press the shock button, and then perform CPR for 2 minutes.
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?
prevention of cardiac arrest
You have been called for a 3-year-old male patient who is "not breathing right." Aside from a notable expiratory wheeze, which of these findings would be a cause of great concern?
prolonged and forced expiration
After blood enters the right ventricle, it next moves into the:
pulmonary artery
A patient who is nonverbal from a previous stroke is in severe respiratory distress. A family member states that she has multiple medical problems, including high bloodpressure, diabetes, and heart failure. When assessing this patient, which sign or symptom would raise your suspicion that the patient has heart failure?
pulmonary crackles
A patient complaining of shortness of breath and dizziness has called 911. Her history includes chronic obstructive pulmonary disease (COPD). When assessing thepatient, which of these findings would cause you to immediately prepare the patient for transport?
pulsating mass in the abdomen
The best way to gauge the effectiveness of oxygen therapy is to monitor the:
pulse oximetry
When administering oxygen to a patient with chest pain, which of these should be used a guide to its use and maintenance?
pulse oximetry reading
A patient has called 911 for chest pain that he describes as "tearing" and radiating between his shoulders. His airway is patent, breathing accelerated but adequate, and radial pulse intact. Your partner reports the following vital signs: pulse, 120; respirations, 22 breaths/min; blood pressure, 88/64 mmHg; and SpO2, 96% on room air. At this time, you should:
recheck the blood pressure in the other arm
When treating a patient with chest discomfort, the EMT's primary goal is to:
recognize the possibility of cardiac compromise and provide proper care.
A patient who is chronically hypoxic because of anemia most likely has a problem with which component of the cardiovascular system?
red blood cells
To save additional heart muscle from dying when a patient suffers an acute myocardial infarction (heart attack), which treatment must occur?
relieving the obstruction in the coronary arteries
What is the most common cause of cardiac arrest in infants and children?
respiratory compromise
A 4-year-old female patient is having great difficulty breathing. She is responsive to verbal stimuli and has an open airway. Her respiratory rate is 40 breaths/min, and she has an SpO2 reading of 88%, which has dropped from 90% despite high-concentration oxygen through a pediatric nonrebreather mask. Her pulse is rapid, and her skin cool to the touch. As a knowledgeable EMT, you would recognize these findings as associated with which condition?
respiratory failure
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 shouldimmediately:
resume cardiopulmonary resuscitation
Which of these is one of the five rights of medication administration?
right dose
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?
shock findings for this age
After you assist a patient with use of her EpiPen, she tells you that it is much easier for her to breathe. However, her heart rate has increased from 92 to 118 beats/min. Regarding the epinephrine, the EMT recognizes the increased heart rate as a(n):
side effect
The primary pacemaker site of the heart is the:
sinoatrial node
On scene, you suspect that a young female patient is suffering from hyperventilation syndrome. Which additional finding would best assist you in confirming thissuspicion?
spasm of the hands
A son has called 911 for his father, who is having difficulty breathing. On scene, the 81-year-old patient is lying on a couch in the living room, lethargic, and in obvious respiratory distress. He is confused, but has an open airway. His respirations are 38 breaths/min and shallow, and his skin is extremely diaphoretic with cyanosis in the fingertips. At this time, the EMT should:
start positive pressure ventilation
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:
start positive pressure ventilation
A 4-year-old female patient with a decreased level of consciousness is in respiratory distress. Her airway is patent and respirations are 12 per minute. Breath sounds are diminished bilaterally, and there is noted accessory muscle use with inspiration and expiration. Her pulse is 84 and SpO2 88%. What should be your immediateaction?
start positive pressure ventilation
On scene, you find a 2-year-old male patient in significant respiratory distress. He is responsive to painful stimuli and exhibits noisy respirations through an open airway. His breathing is shallow at a rate of 44 breaths/min. His pulse is rapid. Assessment of the skin shows it to be cool and diaphoretic, with cyanosis to the extremities and around the mouth. What is the immediate priority for this patient?
start positive pressure ventilation
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?
start transport to the hospital and inform the ALS dispatcher of your intent
Which audible respiratory sounds would make you suspicious of an upper airway problem?
stridor
You have been called for a 58-year-old male patient with an unknown medical emergency. On scene, you find the alert and oriented patient complains of headache as well as weakness and "tingling" to his right arm and leg. He has diabetes and high blood pressure, for which he takes the appropriate medications. When asked, he reports that he may have passed out earlier in the day, immediately after taking his morning dose of insulin. His pulse is 96, respirations 16 breaths/min, and blood pressure 180/106 mmHg. Based on this presentation, you should treat the patient for:
stroke
You are completing the prehospital care report and are documenting the fact that you assisted a patient in taking his nitroglycerin pill. How will you document the route of administration?
sublingual
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?
suction the airway
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?
supplemental oxygen
In which form is activated charcoal administered?
suspension
When reviewing a prehospital care report, you note that a patient received nitroglycerin sublingually. As an EMT, you should recognize that this medication was a:
tablet placed under the tongue
Which sign or symptom should the EMT expect in a patient who has a chronically low white blood cell count?
temperature of 103.4 F
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?
the AED can be used, but the adhesive pad should not be placed directly over the pacemaker
When a person is in shock, what is occurring in the body?
the cells are not getting enough oxygen, and waste products are accumulating
You are by the side of a 77-year-old male patient with a complaint of shortness of breath. Auscultation of his lungs indicates crackles in the bases. In addition, both of his feet are swollen. His SpO2 on room air is 82%. The remainder of his vital signs are pulse, 144; respirations, 26 breaths/min; and blood pressure 168/90, mmHg. The patient reports lower back pain with a history of a "pinched nerve" in that area. He states that he always has this pain. He has difficulty finishing his sentences without gasping for air. What is the most appropriate care for this patient after initiating oxygen?
transport him in a sitting position
A patient in cardiac arrest has regained a pulse after two shocks, but is still apneic. Which action would be appropriate next?
transport the patient supine and secured to a long spine board as treatment is continued
A 56-year-old female patient with a smoking history and COPD complains of the sudden onset of shortness of breath and diaphoresis. Her history indicates no cardiac diagnosis but previous drug abuse 8 years ago. Vital signs are pulse, 96; respirations, 18 breaths/min and mildly labored; blood pressure, 168/102 mmHg; and SpO2, 96% on home oxygen at 4 lpm, which she wears for COPD. The patient's lung sounds are clear but diminished bilaterally. What is your best action?
turn down the oxygen to 2 lpm, monitor, and transport.
You are administering positive pressure ventilation to an elderly male patient with a history of chronic obstructive pulmonary disease (COPD). Which point must you keep in mind as you care for this patient?
use of a CPAP may rupture the lung tissue and cause a pneumothorax
Which of these identifies the major elements of the pathway that blood takes through the heart in the correct sequence?
vena cava, right ventricle, pulmonary artery, left ventricle, aorta
A patient has just gone into cardiac arrest. His heart is most likely in which rhythm?
ventricular fibrillation
Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and ischemia, which then contributes to the rhythm deteriorating to:
ventricular fibrillation
Which cardiac arrest rhythm is the AED designed to shock?
ventricular fibrillation
The AED should never be applied to a patient who is not in cardiac arrest because some patients in:
ventricular tachycardia may still have a pulse.
You realize the EMT is properly ventilating an unresponsive adult male patient when:
you observe the pulse oximeter trending upward
You have been called for a 56-year-old female patient who complains of chest pain. She informs you that she takes nitroglycerin and asks you to get it from the top of her refrigerator. You find it is a clear glass jar hand-labeled "nitroglycerin." What of these statements, based on this observation, would be the most appropriate one to make to the patient?
"It is best to keep the nitro in a dark container since light will inactivate it."
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?
"Let's stop CPR so I can check the airway, breathing, and circulation."
The EMT understands adequate breathing when he states:
"Normal and adequate breathing is specific to the patient and is determined by assessment."
Which of these statements made by your EMT partner regarding care for the adult patient in cardiac arrest is accurate?
"When using an AED, the machine should be turned on before applying the electrodes."