(Operations) Practice Exam

partial-thickness burn.

A 10-year-old male has spilled hot water from a pan onto his chest. The skin is turning red and blisters have begun to form. You would most likely classify this type of burn as a:

initiate a focused examination of the patient's knee.

A 12-year-old male has injured his knee after a minor bicycle crash. He is alert and complains only of knee pain. After completing your primary assessment, you should:

A

A 14-year-old female complains of difficulty breathing and vertigo. You note she has hives on her chest and abdomen. After completing the primary assessment, what is the most important element of your SAMPLE history?

Move the patient to the ambulance and out of the view of the crowd.

A 16-year-old female has fallen in front of her school. She complains of ankle pain. A crowd has gathered. What is the best strategy for assessing this patient?

Seizures

A 17-year-old pregnant female presents with altered mental status. Her boyfriend notes she is 40 weeks pregnant with twins and states, "I can't wake her up." She presents confused and is flushed with obvious swelling in her hands and face. Her vital signs are pulse 90, respiration 28, blood pressure 200/112. What is the most likely immediate complication for this patient?

N95 mask

A 19 year old male complains of fever, sweating, and persistent cough for one week. He is currently not coughing. While treating him, which one of the following is the most appropriate level of personal protective equipment?

Carbon monoxide might be occupying the hemoglobin

A 20-year-old male has been rescued from a fire. He complains of a headache and shortness of breath. Your pulse oximeter reads 95%. Why might the pulse oximeter be inaccurate in this situation?

Straighten and splint the arm.

A 21-year-old female has open, midshaft fractures of her radius and ulna. Bleeding is severe. After applying direct pressure, which one of the following steps would be most appropriate to help control the bleeding?

Remove the OPA.

A 24-year-old suspected overdose patient is found lying on the floor of his apartment. He is unconscious with slow labored respirations. When you attempt to insert an orophyarngeal airway (OPA), the patient gags. What is the most appropriate next step?

suction the airway

A 26-year-old male crashed his motorcycle and was found unconscious on the ground. You notice he is not breathing and has blood coming from his mouth. You should first:

increase tidal volume.

A 26-year-old male is unconscious after a motor-vehicle crash. His airway is patent but he is breathing very rapidly. His respiratory rate is 58, and you notice he is slightly cyanotic. In this case the most important reason to initiate positive pressure ventilation is to:

she has an altered mental status.

A 28-year-old female has ingested about 30 unknown pills. She is semiconscious and her vital signs are pulse 128, respiration 12, blood pressure 88/40. Poison control notes that activated charcoal should be administered. In this case charcoal is contraindicated because:

Apply and inflate the pneumatic anti-shock garment (PASG).

A 29-year-old female has been ejected from a vehicle during a high-speed motor-vehicle crash. She is found unconscious, and you note an unstable pelvis. Her vitals are pulse 130, respiration 38, blood pressure 60/44. What is the most appropriate method to splint her pelvis?

infection.

A 29-year-old male has been involved in a motorcycle crash. He has a large abrasion on his left thigh and lower leg. The most significant threat from this type of injury would be:

agitated delerium.

A 31-year-old male is being arrested by police. As you arrive, police officers are attempting to restrain the patient in order to place him in handcuffs. The patient is extremely combative and is fighting with great force. As the struggle continues, one of the officers says, "I don't think he is breathing." A respiratory arrest in this type of situation is most likely associated with:

apply direct pressure with a clean dressing

A 35-year-old male has lacerated his upper thigh with a chain saw. The wound is bleeding profusely. He has no other obvious injuries. You should first:

9

A 45 year olf male was thrown off a motorcycle when it struck a car. The patient was not wearing a helmet. He opens his eyes and pulls away when you stimulate him. When you ask him questions he provides inappropriate responses to your questions. His Glascow Coma Scale score is

administer high-concentration oxygen via nonrebreather mask.

A 50-year-old male has suffered a deep laceration to his leg in an industrial accident and has lost a great deal of blood. You initiate hemorrhage control and stop the bleeding with a pressure dressing. You should next:

initiate transport to rule out acute myocardial infarction

A 64-year-old male complains of steady abdominal pain radiating across both upper quadrants. He also complains of nausea. His vital signs are: pulse 100, respiration 20, blood pressure 158/90. Given his presentation, you should first:

administer aspirin and initiate transport.

A 70-year-old female complains of acute onset pressure in her jaw. She denies pain but notes the discomfort radiates into her neck. She is alert and her vital signs are pulse 90, respiration 20, blood pressure 160/68. You should:

Pedal edema

A 70-year-old female is complaining of chest pain and shortness of breath. Which one of the following detailed assessment findings might be relevant to her current condition?

start resuscitative efforts

A 72-year-old male patient is found in cardiac arrest. The family on scene states that the patient did not wish to be resuscitated and asks you not to start CPR. There is no "do not resuscitate order." You should:

blood is passing through the nasopharynx

A 72-year-old patient has a severe nosebleed. The patient begins to cough and choke. This airway compromise is possible because:

aortic aneurism.

A 90-year-old female is complaining of sharp, steady abdominal pain. When you palpate her abdomen, you feel a pulsating mass in the lower left quadrant. This finding most likely indicates a(n):

Perfusion status, respiratory status, mental status

A factory explosion on the outskirts of your EMS response area has injured between 15 to 25 workers. According to protocols, the first unit in will implement the "START" Triage System. What are the assessment parameters that are used to determine patient placement into treatment sectors?

hypoxia

A one-year-old male has had a fever for three days and now has developed wheezing and severe respiratory distress. You notice his skin is hot and cyanotic around the lips. The patient suddenly begins to seize. The most likely cause of the seizure in this patient would be:

Bone fractures

A patient diagnosed with bone cancer will typically experience what other types of problem?

Tension pneumothorax

A patient has suffered a penetrating chest injury following an explosion at a construction site. You have applied an occlusive dressing to the wound and initiated PPV for ventilatory insufficiency. Shortly thereafter the patient's heart rate continues to climb, he becomes cyanotic and the pulse ox drops. The patient is now totally unresponsive, and he is difficult to ventilate. What is the most likely reason for this patient's acute deterioration?

Pulmonary edema

A patient presents to you with dyspnea, accessory muscle use, a diminishing pulse ox reading on oxygen, chest pain, inspiratory rales, and tripod positioning. He states that the trouble breathing started before the chest pain. He has a history of heart failure and hypertension. This patient is likely experiencing what respiratory emergency?

Cervical

A patient was a rear seat occupant in a vehicle that was struck from behind by a tractor-trailer that couldn't stop fast enough. There was significant external damage to the car with minimal passenger compartment damage. The patient sustained a vertebral injury. Given this mechanism, what region of the spine would most likely be injured?

Q

A patient with chest pain is being evaluated and tells you the pain is sharp and feels like it is cutting through his chest. What letter of the mnemonic OPQRST does this answer?

Postictal

A pediatric patient with a history of epilepsy is experiencing a grand mal seizure. Upon your arrival the pediatric patient is still seizing, is ashen in color, the jaw is clenched shut, and it appears as if there is vomit escaping from between his teeth. During what phase of a seizure will you most likely be able to clear the airway of these secretions?

scrape the stinger away with a credit card.

A seven-year-old male has been stung in the leg by a bee. He complains of pain. You note redness and slight edema at the site. You also note the stinger is still in place at the site of the sting. You should:

ask the patient's parents to assist you with suctioning the tracheostomy tube.

A six-year-old male patient is ventilated through a home respirator. You were called today because the patient's oxygen saturations have been low. As you assess the patient, you notice many secretions in the tracheostomy tube and gurgling on inhalation. You should:

Acute

After a particularly bad call involving a pediatric trauma arrest, you notice your partner to be extremely agitated, sweating, verbally aggressive, and pacing about the station muttering to himself. These findings may be indicative of what kind of stress reaction?

a violation of your scope of practice.

After finishing a radio report detailing your chest-pain patient, the medical control physician instructs you to administer nitroglycerin. The patient does not take this medication and in your state EMTs do not administer it. However, the medication is carried on your ambulance for use by paramedics. In this case administering nitroglycerin would be:

administration of high-flow oxygen via nonrebreather mask

An 18-month-old female has had a tonic-clonic seizure. You note the child is lethargic, flushed, and hot. The mother states she has had ear pain for the last eight hours. Her vital signs are: pulse 122, respiration 28, blood pressure 94/52. Treatment of this patient should include:

initiate transport immediately.

An 18-year-old female tells you that she has ingested 48 amitriptyline pills. She notes she was trying to harm herself and took the pills about 20 minutes ago. She is alert and her vital signs are pulse 120, respiration 20, blood pressure 100/60. You should first:

Low blood pressure

An 18-year-old male has fallen 30 feet from a ladder. He is semi-conscious and breathing rapidly. You feel for a radial pulse but it is absent in both arms. He does have a carotid pulse. What does this finding most likely indicate?

nonrebreather mask at 12 Lpm

An 81-year-old COPD female complains of three days of shortness of breath. She is alert, but you notice cyanosis in her fingernails and lips. The most appropriate oxygen delivery method for this patient would be a:

administer a tube of oral glucose.

An 81-year-old diabetic female presents with altered mental status. She is conversational, but confused as to where she is. She is pale and diaphoretic and her blood glucose is 62 mg/dL. You should first:

standard of care.

An EMT applies a traction splint upside down. By doing this he has violated his

27%

An adult female patient was cooking when there was a flare up that resulted in burns to the following areas: entire chest, entire abdomen, and circumferential to lower part (elbow to hands) of both arms. Using the "rule of nines," what percentage of body surface area is burned on this patient?

nitroglycerin.

An elderly male complains of fatigue, malaise, nausea, shortness of breath, and significant swelling of the ankles. All of these, he tells you, have developed over the past 24 hours. He has a history of MI, hypertension, diabetes, and prostate cancer. He takes blood pressure medication and aspirin daily. After administering oxygen you should administer

the potential for cardiac complications.

An electrician working on a dryer was thrown back after receiving an electrical shock. You notice a small burn on his hand, but no other injuries. The patient has bandaged his hand himself and does not wish to be transported. The most important reason to encourage this patient to be transported is:

Start CPR and attach an AED.

Arriving at the home of a patient who has chest pain, you are told that she has an automatic implanted cardiac defibrillator (AICD). After your assessment, you begin to gather a SAMPLE history. Before you finish, the patient loses consciousness. You determine she is apneic and pulseless. Of the following which one is the most appropriate action to take?

12 times per minute

At what rate should you ventilate an apenic patient who still has a carotid and radial pulse?

tip of the nose to the earlobe.

Before inserting a nasopharyngeal airway you should measure it from the :

laryngeal edema.

Disruption of upper airway patency in severe anaphylaxis is most likely caused by:

The patient

During the assessment of a 17-year-old female patient with abdominal pain and flank bruising, you are gathering the SAMPLE history and OPQRST findings. If you suspect that the patient is suffering from an ectopic pregnancy, who is the best person to direct these and other questions to?

Quality

During the assessment of a patient with chest pain from a suspected heart attack, he describes the pain as "dull" and "heavy" in nature. This description best serves as the answer to what question in the OPQRST history?

Occlusion of the airway

During the insertion of an OPA in a patient with sonorous airway sounds, you witness your partner not properly size the device before insertion. Should the OPA inserted be too large, what would the likely complication to airway patency be?

Embryonic stage

During the interview of a female patient thought to be experiencing a spontaneous abortion, she relays to you a prenatal history of poor nutrition, drug abuse, and smoking. During what stage of the fetal development would these habits have the greatest potential for malformation?

keep the ambulance in service and make an appointment with maintenance as soon as possible.

During your pre-shift ambulance inspection, you notice that one of the box warning flashers has burnt out. You should:

Beta 1

Epinephrine is a medication administered to a patient who is experiencing an acute allergic reaction due to its alpha and beta effects. One side effect is cardiac irritability and tachycardia. What property of epinephrine is responsible for this?

One car MVC on a heavily traveled freeway.

Of the following situations, which may be the most dangerous for the EMT to enter?

rapidly assess the likelihood of acute stroke

The Cincinnati Prehospital Stroke Scale is used to:

joint above and below the facture.

The appropriate technique for splinting a midshaft tibia/fibula fracture is to immobilize the:

preventing more than one set of tactics at a single incident.

The most important benefit of a unified command would be:

Provision of scene leadership

There are multiple tasks the EMT is responsible for on each EMS run. If the EMT must coordinate the rescue of a patient who is entrapped under rubble from a building collapse, this is an example of which EMT role?

Unstable

Upon arrival at the scene of a two vehicle MVC, you are directed by the fire department to a patient who was thrown from his vehicle. As you complete your primary survey, you note the patient is unresponsive with blood in the airway. Breathing is present and tachypneic. Peripheral pulses are absent. The patient has significant facial trauma and a grossly deformed left leg. Given the findings of the primary survey, how would you categorize the patient's physiologic status?

Lactic acid production

What detrimental side effect occurs at the cellular level when the body's metabolism shifts from aerobic to anaerobic metabolism?

The contents should be considered dangerous

When completing a scene size-up at a work site construction accident where a fork lift was accidently driven into the side of a tanker-trailer, you can see vapor clouds arising from the trailer. What should be assumed by the EMT regarding this observation?

EMS department name

When requesting a helicopter to your emergency scene the flight program will need certain information before launching an aircraft to your location. Of the following, which is the LEAST useful bit of information that the dispatcher from the flight program will need from you?

The heart does not have enough time to fill between beats.

Which one of the following best describes why abnormally fast heart rates cause a drop in cardiac output?

The upper part of the trachea is funnel shaped.

Which one of the following best describes why blind finger sweeps should be avoided in pediatric obstructed airway procedures?

Pulmonary edema

Which one of the following is a sign of left-sided heart failure?

Infants rely more upon their nose to breathe than do adults

Which one of the following reasons best indicates the importance of suctioning the nose of an infant in respiratory distress?

Hormones released during pregnancy cause ligaments to stretch.

Which one of the following reasons explains why you might have a higher index of suspicion for spine injury in a pregnant female compared to a nonpregnant female?

Inhalation

Which one of the following uses negative pressure to move air?

Temporary cavity

Which one of the following would be an injury limited to medium- and high-velocity penetrating trauma?

A three-year-old falls 11 feet without loss of consciousness

Which one of the following would be considered a significant mechanism of injury?

The heart is not pumping effectively.

While assessing the neck of a 72-year-old woman who is in the Fowler's position you observe bulging neck veins. She tells you she felt this way the last time she had fluid built up in her lungs. Of the following which one is the most likely underlying reason for this finding?

Pressure built up in the pleural space compresses the heart.

Why does tension pneumothorax lead to shock?

Absent basal breath sounds

You are assessing a male patient with COPD and respiratory distress. The patient displays nasal flaring, tripod positioning, absent basal breath sounds, and tachypnea. Of these findings, which is most suggestive of inadequate breathing?

I am not comfortable leaving equipment unsecured in the patient compartment

You are assigned to work with a new partner. As you check the ambulance he tells you that he prefers to leave the portable oxygen tank out of its normal rack and on the bench seat so it is easier to grab from the outside. Which one of the following would be the most appropriate response?

Asthma

You are called to a child-care center for a 10 year old boy with a quick onset of respiratory distress. You find the patient sitting on a step in a tripod position. The patient can only speak in short sentences and is using accessory muscles to breathe. You learn from the care providers that the patient has a respiratory disease that requires the occasional use of a metered dose inhaler, which they have tried with no success. The child displays wheezing in all lung fields, a non productive cough, and says his chest is "tight". This presentation is most consistent with what pulmonary disease?

discuss with the patient your concerns based on your scene size-up.

You are called to respond for a 74-year-old male having chest pain. On arrival, the patient greets you at the door and tells you he is fine and does not need help. You note, however, that he is sweaty, pale, and gripping his chest. You should:

Respiratory rate 64/minute

You are caring for a neonate who you suspect is severely depressed and in need of aggressive resuscitation. Which of the below clinical findings would support your suspicion?

Loss of airway patency

You are caring for a pediatric trauma patient who was not properly belted into their car seat and was thrown from the vehicle when it exited the road and rolled multiple times. Given what is known about pediatric trauma and pediatric arrest situations, if this patient does go into cardiopulmonary arrest, what is the most likely cause of this?

attempt to determine what additional resources are necessary

You are first on scene at a motor-vehicle crash involving multiple vehicles. After ensuring that the scene is safe, you should:

return to the ambulance to change your gloves.

You are on the scene of a multiple-casualty motor-vehicle crash, where you have just loaded a patient who had severe bleeding. Your partner now asks you to assist him with a patient who has stopped breathing. You should first:

Breathing

You are treating a bariatric patient with a pathological lumbar fracture. During the difficult patient handling, positioning, extrication, and transport on the cot - there are multiple times when you must lay the patient flat. During these times, what vital bodily function must be diligently monitored?

reassessing previously triaged patients to account for patient deterioration.

You are working at a multiple-casualty incident. Your assignment is secondary triage. Your responsibilities would likely include:

wear a reflective vest and limit on scene time.

You are working on the scene of a highway motor-vehicle crash. Traffic is moving past the crash site. In order to protect yourself you should:

request extrication resources

You arrive first on scene of a serious motor-vehicle crash. You observe a minivan with massive front-end damage and four people inside the vehicle. As you complete your scene size-up, you should first:

"The primary goal is to learn how to always arrive safely at your destination."

You have just completed your emergency vehicle operation program for the local EMS service you work for. When you come in for your next shift, you are assigned an EMS intern who asks you about this class, and wants to know what the class is about. Of the following statements, which would be the most accurate in describing such a class?

Dehydration (shock)

You have responded to a call to the residence of an ill 20-month-old. When you arrive, you notice a pale, limp child with a weak cry being held by a woman who identifies herself as the mother. You attempt to get both a radial and brachial pulse but they are too weak. You listen over the heart with a stethoscope and find the pulse is too fast to count. The skin is cool and clammy, and the child's respirations are rapid. The physical exam is negative for DCAP-BTLS. The mother tells you that the diaper has been dry for hours. She adds that the baby has had very poor oral intake for the past two days. Of the following which one is most likely this patient's problem?

reach out to a supervisor and discuss your concerns.

You notice that a series of difficult calls has produced an abnormal amount of work-related stress. You should:

Bag-valve mask

You respond to a business office where a 50-year-old male is having difficulty breathing. Upon arrival you find him sitting in a chair with cyanosis around the lips, fatigue, and extreme diaphoresis. When he speaks, he uses only one- or two-word sentences, and he appears to be extremely anxious. Based on this information, which device is probably best for administering oxygen?

Upwind and uphill

You respond to a known hazardous-materials incident. A harmful gas has been released. Which one of the following describes the most appropriate placement for the ambulance?

protecting yourself from a secondary device

You respond to the scene of an explosion. Your scene size-up indicates that this situation may have been an intentional terrorist incident. Your most immediate concern should be:

notify dispatch that you will be delayed while changing the stretcher linen.

You transport a routine patient without incident. Immediately after transferring care to the ED, the dispatcher radios you that a priority call is holding. The stretcher has not been changed but does not appear dirty. You should:

Protect the airway.

Your patient has just finished actively seizing after a grand mal seizure. You should:

Blood pressure

Your patient is a 32-year-old hunter who has fallen from a tree. You perform a physical examination and find his vital signs are: pulse, 140 and thready; respirations, 30 and shallow; blood pressure, 80/50; and skin, pale and cool. Which one of the following findings indicates that this patient is in decompensated shock?

Larynx

Your patient is a cross-country motorcycle racer who crashed his motorcycle into a group of trees. Although he was helmeted, he sustained blunt trauma to the anterior neck and is now dyspneic. Damage to what structure in the neck can cause airway occlusion and death to the patient?

Expressed consent

Your patient is complaining of severe respiratory distress and has trouble speaking in full sentences. He makes it obvious though through hand gestures and shaking his head "yes" to you that he wants your help. What type of patient consent would this legally fall under?

Wheezing will be heard initially on exhalation. Eventually the wheezing will be heard on inhalation and exhalation.

Your patient states he has asthma. Asthmatics can develop wheezing. Which of the following best describes the progression of wheezing as the patient's condition worsens?

contact dispatch to warn other responders of the hazard.

Your scene size-up reveals a hazardous gas has been accidentally released. You stage away from the scene at an appropriate distance but can visualize the damaged tank truck. You should next:

something about that run needs to be discussed to improve quality of care.

Your service's quality improvement (QI) committee asks you to discuss a recent run. This means: