Unit 1

80. The first sign(s) of IV occlusion is/are: A) a varying flow rate when the IV catheter is manipulated. B) local tissue swelling and a progressively slowing drip rate. C) point tenderness and an abrupt cessation of the IV flow rate. D) a decreasing drip rate or the presence of blood in the IV tubing.

D) a decreasing drip rate or the presence of blood in the IV tubing.

178. Approximately 20 minutes after starting an IV on a 40-year-old man, he begins complaining of a backache and chills. You should be MOST suspicious of: A) an air embolus. B) an allergic reaction. C) circulatory overload. D) a pyrogenic reaction.

D) a pyrogenic reaction.

50. Situational depression is: A) often characterized by violent bouts of rage. B) ongoing and does not appear to have a cause. C) a condition that usually requires inpatient care. D) a reaction to a stressful event in a patient's life.

D) a reaction to a stressful event in a patient's life.

118. An ET tube that is too large for a patient: A) is much more likely to enter the esophagus. B) will lead to an increased resistance to airflow. C) will make ventilating the patient more difficult. D) can be difficult to insert and may cause trauma.

D) can be difficult to insert and may cause trauma.

75. Common risks associated with cannulation of the external jugular vein include all of the following, EXCEPT: A) an air embolism. B) carotid artery damage. C) a rapidly expanding hematoma. D) cannulation of the subclavian vein.

D) cannulation of the subclavian vein.

122. At 15 g/kg/min, dopamine: A) reduces cardiac contractility. B) antagonizes alpha-1 receptors. C) activates beta-2 receptor sites. D) causes vigorous vasoconstriction.

D) causes vigorous vasoconstriction.

148. Capnography can serve as an indicator of: A) proper ventilatory depth. B) cerebral perfusion pressure. C) coronary perfusion pressure. D) chest compression effectiveness.

D) chest compression effectiveness.

57. When preparing an IV administration set, you should NOT: A) invert the bag if the drip chamber contains too much fluid. B) run IV fluid through the administration set to flush air out. C) fill the drip chamber of the administration set with IV fluid. D) cleanse the piercing spike before inserting it into the IV bag.

D) cleanse the piercing spike before inserting it into the IV bag.

25. The tonicity of a solution is determined by the: A) velocity with which potassium ions shift outside of the cell and sodium ions shift inside the cell. B) permeability of the cell and the ability of sodium and potassium to actively move across its membrane. C) amount of antidiuretic hormone the body produces and the volume of water that is reabsorbed in the tubules of the kidneys. D) concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell.

D) concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell.

149. The use of 0.9% sodium chloride (normal saline) should NOT be considered for patients with: A) freshwater drowning. B) diabetic ketoacidosis. C) shock due to blood loss. D) congestive heart failure.

D) congestive heart failure.

34. The mnemonic "OPQRST" is a tool that: A) is only effective when assessing a patient who is experiencing severe pain. B) allows the paramedic to reach a field diagnosis quickly and initiate treatment. C) is used commonly to rule out conditions that are immediately life threatening. D) offers an easy-to-remember approach to analyzing a patient's chief complaint.

D) offers an easy-to-remember approach to analyzing a patient's chief complaint.

83. Etomidate is a medication that: A) chemically paralyzes a patient prior to intubation. B) requires multiple doses to provide adequate sedation. C) has a duration of action of approximately 45 minutes. D) induces profound sedation following a single dose.

D) induces profound sedation following a single dose.

201. When checking the cuff of the LMA prior to insertion, you should: A) stretch the cuff to check for tears or other damage. B) inflate the cuff with 100 mL of air and then deflate. C) gently pull on the cuff at the tube to ensure integrity. D) inflate the cuff with 50% more air than is required.

D) inflate the cuff with 50% more air than is required.

136. After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then: A) attach the bag-mask device and ventilate. B) secure the tube with a commercial device. C) attach an ETCO2 detector to the tube. D) inflate the distal cuff with 5 to 10 mL of air.

D) inflate the distal cuff with 5 to 10 mL of air.

33. The dorsal respiratory group is primarily responsible for: A) motor control of the inspiratory and expiratory muscles. B) decreasing the respiratory rate when the blood pH is above 7.45. C) terminating inspiration in order to prevent pulmonary overexpansion. D) initiating respiration based on information received from the chemoreceptors.

D) initiating respiration based on information received from the chemoreceptors.

148. Drug reconstitution involves: A) shaking a medication vial vigorously so that the drug is appropriately separated from its liquid base. B) adding 3 mL to 5 mL of sterile saline to an already existing liquid medication to achieve the appropriate concentration. C) injecting a certain volume of a medication into a 500-mL bag of normal saline to achieve the correct concentration. D) injecting diluent or sterile water from one vial into the vial that contains the powdered form of the medication.

D) injecting diluent or sterile water from one vial into the vial that contains the powdered form of the medication.

30. Which of the following questions will yield the LEAST reliable information when assessing a patient with abdominal pain? A) "In your opinion, how severe is the pain?" B) "Are you experiencing any other symptoms?" C) "Does the pain radiate to your chest or back?" D) "Have you ever experienced pain like this before?"

C) "Does the pain radiate to your chest or back?"

99. What phases of the cardiac cellular action potential comprise the absolute refractory period? A) 1 and 2 only B) 2 and 3 only C) 0 through 3 D) 0 through 4

C) 0 through 3

185. In some cases, atropine sulfate, in a dose of ______, may be given to children to prevent vagal-induced bradycardia during ET intubation. A) 0.5 mg B) 1 to 2 mg C) 0.02 mg/kg D) at least 0.01 mg

C) 0.02 mg/kg

121. When assessing a hemodynamically stable child, the toe-to-head approach is generally indicated for children who are: A) younger than 12 months of age. B) younger than 2 years of age. C) 1 to 3 years of age. D) 4 to 5 years of age.

C) 1 to 3 years of age.

108. 1 mg is equal to ______ µg. A) 10 B) 100 C) 1,000 D) 10,000

C) 1,000

187. You are preparing to administer a dopamine infusion to a severely hypotensive patient. What is the concentration on hand if you add 800 mg of dopamine to a 500-mL bag of normal saline? A) 1.6 µg/mL B) 1,600 mg/mL C) 1,600 µg/mL D) 0.16 mg/mL

C) 1,600 µg/mL

133. What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? A) 10 B) 11 C) 12 D) 13

C) 12

106. Medical control orders you to administer 500 mL of normal saline over 1 hour to your patient. You have a macrodrip administration set that allows 15 gtts/mL and an 18-gauge catheter in the patient's antecubital vein. At how many gtts/min should you set the IV flow rate? A) 100 B) 110 C) 125 D) 150

C) 125

23. Approximately ____ mL of air remains in the anatomic dead space of an adult with a tidal volume of 500 mL. A) 100 B) 125 C) 150 D) 175

C) 150

67. If an adult patient does NOT require fluid replacement, which of the following over-the-needle catheters is usually an appropriate size to use? A) 14 or 16 gauge B) 16 or 18 gauge C) 18 or 20 gauge D) 22 or 24 gauge

C) 18 or 20 gauge

98. Repolarization and myocardial contraction are occurring through phases: A) 0 and 1. B) 1 and 2. C) 2 and 3. D) 3 and 4.

C) 2 and 3.

27. A healthy person loses approximately ___ to ___ liters of fluid daily through urine output, through exhalation, and through the skin. A) 0.5, 1 B) 1, 1.5 C) 2, 2.5 D) 3, 4

C) 2, 2.5

118. A prefilled syringe of lidocaine contains 100 mg/5 mL of volume. How many milligrams per milliliter (mg/mL) are present in the syringe? A) 5 B) 10 C) 20 D) 25

C) 20

168. When administering a medication via small-volume nebulizer, you should add ___ mL of sterile saline to the medication and set the oxygen flow rate at ___ L/min. A) 1, 3 B) 2, 4 C) 3, 6 D) 6, 10

C) 3, 6

24. The normal alveolar volume in a healthy adult is: A) 250 mL. B) 300 mL. C) 350 mL.. D) 400 mL.

C) 350 mL..

181. Medical control orders an infusion of 1 L of normal saline over 4 hours during a long-distance transport. You have a 1,000-mL bag of normal saline and a macrodrip administration set that allows 10 gtts/mL. At how many gtts/min will you set the IV flow rate? A) 29 B) 36 C) 42 D) 50

C) 42

126. Following return of spontaneous circulation, you are ordered to begin a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 15 B) 30 C) 45 D) 60

C) 45

121. How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/50 mL? A) 100 B) 250 C) 500 D) 1,000

C) 500

15. The United States Pharmacopeia (USP) recommended temperature range for MOST medications in the prehospital setting is: A) 40°F to 76°F. B) 45°F to 80°F. C) 55°F to 86°F. D) 60°F to 90°F.

C) 55°F to 86°F.

114. A 130-lb patient weighs ____ kg. A) 49 B) 55 C) 59 D) 62

C) 59

1. Approximately ___% of an adult male's weight is constituted by water. A) 40 B) 50 C) 60 D) 70

C) 60

81. A patient takes 500 mg of a medication that has a half-life of 2 hours. How much medication will be in the patient's body after 6 hours? A) 250 mg B) 125 mg C) 62.5 mg D) 31.25 mg

C) 62.5 mg

119. Normally, an adult male will require an ET tube that ranges from: A) 6.5 to 7.0 mm. B) 7.0 to 7.5 mm. C) 7.5 to 8.5 mm. D) 8.5 to 9.0 mm.

C) 7.5 to 8.5 mm.

99. Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag-mask device? A) The patient's heart rate slows down. B) One breath is given every 10 to 12 seconds. C) About 12 to 20 breaths/min are being delivered. D) Each ventilation is delivered over 1 second.

C) About 12 to 20 breaths/min are being delivered.

105. Which of the following statements regarding adenosine is correct? A) Adenosine has a half-life of between 20 and 30 seconds and should be given slowly. B) Adenosine increases conduction velocity and shortens the effective refractory period. C) Adenosine is used to assess for P waves when slowing a supraventricular tachycardia. D) Ventricular tachycardia is often terminated following the administration of adenosine.

C) Adenosine is used to assess for P waves when slowing a supraventricular tachycardia.

214. Which of the following medications does NOT possess hypnotic properties? A) Versed B) Brevital C) Alfentanil D) Etomidate

C) Alfentanil

29. Which adrenergic receptor, when stimulated, inhibits norepinephrine release? A) Beta-1 B) Alpha-1 C) Alpha-2 D) Beta-2

C) Alpha-2

44. How much isotonic crystalloid solution should you administer to a patient who weighs 65 kg and who has signs and symptoms of internal bleeding? A) Boluses of up to 1,625 mL each B) 10 to 20 mL/kg every 5 to 10 minutes C) An amount adequate to maintain perfusion D) Enough to increase blood pressure to a normal level

C) An amount adequate to maintain perfusion

104. Which of the following statements regarding osteomyelitis is NOT correct? A) Osteomyelitis is the result of an infection. B) Osteomyelitis is an inflammation of the bone and muscle. C) Osteomyelitis occurs in up to 15% of IO insertions. D) The risk of osteomyelitis during IO infusion is relatively low.

C) Osteomyelitis occurs in up to 15% of IO insertions.

86. Which of the following statements regarding oxygen is correct? A) Oxygen is a highly flammable gas. B) Grease prevents oxygen from exploding. C) Oxygen supports the process of combustion. D) Oxygen must be stored in a warm environment.

C) Oxygen supports the process of combustion.

35. Which of the following factors would be the LEAST likely to affect a patient's response to a medication? A) Body temperature B) Pregnancy C) Past medical history D) Age and weight

C) Past medical history

262. Which of the following findings is MOST clinically significant in a 30-year-old woman with difficulty breathing and a history of asthma? A) Oral temperature of 97.9°F B) Expiratory wheezing on exam C) Prior ICU admission for her asthma D) 3 mm Hg drop in systolic BP during inhalation

C) Prior ICU admission for her asthma

57. Which of the following findings is MOST significant in a patient with acute respiratory distress? A) A regular heart rate of 110 beats/min B) A family history of pulmonary embolism C) Prior ICU admission for the same problem D) Low-grade fever and flu-like symptoms

C) Prior ICU admission for the same problem

186. You reassess your patient after administering a medication via the IV bolus route and note that his clinical condition is unchanged. What is the LEAST likely cause of the patient's unchanged condition? A) The patient may require another dose of the same drug. B) The dose was too low for the patient's clinical condition. C) The IV tubing was occluded proximal to the injection port. D) You diluted the bolus by following it with a 20-mL saline flush.

C) The IV tubing was occluded proximal to the injection port.

100. Which of the following statements regarding the automatic transport ventilator (ATV) is correct? A) The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest. B) Inadvertent variations in the rate and duration of ventilations often occur when the ATV is used. C) The paramedic can control an apneic patient's minute volume with accuracy when using an ATV. D) Most ATVs are large and cumbersome and are therefore impractical to use in the prehospital setting.

C) The paramedic can control an apneic patient's minute volume with accuracy when using an ATV.

8. Which of the following statements regarding the tonsils is correct? A) The tonsils are located on the posterior nasopharyngeal wall. B) The tonsils rarely become swollen enough to obstruct the airway. C) The tonsils are comprised of lymphatic tissue and help to trap bacteria. D) The tonsils are located in the anterior pharynx and filter bacteria.

C) The tonsils are comprised of lymphatic tissue and help to trap bacteria.

137. Which of the following medications is indicated for patients with delirium tremens? A) Brethine B) Isoptin C) Thiamine D) Luminal

C) Thiamine

170. Which of the following indicates that the lighted stylet has entered the trachea? A) Dim, diffuse light at the anterior part of the neck B) Bulging of the soft tissue above the thyroid cartilage C) Tightly circumscribed light below the thyroid cartilage D) Absent illumination at the midline of the patient's neck

C) Tightly circumscribed light below the thyroid cartilage

141. Which of the following is an influencing factor regarding the administration of a fibrinolytic drug to a patient experiencing an acute myocardial infarction? A) Quality of the chest pain B) History of unstable angina C) Time of symptom onset D) Concurrent use of aspirin

C) Time of symptom onset

280. You have intubated a 70-year-old man with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and the digital capnometry reading is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient? A) Immediate extubation B) Withdrawing the tube 2 cm C) Tracheobronchial suctioning D) Hyperventilation at 24 breaths/min

C) Tracheobronchial suctioning

138. Which of the following statements regarding vasopressin (Pitressin) is correct? A) Vasopressin stimulates beta-1 receptors during cardiac arrest. B) The usual adult dose of vasopressin is 40 U every 5 minutes. C) Vasopressin is an alternative to epinephrine in cardiac arrest. D) There are no data to support the use of vasopressin in adults.

C) Vasopressin is an alternative to epinephrine in cardiac arrest.

98. Visceral abdominal pain is: A) highly suggestive of a ruptured hollow abdominal organ. B) characterized by a localized area of abdominal tenderness or pain. C) commonly encountered in patients with cholecystitis or pancreatitis. D) often less localized on palpation and is poorly described by the patient.

D) often less localized on palpation and is poorly described by the patient.

103. Physiologic effects of CPAP include: A) increased intrathoracic pressure. B) forcing of fluid into the alveoli. C) increased alveolar surface tension. D) opening of collapsed alveoli.

D) opening of collapsed alveoli.

236. Which of the following statements regarding translaryngeal catheter ventilation is correct? A) It is more difficult to perform than an open cricothyrotomy. B) It provides a more definitive airway than an open cricothyrotomy. C) Ventilation is achieved by the use of a high-pressure jet ventilator. D) The technique uses the tracheal wall as an entry point to the airway.

C) Ventilation is achieved by the use of a high-pressure jet ventilator.

151. Which of the following statements regarding subcutaneous medication administration is correct? A) A subcutaneous injection involves using a 20- or 21-gauge needle. B) The needle is inserted at a 90° angle during a subcutaneous injection. C) Volumes of a drug given subcutaneously are typically 1 mL or less. D) The rectus femoris muscle is a common site for subcutaneous injections.

C) Volumes of a drug given subcutaneously are typically 1 mL or less.

60. Blood pressure is the product of: A) stroke volume and heart rate. B) left ventricular ejection fraction and afterload. C) cardiac output and peripheral vascular resistance. D) right atrial preload and ventricular stroke volume.

C) cardiac output and peripheral vascular resistance.

80. An opaque black area against the red reflex of the eye is indicative of: A) retinitis. B) conjunctivitis. C) cataracts. D) macular degeneration.

C) cataracts.

241. After inserting the needle into through the cricothyroid membrane, you should next: A) change your angle to 90° and advance the catheter over the needle. B) aspirate with the syringe and then insert the needle about 2 cm farther. C) insert the needle about 1 cm farther and then aspirate with the syringe. D) advance the catheter over the needle until the hub is flush with the skin.

C) insert the needle about 1 cm farther and then aspirate with the syringe.

44. A patient with respiratory splinting: A) is often tachypneic with deep breathing. B) is holding his or her arm against the chest. C) is breathing shallowly to alleviate chest pain. D) has an increased tidal volume due to a chest injury.

C) is breathing shallowly to alleviate chest pain.

2. Intracellular fluid: A) is the fluid that bathes the cells. B) transports red and white blood cells. C) is the water contained inside the cells. D) accounts for about 15% of body weight.

C) is the water contained inside the cells.

50. The MOST important point to remember about IV therapy is to: A) locate the largest vein. B) wear two pairs of gloves. C) keep the IV equipment sterile. D) prepare all supplies ahead of time.

C) keep the IV equipment sterile.

79. Thrombophlebitis is MOST commonly caused by: A) abuse of IV drugs. B) long-term IV therapy. C) lapses in aseptic technique. D) any type of hypotonic solution.

C) lapses in aseptic technique.

38. During sleep, the metabolic rate is ________ and the number of respirations _________. A) low, increases B) high, decreases C) low, decreases D) high, increases

C) low, decreases

93. When examining the anterior abdomen of a patient who complains of abdominal pain: A) auscultate bowel sounds for at least 5 minutes. B) you should first percuss over the four quadrants. C) routinely palpate the least painful area(s) first. D) it is often necessary to administer analgesia first.

C) routinely palpate the least painful area(s) first.

56. When a patient needs rapid fluid replacement, you should: A) use a microdrip administration set because you can deliver more precise volumes of IV fluid. B) choose an administration set that delivers the least amount of volume per the most number of drops. C) select an administration set that contains a large opening between the piercing spike and drip chamber. D) use a microdrip administration set in order to avoid inadvertently overloading the patient with fluid.

C) select an administration set that contains a large opening between the piercing spike and drip chamber.

99. Assessment of the female genitalia: A) is not performed by the paramedic. B) is only necessary in pregnant patients. C) should be limited to inspection only. D) is a routine part of the physical exam.

C) should be limited to inspection only.

5. A composition of dissolved elements and water is called a(n): A) solute. B) solvent. C) solution. D) electrolyte.

C) solution.

9. When assessing any patient, the paramedic should remember that: A) the past medical history is of even greater importance if the patient has a traumatic injury. B) it is extremely common for patients with a medical complaint to have an underlying injury. C) some patients with a traumatic injury could also have an underlying medical component. D) the patient's underlying medical problem can usually be identified by a rapid assessment.

C) some patients with a traumatic injury could also have an underlying medical component.

143. Narcotic analgesics relieve pain by: A) blocking opioid receptors. B) suppressing adrenergic function. C) stimulating opioid receptors. D) blocking neuromuscular activity.

C) stimulating opioid receptors.

28. The fraction of inspired oxygen (FIO2) increases with: A) increased tidal volume. B) forceful inhalation. C) supplemental oxygen. D) an increase in respirations.

C) supplemental oxygen.

61. First-pass metabolism of a medication occurs when: A) a medication's effects are greatly enhanced by digestive enzymes in the stomach. B) a medication's bioavailability is immediately reduced when it enters the bloodstream. C) the bioavailability of a medication is reduced before it reaches the systemic circulation. D) the liver increases a medication's effects before it reaches the systemic circulation.

C) the bioavailability of a medication is reduced before it reaches the systemic circulation.

107. When administering CPAP therapy to a patient, it is important to remember that: A) acute symptomatic bradycardia has been directly linked to CPAP therapy. B) SpO2 of 100% must be achieved as quickly as possible. C) the increased intrathoracic pressure caused by CPAP can result in hypotension. D) the head straps must be secured immediately in order to achieve an adequate seal.

C) the increased intrathoracic pressure caused by CPAP can result in hypotension.

230. Open cricothyrotomy is indicated when: A) ET intubation is unsuccessful after three attempts. B) all other methods of advanced airway management have failed. C) you are unable to secure a patent airway with less invasive means. D) the patient has a head injury that precludes nasotracheal intubation.

C) you are unable to secure a patent airway with less invasive means.

160. If you see a soft-tissue bulge on either side of the airway when performing nasotracheal intubation: A) inadvertent esophageal intubation has likely occurred. B) you should completely remove the tube and reoxygenate. C) you have probably inserted the tube into the pyriform fossa. D) the tube is positioned correctly just above the glottic opening.

C) you have probably inserted the tube into the pyriform fossa.

106. In general, +3 pitting edema is characterized by indentation of the skin to a depth of: A) 0 in to ¼ in. B) ¼ in to ½ in. C) ½ in to 1 in. D) greater than 1 in.

C) ½ in to 1 in.

89. The Venturi mask is MOST useful in the prehospital setting when: A) a patient requires less than 15% oxygen. B) high-flow oxygen is required for severe hypoxia. C) patients cannot tolerate a nonrebreathing mask. D) a COPD patient requires a long-range transport.

D) a COPD patient requires a long-range transport.

234. You should be MOST suspicious of tube misplacement following an open cricothyrotomy if: A) bleeding from the subcutaneous tissues is observed. B) there is minimal rise of the chest during ventilations. C) progressive redness is noted around the insertion site. D) a crackling sensation is noted when palpating the neck.

D) a crackling sensation is noted when palpating the neck.

182. Cuffed ET tubes are generally not used in the field until the child is 8 to 10 years old because: A) the cuff would apply pressure and obstruct the airway. B) the high-pressure cuff would likely rupture the trachea. C) most children are only intubated for short periods of time. D) a cuff at the cricoid ring is not necessary to obtain a seal.

D) a cuff at the cricoid ring is not necessary to obtain a seal.

113. Endotracheal intubation is MOST accurately defined as: A) inserting an ET tube through the vocal cords via the patient's mouth. B) passing an ET tube through an opening in the cricothyroid membrane. C) inserting an ET tube through the glottic opening via the patient's nose. D) passing an ET tube through the glottic opening and sealing off the trachea.

D) passing an ET tube through the glottic opening and sealing off the trachea.

74. Bulging of a child's anterior fontanelle is: A) suggestive of significant dehydration. B) benign if the child is not flailing around. C) suggestive of an intracerebral hemorrhage. D) pathologic when observed in a quiet child.

D) pathologic when observed in a quiet child.

267. Two attempts to ventilate an unconscious 10-year-old boy have been unsuccessful. You should next: A) intubate his trachea. B) deliver abdominal thrusts. C) look inside the patient's mouth. D) perform chest compressions.

D) perform chest compressions.

15. Potassium: A) helps stimulate the release of insulin. B) is found predominantly outside the cell. C) is a bivalent cation that tends to follow water. D) plays a major role in neuromuscular function.

D) plays a major role in neuromuscular function.

31. The involuntary control of breathing originates in the: A) diencephalon. B) hypothalamus. C) cerebral cortex. D) pons and medulla.

D) pons and medulla.

161. Which of the following steps is usually necessary when administering a drug via the IO route, but not necessary when administering a drug via the IV bolus route? A) Rapid administration of any drug that you give B) Placing a pressure infuser device around the IV bag C) Flushing with 20 mL of saline after the drug is given D) Clamping off the tubing proximal to the injection port

B) Placing a pressure infuser device around the IV bag

54. When ventilating a patient with a bag-mask device, you note increased compliance. This means that: A) you are meeting resistance when ventilating. B) air can be forced into the lungs with relative ease. C) a lower airway obstruction should be suspected. D) the patient likely has an upper airway obstruction.

B) air can be forced into the lungs with relative ease.

39. Negative-pressure ventilation occurs when: A) the diaphragm ascends and the intercostal muscles retract. B) air is drawn into the lungs when intrathoracic pressure decreases. C) pressure within the chest decreases and air is forced from the lungs. D) the phrenic nerves stop sending messages to the diaphragm.

B) air is drawn into the lungs when intrathoracic pressure decreases.

84. A(n) __________________ agent is used to increase the pH of the serum or urine? A) antacid B) alkalinizing C) anticoagulant D) antihistamine

B) alkalinizing

65. In contrast to butterfly catheters, over-the-needle catheters: A) are more likely to rupture the vein due to excessive movement of the patient. B) allow for greater patient movement without the need to immobilize the entire limb. C) are more difficult to insert and are more cumbersome to secure in place effectively. D) may cause blood cell damage when drawing blood through the Teflon catheter.

B) allow for greater patient movement without the need to immobilize the entire limb.

37. Lactated Ringer's (LR) solution should not be given to patients with liver problems because: A) LR is a hypertonic solution and cannot be metabolized by the liver. B) the lactate contained within LR can cause necrosis of the liver tissue. C) patients with liver disease commonly experience renal insufficiency. D) the liver cannot metabolize the lactate in the solution.

B) the lactate contained within LR can cause necrosis of the liver tissue.

91. Arterial pulses are a physical expression of: A) pressure in the vena cavae. B) left ventricular contraction. C) the diastolic blood pressure. D) right ventricular contraction.

B) left ventricular contraction.

70. Medications commonly administered via a nebulizer include all of the following, EXCEPT: A) albuterol. B) lidocaine. C) Xopenex. D) Racemic epinephrine.

B) lidocaine.

109. An inward curve of the lumbar spine just above the buttocks is called: A) scoliosis. B) lordosis. C) kyphosis. D) sclerosis.

B) lordosis.

106. In general, alpha-adrenergic receptor antagonists: A) decrease the heart rate. B) lower the blood pressure. C) are used for hypotension. D) increase vascular resistance.

B) lower the blood pressure.

204. The King LT airway can be used to: A) administer certain cardiac medications directly into the trachea. B) maintain a patent airway in spontaneously breathing patients. C) establish a patent airway in patients of any age and body size. D) suction pulmonary secretions from the tracheobronchial tree.

B) maintain a patent airway in spontaneously breathing patients.

135. Succinylcholine (Anectine) is contraindicated for patients with: A) head trauma. B) major burns. C) tachycardia. D) blunt force trauma.

B) major burns.

42. Oxygen that is dissolved in the blood plasma: A) can be measured with a pulse oximeter. B) makes up the partial pressure of oxygen. C) is quickly absorbed by bicarbonate ions. D) cannot participate in pulmonary respiration.

B) makes up the partial pressure of oxygen.

94. Hyperventilating an apneic patient: A) is appropriate if the patient is an adult. B) may decrease venous return to the heart. C) is beneficial if the pulse rate is too slow. D) reduces the incidence of gastric distention.

B) may decrease venous return to the heart.

18. Newer medications are designed to target only specific receptor sites on certain cells in an attempt to: A) treat more than one condition. B) minimize the adverse effects. C) reduce their therapeutic effect. D) eliminate all side effects.

B) minimize the adverse effects.

126. The general type of illness a patient is experiencing is called the: A) chief complaint. B) nature of illness. C) general impression. D) differential diagnosis.

B) nature of illness.

121. Dopamine is commonly used in the prehospital setting as the primary medication for: A) right-sided heart failure. B) nonhypovolemic hypotension. C) severe intracranial hemorrhage. D) vagal-induced bradycardia.

B) nonhypovolemic hypotension.

14. The paramedic must use caution when referencing a medication in an American Medical Association (AMA) publication because: A) the AMA publication only lists medications that are in human clinical trials. B) not every medication listed in the compendium has received FDA approval. C) medications listed in an AMA publication are typically not for prehospital use. D) all medications in an AMA publication are listed by their chemical name only.

B) not every medication listed in the compendium has received FDA approval.

103. The diagnosis of a problem involving the shoulder can often be made by simply: A) assessing range of motion. B) noting the patient's posture. C) palpating for gross deformities. D) asking the patient to bend the elbow.

B) noting the patient's posture.

177. Shortly after establishing an IV line of normal saline, your patient complains of a burning sensation along the course of the vein. You should: A) increase the IV flow rate until the patient expresses relief. B) observe the patient for signs and symptoms of an allergic reaction. C) inject 10 mL of lidocaine into the IV line to provide pain relief. D) immediately discontinue the IV and reestablish it in another location.

B) observe the patient for signs and symptoms of an allergic reaction.

237. Needle cricothyrotomy is contraindicated in patients with: A) uncontrolled oropharyngeal bleeding. B) obstruction above the catheter insertion site. C) massive maxillofacial trauma and trismus. D) a suspected injury to the cervical spine..

B) obstruction above the catheter insertion site.

40. When asking questions pertaining to a patient's sexual history, it is important to remember that: A) you should inquire about the patient's HIV status. B) obtaining the history in a private setting is essential. C) a physical examination should be performed as well. D) the patient's sexual preference is especially relevant.

B) obtaining the history in a private setting is essential.

144. Patients who receive opioid substances on a long-term basis: A) are less likely to develop cross-tolerance than a non-opioid user. B) often need higher doses of an opioid medication for pain relief. C) are less likely to experience severe nervous system depression. D) typically respond to lower doses of an opioid medication.

B) often need higher doses of an opioid medication for pain relief.

112. If a patient is able to sense smell, his or her __________ nerve is intact. A) abducens B) olfactory C) trigeminal D) trochlear

B) olfactory

53. Asymmetric chest wall movement is characterized by: A) chest rise that is minimally visible. B) one side of the chest moving less than the other. C) alternating movement of the chest and abdomen. D) a part of the chest wall that bulges during exhalation.

B) one side of the chest moving less than the other.

71. After attaching the prepared IV line to the hub of the IV catheter and removing the constricting band, you should: A) set the IV flow rate to keep the vein open (KVO). B) open the IV line and observe for swelling or infiltration. C) apply a sterile gauze pad directly over the venipuncture site. D) secure the catheter and tubing in place with a commercial device.

B) open the IV line and observe for swelling or infiltration.

12. During forceful inhalation, the vocal cords: A) are partially open to allow for turbulent air flow. B) open widely to provide minimum resistance to air flow. C) abruptly spasm in order to protect the lower airway. D) bulge anteriorly to facilitate air flow into the trachea.

B) open widely to provide minimum resistance to air flow.

176. The MOST obvious risk associated with extubation is: A) moderate airway swelling as the ET tube is removed. B) overestimating the patient's ability to protect his or her own airway. C) patient retching and gagging as you remove the ET tube. D) stimulation of the parasympathetic nervous system with resulting bradycardia.

B) overestimating the patient's ability to protect his or her own airway.

166. The MOST common inhaled medication is: A) Alupent.. B) oxygen. C) Ventolin. D) Bronkosol.

B) oxygen.

35. Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the: A) PaO2 level falls quickly. B) pH of the CSF decreases. C) PaCO2 decreases slowly. D) pH of the CSF increases.

B) pH of the CSF decreases.

30. Changes in the rate and depth of breathing are regulated primarily by the: A) pH of venous blood. B) pH of the CSF. C) saturation of oxygen and hemoglobin. D) amount of oxygen in the blood plasma.

B) pH of the CSF.

76. Prior to cannulating an external jugular vein, it is MOST important to: A) cleanse the puncture site. B) palpate for the carotid pulse. C) turn the patient's head to the side. D) occlude the vein distal to the puncture site.

B) palpate for the carotid pulse.

61. To obtain a heart rate in infants younger than 1 year of age, you should: A) apply a cardiac monitor. B) palpate the brachial artery. C) auscultate directly over the heart. D) count the pulse for a full minute.

B) palpate the brachial artery.

60. When selecting a vein for cannulation, you should avoid areas of the vein that: A) are straight. B) pass over joints. C) are firm and springy. D) appear to be straight.

B) pass over joints.

66. When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should: A) ask the patient to fully exhale before blowing into the mouthpiece. B) perform the test three times and take the best rate of the three readings. C) administer one bronchodilator treatment before obtaining the first reading. D) ensure that the patient is in a supine position to obtain an accurate reading.

B) perform the test three times and take the best rate of the three readings.

97. Abdominal guarding is MOST commonly encountered in patients with: A) acute renal failure. B) peritoneal irritation. C) intra-abdominal bleeding. D) chronic liver inflammation.

B) peritoneal irritation.

249. Whether you are providing ventilations to a patient with a stoma using a resuscitation mask or bag-mask device, you must FIRST: A) perform a head tilt-chin lift maneuver. B) place the patient's head in a neutral position. C) adequately cleanse the stoma site with iodine. D) suction the stoma for no longer than 10 seconds.

B) place the patient's head in a neutral position.

68. If you suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by: A) applying firm pressure to the patient's forehead and tilting the head back. B) placing your fingers behind the angle of the jaw and lifting the jaw forward. C) carefully grasping the tongue and jaw and slowly lifting the jaw forward. D) lifting up on the jaw while placing the head in a slightly extended position.

B) placing your fingers behind the angle of the jaw and lifting the jaw forward.

8. Cations are electrolytes that have an overall __________ charge, and anions are electrolytes that have an overall ___________ charge.. A) negative, neutral B) positive, negative C) neutral, positive D) negative, positive

B) positive, negative

278. You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should: A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once. B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation. C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once. D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.

B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation.

153. Glucagon is used in the treatment of beta-blocker overdose because it: A) causes vasoconstriction and increases blood pressure. B) produces positive inotropic and chronotropic effects. C) activates beta-1 receptors and increases the heart rate. D) blocks alpha-2 receptors and increases blood pressure.

B) produces positive inotropic and chronotropic effects.

101. The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with all of the following conditions, EXCEPT: A) airway obstruction. B) prolonged apnea. C) poor lung compliance. D) increased airway resistance.

B) prolonged apnea.

115. The major advantage of ET intubation is that it: A) facilitates tracheal suctioning. B) protects the airway from aspiration. C) is an easy skill to learn and perform. D) provides a route for certain medications.

B) protects the airway from aspiration.

28. An empathetic attitude: A) is often offensive to the patient. B) puts you in your patient's shoes. C) will put your patient at ease quickly. D) allows you to feel sorry for the patient.

B) puts you in your patient's shoes.

149. If using a bulb-style esophageal detector device to assist you in confirming proper ET tube placement, you should expect the bulb to: A) inflate slowly when you let go of it. B) refill briskly if the tube is in the trachea. C) stay collapsed if the tube is in the trachea. D) expand quickly if the tube is in the esophagus.

B) refill briskly if the tube is in the trachea.

94. The desired clinical effect after administering a beta-2 agonist medication is: A) dilation of the systemic vasculature. B) relaxation of bronchiole smooth muscle. C) increased cardiac contractility D) contraction of vascular smooth muscle..

B) relaxation of bronchiole smooth muscle.

74. Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by: A) sweeping the patient's mouth with your fingers. B) reopening the airway and reattempting to ventilate. C) performing 30 chest compressions and reassessing. D) administering 15 subdiaphragmatic thrusts at once.

B) reopening the airway and reattempting to ventilate.

208. Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT: A) auscultation of bilateral breath sounds. B) the esophageal detector device. C) quantitative waveform capnography. D) observation for symmetrical chest rise.

B) the esophageal detector device.

53. When caring for a patient who is mentally challenged: A) it is highly unlikely that you will obtain a reliable medical history. B) you may have to obtain the medical history from a family member. C) your priority should be to transport the patient to a psychiatric facility. D) you should speak to the patient as though he or she is younger in age.

B) you may have to obtain the medical history from a family member.

195. In general, a multilumen airway should not be used in patients who are: A) greater than 6 ft tall. B) younger than 16 years of age. C) older than 65 years of age. D) less than 4 ft 5 in tall.

B) younger than 16 years of age.

175. Which of the following statements regarding field extubation is correct? A) It is generally better to sedate the patient rather than extubate. B) The patient should be extubated if spontaneous breathing occurs. C) The risk of laryngospasm following extubation is relatively low. D) Extubation should be performed with the patient in a supine position.

A) It is generally better to sedate the patient rather than extubate.

46. A medication that has a narrow therapeutic index: A) can be given, but not without close patient monitoring. B) should not be given to patients over 50 years of age. C) is safe to give because the chance of toxicity is remote. D) should not be given because its effects are too harmful.

A) can be given, but not without close patient monitoring.

92. Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous in that it: A) can be used in conjunction with supplemental oxygen. B) carries a lower risk of gastric distention and vomiting. C) is less likely to result in hyperventilation of the rescuer. D) allows greater tidal volume to be delivered to the patient.

A) can be used in conjunction with supplemental oxygen.

118. Catecholamines and sympathomimetic medications should be administered with caution because they: A) can increase cardiac workload and myocardial oxygen demand. B) have an average duration of action of between 24 and 48 hours.. C) are associated with paradoxical bradycardia in younger patients. D) have a tendency to cause a significant decrease in cardiac output.

A) can increase cardiac workload and myocardial oxygen demand.

139. Capnography is a reliable method for confirming proper ET tube placement because: A) carbon dioxide is not present in the esophagus. B) it is a reliable indicator of the patient's PaO2 level. C) capnographers measure the amount of exhaled oxygen. D) capnographers measure the amount of carbon dioxide in inhaled air.

A) carbon dioxide is not present in the esophagus.

69. If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful, you should: A) carefully tilt the patient's head back while lifting up on the chin. B) maintain the patient's head in a neutral position and intubate at once. C) insert an oropharyngeal airway and reattempt the jaw-thrust maneuver. D) suction the mouth for 15 seconds and then reattempt to open the airway.

A) carefully tilt the patient's head back while lifting up on the chin.

27. A medication that possesses a negative chronotropic effect will: A) cause a decrease in the heart rate. B) cause an increase in blood pressure. C) decrease myocardial contractile force. D) increase cardiac electrical conduction velocity.

A) cause a decrease in the heart rate.

91. Unlike a nondepolarizing paralytic, a competitive depolarizing paralytic: A) causes muscle fasciculations. B) does not induce full paralysis. C) causes profound sedation. D) lowers serum potassium.

A) causes muscle fasciculations.

77. If you discover that an IV is not flowing sufficiently, you should: A) check the height of the IV bag. B) reapply the constricting band. C) discontinue the IV infusion. D) pull back on the IV catheter.

A) check the height of the IV bag.

36. The hypoxic drive stimulates breathing in patients with: A) chronically decreased PaO2 levels. B) emphysema or chronic bronchitis. C) chronically decreased PaCO2 levels. D) mild bronchospasm caused by asthma.

A) chronically decreased PaO2 levels.

86. S1, the first heart sound, represents: A) closure of the mitral and tricuspid valves. B) the sound heard at the end of diastole. C) closure of the aortic and pulmonic valves. D) the sound heard at the end of systole.

A) closure of the mitral and tricuspid valves.

167. When determining whether transillumination-guided intubation should be attempted, you should: A) consider the amount of soft tissue that is overlying the trachea. B) avoid the procedure if the patient is thin or is greater than 6 ft tall. C) ensure the airway is clear of secretions by suctioning for 30 seconds. D) recall that patients with short necks are often easy to transilluminate.

A) consider the amount of soft tissue that is overlying the trachea.

152. Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because: A) it must be performed on spontaneously breathing patients. B) the procedure should be performed in less than 10 seconds. C) it does not involve direct visualization of the vocal cords. D) patients requiring nasotracheal intubation are usually stable.

A) it must be performed on spontaneously breathing patients.

72. The pulse of the superficial temporal artery can be felt: A) just anterior to the ear, in the temporal region. B) inferior to the ear, slightly below the earlobe. C) slightly superior to the ear, in the temporal region. D) posterior to the ear, directly over the mastoid bone.

A) just anterior to the ear, in the temporal region.

191. The MOST effective way to minimize the risk of hypoxia while intubating a child is to: A) limit your intubation attempt to 20 seconds. B) monitor the child's cardiac rhythm at all times. C) premedicate the child with 0.02 mg/kg of atropine. D) not allow the oxygen saturation to fall below 100%.

A) limit your intubation attempt to 20 seconds.

60. A medication undergoes first-pass metabolism in the: A) liver. B) spleen. C) stomach. D) bone marrow.

A) liver.

77. Most medication biotransformation occurs in the: A) liver. B) kidneys. C) lungs. D) GI tract.

A) liver.

18. Your patient will MOST likely develop a good first impression of you if you: A) look and act professional and confident. B) tell him or her that everything will be okay. C) address him or her as "dear" or "honey." D) quickly determine his or her chief complaint.

A) look and act professional and confident.

85. All of the following medications are used to reduce a patient's heart rate and blood pressure, EXCEPT: A) lorazepam. B) diltiazem. C) metoprolol. D) Tenormin.

A) lorazepam.

77. Placing a suction catheter past the base of the tongue: A) may cause the patient to gag or vomit. B) will result in aspiration of gastric contents. C) is effective in thoroughly clearing the airway. D) commonly causes bradycardia in adult patients.

A) may cause the patient to gag or vomit.

91. In contrast to negative-pressure ventilation, positive-pressure ventilation: A) may impair blood return to the heart. B) moves air into the esophagus and trachea. C) causes decreased intrathoracic pressure. D) is the act of normal, unassisted breathing.

A) may impair blood return to the heart.

233. Incising the cricothyroid membrane vertically will: A) minimize the risk of damaging the thyroid gland. B) facilitate insertion of an 8.0- to 9.0-mm ET tube. C) completely eliminate the risk of any external bleeding. D) increase the risk of damaging the external jugular veins.

A) minimize the risk of damaging the thyroid gland.

12. Sodium is a ________ cation and can react completely with _______. A) monovalent, 1 mEq of a singly charged anion B) bivalent, 2 mEq of a doubly charged cation C) monovalent, 2 mEq of a singly charged anion D) bivalent, 1 mEq of a doubly charged cation

A) monovalent, 1 mEq of a singly charged anion

22. Pumping sodium out of the cell and potassium into the cell has the added benefit of: A) moving glucose into the cell at the same time.. B) transiently decreasing serum levels of calcium. C) facilitating water reabsorption in the renal tubules. D) expending minimal levels of adenosine triphosphate.

A) moving glucose into the cell at the same time..

37. All of the following factors would increase a person's respiratory rate, EXCEPT: A) narcotic analgesic use. B) increased metabolism. C) the use of amphetamines. D) a rise in body temperature.

A) narcotic analgesic use.

213. Fentanyl (Sublimaze) is a: A) narcotic analgesic. B) benzodiazepine sedative. C) sedative-hypnotic drug. D) butrophenone sedative.

A) narcotic analgesic.

145. In up to one third of all patients, morphine sulfate causes: A) nausea and vomiting. B) severe hypotension. C) complete heart block. D) a reflex tachycardia.

A) nausea and vomiting.

156. The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will: A) reduce the likelihood and severity of nasal bleeding. B) sedate the patient and facilitate his or her compliance. C) dilate the nasal vasculature and facilitate tube insertion. D) anesthetize the nasopharynx and reduce patient discomfort.

A) reduce the likelihood and severity of nasal bleeding.

85. A Bourdon-gauge oxygen flowmeter: A) reduces the high pressure in the oxygen cylinder to a safe pressure. B) allows you to administer oxygen to a patient under high pressures. C) is used for transferring oxygen from a larger tank to a smaller tank. D) must be placed in an upright position because it is affected by gravity.

A) reduces the high pressure in the oxygen cylinder to a safe pressure.

26. Pausing to consider something significant that you have just been told is called: A) reflection. B) interpretation. C) facilitation. D) clarification..

A) reflection.

36. Your patient says, "I can't catch my breath." In response, you state, "That's very helpful. Let me think about that for a moment." This dialogue is an example of: A) reflection. B) clarification. C) facilitation. D) interpretation.

A) reflection.

29. When asking a patient if he or she uses illegal drugs, you will MOST likely get accurate information if you: A) remain professional and nonjudgmental. B) reassure the patient that you can be trusted and will not tell anyone. C) question the patient in the presence of a trusted family member. D) tell the patient that withholding such information from you is illegal.

A) remain professional and nonjudgmental.

269. After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should: A) remove the airway and have suction ready. B) suction her oropharynx for up to 15 seconds. C) spray an anesthetic medication into her mouth. D) turn the patient on her side in case she vomits.

A) remove the airway and have suction ready.

79. Patients with _________________ are at significant risk for toxic effects of medications or metabolic waste products in the body. A) renal failure B) diabetes mellitus C) stomach cancer D) heart failure

A) renal failure

38. If you suspect that a patient has been abused, it is MOST important that you: A) request law enforcement personnel if necessary. B) discreetly ask the patient if he or she was abused. C) contact medical control to make him or her aware. D) ask a family member about the possibility of abuse.

A) request law enforcement personnel if necessary.

71. An airway obstruction secondary to a severe allergic reaction: A) requires specific and aggressive treatment. B) often responds well to humidified oxygen. C) is usually the result of pulmonary aspiration. D) is treated effectively with abdominal thrusts.

A) requires specific and aggressive treatment.

212. Undersedation of a patient during airway management would likely result in all of the following, EXCEPT: A) respiratory depression. B) trauma to the airway. C) poor patient compliance. D) tachycardia and hypertension.

A) respiratory depression.

23. When transferring a geriatric patient from a hospital to an extended care facility, it is MOST important to: A) review the patient's transfer paperwork. B) document at least two full sets of vital signs. C) call a radio report to the extended care facility. D) presume that the patient will not wish to speak.

A) review the patient's transfer paperwork.

63. "Track marks" along the course of a patient's vein are usually a sign of: A) sclerosis caused by frequent cannulation. B) numerous one-way valves inside the vein. C) small vein rupture caused by hypertension. D) multiple thromboses deep within the vein.

A) sclerosis caused by frequent cannulation.

123. When inserting a stylet into an ET tube, you must ensure that: A) the stylet rests at least ½ in back from the end of the tube. B) you use a petroleum-based gel to facilitate easy removal. C) the stylet is rigid and does not allow the ET tube to bend. D) the tube is bent in the form of a U to facilitate placement.

A) the stylet rests at least ½ in back from the end of the tube.

137. The paramedic may be called upon to administer platelets to patients with: A) thrombocytopenia. B) hemolytic anemia. C) a low hematocrit. D) hypercoagulopathy.

A) thrombocytopenia.

21. The volume of air that is moved into or out of the respiratory tract in one breath is called: A) tidal volume. B) alveolar volume. C) minute volume. D) inspiratory reserve volume.

A) tidal volume.

136. In contrast to an antiseptic, a disinfectant is: A) toxic to living tissues and should never be used on a patient. B) capable of destroying pathogens but is not toxic to living tissues. C) not intended to be used on nondisposable patient care equipment. D) used to cleanse an area before performing an invasive procedure.

A) toxic to living tissues and should never be used on a patient.

135. When using a straight blade, a major mistake of new paramedics is to: A) try to pass the ET tube down the barrel of the blade. B) insert the blade directly between the vocal cords. C) use traction while lifting up on the patient's mandible. D) insert the blade into the left side of the patient's mouth.

A) try to pass the ET tube down the barrel of the blade.

131. You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see: A) two white fibrous bands that lie vertically within the glottic opening. B) the tip of the straight blade touching the posterior wall of the pharynx. C) the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope. D) the epiglottis lift when the tip of the curved blade is resting underneath it.

A) two white fibrous bands that lie vertically within the glottic opening.

164. Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is_______ and _______. A) unconscious, apneic B) stuporous, bradypneic C) comatose, breathing inadequately D) semiconscious, tachypneic

A) unconscious, apneic

9. The __________ is an anatomic space located between the base of the tongue and the epiglottis. A) vallecula B) uvula C) adenoid D) larynx

A) vallecula

227. The external jugular veins run ____________ and are located ____________ to the cricothyroid membrane. A) vertically, lateral B) vertically, medial C) horizontally, lateral D) horizontally, medial

A) vertically, lateral

58. Other than overall patient appearance, the patient's __________ is/are the MOST objective data for determining his or her status. A) vital signs B) medications C) chief complaint D) medical history

A) vital signs

65. IO infusion rates are comparable to IV infusion rates: A) when a pressure bag or mechanical infusion device is used. B) only when the extremity with the IO needle inserted is elevated. C) if the patient's systolic blood pressure is at least 100 mm Hg. D) only if the IO needle is inserted in the proximal tibia.

A) when a pressure bag or mechanical infusion device is used.

147. Following ET intubation, the ideal time to attach the capnography T-piece is: A) when the bag is attached to the ET tube. B) after 6 to 8 positive pressure breaths. C) immediately after removing the stylet. D) after auscultating the lungs and epigastrium.

A) when the bag is attached to the ET tube.

155. Neither subcutaneous nor intramuscular injections should be given to patients: A) with inadequate peripheral perfusion. B) who are morbidly obese or very thin. C) who require less than 5 mL of a drug. D) with a systolic BP greater than 140 mm Hg.

A) with inadequate peripheral perfusion.

207. The King airway should NOT be used in patients: A) with known esophageal disease. B) with prolonged cardiac arrest. C) with a traumatic brain injury. D) who weigh less than 25 kg.

A) with known esophageal disease.

34. Which of the following statements regarding isotonic solutions is correct? A) Isotonic solutions have almost the same osmolarity as bodily fluids. B) D5W becomes an isotonic solution once it is introduced into the body. C) Normal saline is the only isotonic solution used in the prehospital setting. D) Isotonic solutions expand the vascular space by shifting fluid from other compartments.

A) Isotonic solutions have almost the same osmolarity as bodily fluids.

150. What medication route is typically used during allergy testing or when performing a skin test for tuberculosis? A) Intradermal B) Subcutaneous C) Intramuscular D) Percutaneous

A) Intradermal

16. Which of the following questions would be of LEAST pertinence when trying to determine a patient's current health status? A) "Are your mother and father still living?" B) "Are your immunizations up to date?" C) "Are you currently taking any prescription medicines?" D) "Do you have a history of any specific diseases in your family?"

A) "Are your mother and father still living?"

120. If a 10-mL vial contains 1 mg of a drug, how many mg/mL are present? A) 0.1 B) 0.01 C) 0.001 D) 0.0001

A) 0.1

112. 100 mL is equal to: A) 0.1 L B) 0.01 L C) 0.001 L D) 0.0001 L

A) 0.1 L

125. A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer? A) 0.1 mg B) 0.15 mg C) 0.01 mg D) 0.2 mg

A) 0.1 mg

109. 1 cc is equal to _____ mL. A) 1 B) 10 C) 100 D) 1,000

A) 1

68. If an adult patient is in hypovolemic shock, you should attempt to insert a(n) ______ over-the-needle catheter into the _______. A) 14-gauge, antecubital vein B) 16-gauge, metacarpal vein C) 14-gauge, metacarpal vein

A) 14-gauge, antecubital vein

115. An 80-kg patient weighs ____ lb. A) 176 B) 179 C) 182 D) 185

A) 176

174. An elderly man with congestive heart failure and shortness of breath requires an IV line in case medication administration is necessary. Which of the following IV catheters is MOST appropriate to use when starting the IV? A) 20 gauge, 1 ¼ B) 18 gauge, 2 ¼ C) 16 gauge, 1 ¼ D) 14 gauge, 2 ¼

A) 20 gauge, 1 ¼

150. The average depth of ET tube insertion for adult patients is: A) 21 to 25 cm. B) 22 to 26 cm. C) 23 to 27 cm. D) 24 to 28 cm.

A) 21 to 25 cm.

256. A mouth-opening width of less than ___ cm indicates a potentially difficult airway. A) 3 B) 4 C) 5 D) 6

A) 3

102. A length-based resuscitation tape measure can be used to determine the most appropriate size of bag-mask device for pediatric patients who weigh up to: A) 34 kg. B) 38 kg. C) 42 kg. D) 46 kg.

A) 34 kg.

243. Proper insertion of the needle into the cricothyroid membrane involves a ___ angle toward the ________. A) 45°, feet B) 90°, posterior trachea C) 45°, posterior trachea D) 90°, feet

A) 45°, feet

4. In a 175-lb man, intravascular fluid accounts for approximately ____ lb. A) 8 B) 9 C) 10 D) 12

A) 8

253. Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance? A) Abdominal thrusts B) Chest compressions C) Direct laryngoscopy D) Use of Magill forceps

A) Abdominal thrusts

106. Which of the following patients may benefit from CPAP? A) Alert patient with respiratory distress following submersion in water B) Comatose patient with shallow breathing after overdosing on heroin C) Trauma patient with labored breathing and extensive chest wall bruising D) Patient with pulmonary edema who is unable to follow verbal commands

A) Alert patient with respiratory distress following submersion in water

43. Which of the following statements regarding anemia is correct? A) Anemia results in a decreased ability of the blood to carry oxygen. B) Patients with anemia have a chronically low level of hemoglobin. C) Anemia is a condition caused exclusively by a deficiency of iron. D) Anemic patients typically present with flushed skin and bradycardia.

A) Anemia results in a decreased ability of the blood to carry oxygen.

95. Which of the following statements regarding ascites is correct? A) Ascites is a collection of fluid within the peritoneal cavity. B) Percussion of the abdomen will often yield hyperresonance. C) The most common cause of ascites is an acute splenic injury. D) The abdomen of a patient with ascites has a sunken appearance.

A) Ascites is a collection of fluid within the peritoneal cavity.

13. Which of the following statements regarding calcium is correct? A) Calcium is needed for bone growth and proper blood clotting. B) Patients with ataxia should be suspected of being hypocalcemic. C) Calcium can react completely with 1 mEq of a singly charged anion. D) Abdominal cramps are a sign of an increased level of serum calcium.

A) Calcium is needed for bone growth and proper blood clotting.

63. Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading? A) Carboxyhemoglobin B) Peripheral vasodilation C) A dimly lit environment D) Heart rate above 120 beats/min

A) Carboxyhemoglobin

10. Which of the following electrolytes is NOT a cation? A) Chloride B) Calcium C) Potassium D) Magnesium

A) Chloride

158. Which of the following is NOT always considered a mandatory action after administering a medication via the enteral or parenteral route? A) Contacting on-line medical control B) Monitoring the patient's condition C) Immediately disposing of any sharps D) Documenting the time of administration

A) Contacting on-line medical control

84. Which of the following conditions or situations is associated with the HIGHEST risk of vein rupture during IV cannulation? A) Diabetes B) Hypertension C) Ibuprofen use D) Atherosclerosis

A) Diabetes

170. A 71-year-old woman presents with tachypnea, flushed skin, and postural hypotension. Which of the following chief complaints is MOST consistent with these clinical findings? A) Diarrhea B) Renal failure C) Acute weight gain D) Shortness of breath

A) Diarrhea

147. Which of the following medications should NOT be given through an IV line of D5W? A) Dilantin B) Solu-Medrol C) Verapamil D) Amiodarone

A) Dilantin

180. While establishing IO access in a critically ill patient, you locate the appropriate anatomic landmark, cleanse the site, and insert the IO catheter at a 45° angle. After attaching the IV line and turning the flow on, you note edema developing on the opposite side of the extremity. What has MOST likely happened? A) Extravasation due to an inappropriate angle of IO catheter insertion B) Inadvertent entry of a large vein, which has caused infiltration C) Fracture of the bone with leakage of bone marrow into the soft tissue D) Acute osteomyelitis secondary to inappropriate cleansing of the site

A) Extravasation due to an inappropriate angle of IO catheter insertion

146. Which of the following statements regarding hetastarch (Hespan) is correct? A) Hetastarch can expand circulating volume for up to 36 hours. B) Hetastarch is an isotonic crystalloid used primarily for blood loss. C) Patients who are allergic to peanuts may be allergic to hetastarch. D) Hetastarch has been shown to antagonize anticoagulant medications.

A) Hetastarch can expand circulating volume for up to 36 hours.

64. Which of the following factors would likely NOT skew a pulse oximetry reading? A) Hypertension B) Cold temperature C) Carbon monoxide D) Sickle-cell disease

A) Hypertension

205. Which of the following statements regarding the King LT airway is correct? A) In the prehospital setting, the King LTS-D is only used in adults.. B) The King LT airway provides better airway protection than the ET tube. C) The King LT airway has two lumens that effectively seal the esophagus. D) In contrast to the King LT-D, the LTS-D is closed at the distal end.

A) In the prehospital setting, the King LTS-D is only used in adults..

86. Which of the following medications possesses positive inotropic effects, allows the cellular uptake of glucose, and is used in the treatment of hyperkalemia? A) Insulin B) Osmitrol C) Glucophage D) Clopidogrel

A) Insulin

28. Which of the following statements regarding dehydration is correct? A) It is often a chronic condition in elderly patients and may take days to manifest. B) During early dehydration, a profound loss of interstitial fluid occurs in the body. C) In younger patients, dehydration is typically caused by an acute loss of more than 50 mL of blood. D) During dehydration, fluid shifts from the extracellular compartment to the intracellular compartment.

A) It is often a chronic condition in elderly patients and may take days to manifest.

129. For which of the following conditions may a patient be prescribed furosemide? A) Kidney dysfunction B) Chronic dehydration C) Low serum potassium D) Reactive airway disease

A) Kidney dysfunction

67. Which of the following statements regarding the IM route of medication administration is correct? A) Medications have a bioavailability of 75% to 100% following IM administration. B) Any medication given by the IV route can be given by the IM route. C) IM-administered medications are subject to first-pass metabolism in the liver. D) Muscle perfusion has minimal effect on the absorption of IM-administered drugs.

A) Medications have a bioavailability of 75% to 100% following IM administration.

55. In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus? A) Moderate asthma attack B) Pericardial tamponade C) Tension pneumothorax D) Decompensating COPD

A) Moderate asthma attack

51. Which of the following represents the correct sequence for managing a patient's airway? A) Open, clear, assess, intervene B) Clear, open, assess, intervene C) Assess, clear, open, intervene D) Open, assess, clear, intervene

A) Open, clear, assess, intervene

140. Which of the following is NOT an oral antiplatelet medication? A) ReoPro B) Plavix C) Ticlid D) Aspirin

A) ReoPro

72. In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? A) Seizure termination B) Acute renal failure C) Respiratory failure D) Anaphylactic shock

A) Seizure termination

155. Which of the following medications is used to provide cardiac cell membrane stabilization following tricyclic antidepressant overdose? A) Sodium bicarbonate B) Magnesium sulfate C) Diphenhydramine D) Calcium chloride

A) Sodium bicarbonate

97. Which of the following occurs during phase 1 of the cardiac cellular action potential? A) Sodium influx decreases while potassium slowly exits the cell B) Rapid influx of sodium ions through channels in the cardiac cell C) Calcium enters the cell while potassium continues to leave the cell D) Calcium movement ceases with continued outflow of potassium

A) Sodium influx decreases while potassium slowly exits the cell

55. Which of the following is NOT an effective way of obtaining a medical history from a patient who is totally deaf? A) Speaking slowly and slightly more loudly to the patient B) Using paper and pencil to write down your questions C) Addressing the patient face-to-face if he or she can read lips D) Using an interpreter who knows American Sign Language

A) Speaking slowly and slightly more loudly to the patient

51. A patient receives several doses of the same drug within a short period of time, after which point the medication does not relieve his symptoms. Which of the following has MOST likely occurred? A) Tachyphylaxis B) Cross-tolerance C) Down-regulation D) Dependence

A) Tachyphylaxis

98. Which of the following statements regarding IO cannulation and infusion is correct? A) The IO space remains patent, even when peripheral veins have collapsed. B) The IO route is reserved for select medications and certain blood products. C) IO infusion should only be attempted in children younger than 6 years of age. D) Medication absorption occurs more slowly through the IO space than through the IV route.

A) The IO space remains patent, even when peripheral veins have collapsed.

179. As you are preparing to start an IV on a young man, he sees the needle, becomes acutely diaphoretic, and passes out. After placing him in the appropriate position, you should: A) administer high-flow oxygen. B) assess his blood glucose level. C) start the IV in case he needs fluids. D) obtain a complete set of vital signs.

A) administer high-flow oxygen.

10. Which of the following statements regarding the patient assessment process is correct? A) The assessment process must be organized and systematic, yet flexible enough to allow you to maximize the amount of information you can gather. B) It is critical that you think of patient assessment as a static sequence of events that are carried out on every patient that you encounter. C) Expanding your questioning of a patient in order to elicit more information often confuses the patient and should be avoided if possible. D) As the patient interview unfolds, you must remain focused on the patient's chief complaint, as it is likely his or her most serious problem.

A) The assessment process must be organized and systematic, yet flexible enough to allow you to maximize the amount of information you can gather.

141. In which of the following cases would the paramedic MOST likely instill medication down a gastric tube? A) Toxic ingestion in patients with a depressed swallowing mechanism B) In the absence of vascular access in a patient who is clinically unstable C) Acute overdose to lavage the stomach and prevent digestion of the drug D) To instill nutritional substances in patients who cannot swallow effectively

A) Toxic ingestion in patients with a depressed swallowing mechanism

190. Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child? A) Tracheobronchial suctioning B) Immediate extubation of the child C) Needle decompression of the chest D) Checking the bag-mask device for defects

A) Tracheobronchial suctioning

279. Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag-mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask-to-face seal with the bag-mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate? A) Transillumination intubation B) Blind nasotracheal intubation C) An open or needle cricothyrotomy D) Further attempts at orotracheal intubation

A) Transillumination intubation

124. Which of the following hazards would you LEAST likely encounter at the scene of a motor vehicle crash? A) Unruly patient B) Moving traffic C) Broken glass D) Hazardous materials

A) Unruly patient

125. Which of the following statements regarding vasopressin is correct? A) Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion. B) In cardiac arrest, current guidelines recommend 20 to 40 units of vasopressin every 5 minutes. C) Vasopressin reduces cardiac afterload, which may cause clinically significant hypotension. D) Vasopressin is a useful medication for patients with right heart failure and peripheral edema.

A) Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion.

48. Which of the following statements regarding an intoxicated patient is correct? A) While the patient is trying to explain things to you, his or her anger can escalate faster than if he or she were not intoxicated. B) Although the intoxicated patient is a poor historian, his or her family members usually provide the information that you need. C) You should promptly transport the intoxicated patient, because attempting to obtain a medical history will be unsuccessful. D) The risk of an intoxicated patient's behavior turning violent is low because his or her cognitive skills are impaired significantly.

A) While the patient is trying to explain things to you, his or her anger can escalate faster than if he or she were not intoxicated.

120. Regardless of the internal diameter, all ET tubes have: A) a 15/22-mm proximal adaptor. B) an inflatable cuff at the distal tip. C) a pilot balloon on the proximal end. D) black millimeter markings on the side.

A) a 15/22-mm proximal adaptor.

6. When determining whether a patient is sick, your MOST effective tool is often: A) a quick visual assessment. B) the patient's chief complaint. C) past medical history findings.. D) the patient's baseline vital signs.

A) a quick visual assessment.

20. The term affinity, as it applies to pharmacology, is MOST accurately defined as the: A) ability of a medication to bind to a receptor. B) process of a medication binding to a receptor. C) blocking of a receptor site by a particular medication. D) strength of the bond between a medication and its receptor.

A) ability of a medication to bind to a receptor.

10. Unlike Schedule I drugs, Schedule II drugs have: A) accepted medical uses. B) a higher abuse potential. C) limited dependence potential. D) no accepted medical application..

A) accepted medical uses.

112. The vagus nerve releases _________________, which acts on _________________ receptors. A) acetylcholine, muscarinic-2 B) norepinephrine, alpha-1 C) epinephrine, beta-2 D) acetylcholinesterase, nicotinic

A) acetylcholine, muscarinic-2

120. At 5 to 10 g/kg/min, dopamine: A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility. B) activates dopaminergic receptor sites, causing renal and mesenteric artery vasodilation. C) no longer activates dopaminergic receptor sites and predominately activates alpha-1 receptor sites. D) has a negative chronotropic effect on the heart, but an increased inotropic effect.

A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility.

281. An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should: A) administer a sedative medication. B) suction his airway and carefully extubate. C) chemically paralyze him with vecuronium. D) physically restrain his head to the stretcher.

A) administer a sedative medication.

29. Signs and symptoms of dehydration include all of the following, EXCEPT: A) bradypnea. B) flushed, dry skin. C) postural hypotension. D) dry mucous membranes.

A) bradypnea.

270. A construction worker fell approximately 15 ft and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should: A) administer oxygen via nonrebreathing mask and continue your assessment. B) insert a nasopharyngeal airway and assist ventilations with a bag-mask device. C) suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula. D) insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask.

A) administer oxygen via nonrebreathing mask and continue your assessment.

129. It is MOST important to identify the age and sex of your patient because: A) age and sex can change how your patient presents. B) the differential diagnosis is modified for older patients. C) this is required information for the patient care report. D) the patient should be assessed by a medic of the same sex.

A) age and sex can change how your patient presents.

239. Compared with an open cricothyrotomy, needle cricothyrotomy: A) allows for subsequent attempts to intubate the patient. B) requires the paramedic to manipulate the patient's cervical spine. C) is technically more difficult and takes longer to perform. D) is associated with a higher risk of damage to adjacent structures.

A) allows for subsequent attempts to intubate the patient.

120. In contrast to dementia, delirium is: A) an acute change in mental status. B) characteristic of Alzheimer's disease. C) more common in the elderly population. D) a gradual deterioration in cognitive function.

A) an acute change in mental status.

91. During IV therapy, the presence of shortness of breath, unequal breath sounds, and cyanosis despite administration of high-flow oxygen should make you MOST suspicious for: A) an air embolus. B) circulatory overload. C) acute pulmonary edema. D) spontaneous pneumothorax.

A) an air embolus.

96. Ipratropium bromide (Atrovent) causes bronchodilation by: A) antagonizing muscarinic receptors. B) agonizing nicotinic receptors. C) agonizing beta-2 receptors. D) antagonizing beta-2 receptors.

A) antagonizing muscarinic receptors.

1. Your entire assessment of a patient should: A) appear to be a seamless process. B) yield a definitive field diagnosis. C) only focus on his or her complaint. D) not deviate at all from a strict format.

A) appear to be a seamless process

173. While attempting to start an IV on a patient with large protruding veins, you note that the vein rolls from side to side during your cannulation attempt. The BEST way to remedy this situation is to: A) apply downward manual traction below the venipuncture site to stabilize the vein in position. B) remove the proximal constricting band to improve venous return and decrease the size of the vein. C) use a through-the-needle IV catheter in order to gain better control over the rolling vein. D) place a chemical heat pack over the vein for 10 minutes in order to decrease movement of the vein.

A) apply downward manual traction below the venipuncture site to stabilize the vein in position.

59. The purpose of a Volutrol (Buretrol) administration set is to: A) avoid inadvertent fluid overload. B) deliver large volumes of IV fluid. C) facilitate piggyback medication infusions.. D) deliver a maximum of 50 mL of IV solution.

A) avoid inadvertent fluid overload.

81. Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): A) basilar skull fracture. B) orbital blowout fracture. C) fracture of the cribriform plate. D) ruptured tympanic membrane.

A) basilar skull fracture.

63. When using a tympanic device to obtain a patient's body temperature, you should: A) be aware of extrinsic factors that can skew the reading. B) hold the device in the patient's ear for 30 to 60 seconds. C) irrigate any wax from the ear with lukewarm water first. D) ensure that the patient is in a laterally recumbent position.

A) be aware of extrinsic factors that can skew the reading

25. In order to cause a negative inotropic effect on the heart, you would have to administer a(n): A) beta-1 adrenergic antagonist. B) alpha-2 adrenergic agonist. C) beta-2 adrenergic agonist. D) alpha-1 adrenergic antagonist.

A) beta-1 adrenergic antagonist.

17. The primary buffer used in all circulating body fluids is: A) bicarbonate. B) phosphorus. C) potassium. D) magnesium.

A) bicarbonate.

55. The percentage of an unchanged medication that reaches the systemic circulation is referred to as: A) bioavailability. B) drug interference. C) peak plasma level. D) pharmacodynamics.

A) bioavailability.

155. The MOST common complication associated with nasotracheal intubation is: A) bleeding. B) aspiration. C) hypoxemia. D) regurgitation.

A) bleeding.

45. Colloid solutions: A) contain proteins that are too large to pass out of the capillary membranes, so the solutions remain in the vascular compartment. B) include solutions such as lactated Ringer's and normal saline and rapidly expand the intravascular compartment. C) are safe to use in the prehospital setting because they rapidly and effectively expand the intravascular compartment. D) do not contain large molecules and are therefore ineffective in expanding the intravascular compartment.

A) contain proteins that are too large to pass out of the capillary membranes, so the solutions remain in the vascular compartment.

39. A paramedic gives a woman with chronic pain an injection of sterile saline and tells her that it is a narcotic analgesic. The paramedic's action: A) could result in criminal prosecution. B) will likely be of therapeutic benefit. C) is acceptable under the circumstances. D) demonstrates compassion and empathy.

A) could result in criminal prosecution.

252. Removal of a dental appliance after intubating a patient is: A) dangerous and may cause dislodgement of the tube. B) generally preferred but should be performed carefully. C) mandatory in the event the patient will require surgery. D) acceptable only if the device is an upper or lower bridge.

A) dangerous and may cause dislodgement of the tube.

103. Calcium chloride or calcium gluconate may mitigate hypotension or bradycardia following an overdose of: A) diltiazem. B) adenosine. C) Cordarone. D) metoprolol.

A) diltiazem.

150. The paramedic should administer promethazine (Phenergan) by: A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes. B) rapid IV push undiluted, as this will minimize the risk of vascular injury. C) mixing it with 25 mg of diphenhydramine in order to prevent dystonia. D) diluting it in 50 to 100 mL of normal saline and giving it over 30 minutes.

A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes.

185. Immediately after administering intramuscular epinephrine to a patient with an allergic reaction, you should: A) dispose of the needle and syringe in a sharps container. B) monitor the patient and obtain another set of vital signs. C) reassess the patient for signs of clinical improvement. D) document the medication name and time of administration.

A) dispose of the needle and syringe in a sharps container.

8. Medications that are manufactured synthetically: A) do not use animal, mineral, or vegetable sources. B) include insulin, digitalis, and thyroid medications. C) are derived from certain plants and animal organs. D) include calcium, iron, magnesium, and other minerals.

A) do not use animal, mineral, or vegetable sources.

199. The main disadvantage of the LMA is that it: A) does not provide protection against aspiration. B) spontaneously dislodges in the majority of patients. C) is associated with significant upper airway swelling. D) is technically more difficult to perform than intubation.

A) does not provide protection against aspiration.

32. Signs and symptoms of overhydration include: A) edema. B) oliguria. C) weight loss. D) wheezing.

A) edema.

73. When changing an IV bag, it is important to: A) ensure that fluid remains in the drip chamber. B) attach a new fluid administration set to the bag. C) ensure that the tubing is completely depleted of fluid. D) allow the bag to become completely depleted of fluid.

A) ensure that fluid remains in the drip chamber.

196. Multilumen airways are contraindicated in patients with: A) esophageal cancer. B) cervical spine trauma. C) traumatic cardiac arrest. D) a history of gastric ulcers.

A) esophageal cancer.

223. Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when: A) extended periods of paralysis are needed. B) longer-acting paralytics are contraindicated. C) you have a transport time of less than 15 minutes. D) intubation of the patient is anticipated to be difficult.

A) extended periods of paralysis are needed.

87. The MOST prominent clinical indicator of a pyrogenic reaction is: A) fever. B) nausea. C) a headache. D) vascular collapse.

A) fever.

88. When auscultating heart sounds, you should place your stethoscope at the: A) fifth intercostal space, over the apex of the heart. B) second intercostal space, over the base of the heart. C) third or fourth intercostal space, in the midaxillary line. D) sternal border at the second or third intercostal space.

A) fifth intercostal space, over the apex of the heart.

112. When determining the correct-sized nasogastric tube for a patient, you should measure the tube: A) from the nose to the ear and to the xiphoid process. B) from the nose to the chin and to the epigastric region. C) from the mouth to the chin and to the xiphoid process. D) from the nose, around the ear, and to the xiphoid process.

A) from the nose to the ear and to the xiphoid process.

27. Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the: A) functional reserve capacity. B) expiratory reserve volume. C) residual expiratory volume. D) fraction of inspired oxygen.

A) functional reserve capacity.

173. Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves: A) gently inserting the catheter until resistance is felt. B) inserting the catheter until secretions are observed. C) inserting the catheter no farther than 6 to 8 in. D) applying suction while gently inserting the catheter.

A) gently inserting the catheter until resistance is felt.

79. When assessing a patient's conjunctivae, you note they are injected. This means that the conjunctivae are: A) red. B) pale. C) yellow. D) cyanotic.

A) red.

98. The flow-restricted, oxygen-powered ventilation device: A) has a demand valve that is triggered by the negative pressure generated during inhalation. B) is the preferred initial device for ventilating an apneic or inadequately breathing patient. C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min. D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma.

A) has a demand valve that is triggered by the negative pressure generated during inhalation.

136. Succinylcholine (Anectine) is preferred by many paramedics because it: A) has a short duration of action. B) is a nondepolarizing paralytic. C) does not cause fasciculations. D) has a slow onset of action.

A) has a short duration of action.

18. In contrast to the right lung, the left lung: A) has two lobes. B) has three lobes. C) is encased in the parietal pleura. D) can only hold a small volume of air.

A) has two lobes.

218. When a patient is given a paralytic without sedation: A) he or she is fully aware and can hear and feel. B) you should only give one tenth of the standard dose. C) placement of an ET tube is less traumatic. D) paralysis is not achieved and intubation is not possible.

A) he or she is fully aware and can hear and feel.

108. You would MOST likely encounter bilateral dependent edema in a patient with: A) heart failure. B) arterial occlusion. C) diabetes mellitus. D) deep vein occlusion.

A) heart failure.

83. Pain, tenderness, and blood rapidly pooling around the IV site are MOST indicative of: A) hematoma. B) phlebitis. C) vein occlusion. D) thrombophlebitis.

A) hematoma.

165. The MOST significant complication associated with digital intubation is: A) hypoxia. B) dental trauma. C) airway swelling. D) vocal cord damage.

A) hypoxia.

54. Once the pigtail is removed from the sterile access port of an IV solution, the solution must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.

A) immediately.

275. You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should: A) inflate the distal cuff with 5 to 10 mL of air. B) attach an ETCO2 detector to the tube. C) secure the ET tube with a commercial device. D) begin ventilations and auscultate breath sounds.

A) inflate the distal cuff with 5 to 10 mL of air.

130. Prior to administering a medication to any patient, the paramedic should: A) inquire about drug allergies. B) repeat the initial assessment. C) always contact medical control. D) perform a detailed physical exam.

A) inquire about drug allergies.

247. When suctioning a patient's stoma, you should: A) insert the catheter until resistance is felt. B) ask the patient to inhale as you are suctioning. C) insert the catheter no more than 15 cm. D) provide suction for no longer than 20 seconds.

A) insert the catheter until resistance is felt.

143. When injecting a medication via the rectal route, you should: A) instruct the patient not to bear down. B) use a large uncuffed endotracheal tube. C) ensure that the patient is fully conscious. D) recall that the rectal mucosae are relatively avascular.

A) instruct the patient not to bear down.

164. When administering sublingual nitroglycerin to a patient, you should do all of the following, EXCEPT: A) instruct the patient to chew and swallow the tablet. B) perform a focused history and physical examination. C) ensure that the patient's mucous membranes are moist. D) thoroughly assess the patient for any transdermal patches.

A) instruct the patient to chew and swallow the tablet.

129. After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade: A) into the right side of the mouth and sweep the tongue to the left. B) in the midline of the mouth and gently lift upward on the tongue. C) into the left side of the mouth and move the blade to the midline. D) in the midline of the mouth and gently sweep the tongue to the left.

A) into the right side of the mouth and sweep the tongue to the left.

111. In contrast to the nasogastric tube, the orogastric tube: A) is safer to use in patients with severe facial trauma. B) should only be used in patients who are conscious. C) can be used in patients who require gastric lavage. D) is not necessary in patients who have been intubated.

A) is safer to use in patients with severe facial trauma.

73. Examination of the head is MOST important when assessing a patient who: A) is unresponsive. B) complains of nausea. C) has shortness of breath. D) presents with hemiparesis.

A) is unresponsive.

3. A medication is used "off-label." This means that it: A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA. B) has been determined to be safe by a physician, and is used to treat a patient's illness before the medication has been approved by the FDA for any purpose. C) is administered in clinical trials while the manufacturer conducts further research and before the FDA has approved the medication for use. D) is administered in an extreme emergency situation, but only if initial clinical trials have determined that the medication will not cause harm to the patient.

A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA.

149. The main benefit of using a prefilled medication syringe is that: A) it does not require you to draw up each individual medication dose. B) it is made of plastic and is less likely to break or get damaged. C) there is no need to expel air from the syringe prior to giving the drug. D) all of the contents of a prefilled syringe are administered at one time.

A) it does not require you to draw up each individual medication dose.

21. A medication is called an antagonist if: A) it has a higher affinity for the receptor site than the chemical mediator. B) it stimulates a receptor site to cause the response that that receptor normally causes. C) it attaches to a receptor site and produces an effect or series of effects. D) the chemical mediator of a receptor has a higher affinity than the medication.

A) it has a higher affinity for the receptor site than the chemical mediator.

141. Prior to administering vecuronium bromide (Norcuron), or any other neuromuscular blocker, it is important for the paramedic to remember that: A) neuromuscular blockers have no effect on a patient's level of consciousness. B) chemical paralysis should be achieved prior to administering a sedative drug. C) the airway should be secured with an ET tube or other advanced airway device. D) neuromuscular blockers are potent analgesics and may cause severe hypotension.

A) neuromuscular blockers have no effect on a patient's level of consciousness.

229. The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because: A) no important structures lie between the skin covering the cricothyroid membrane and the airway. B) the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel. C) there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane. D) the cricoid cartilage helps prevent accidental perforation through the back of the airway and into the esophagus.

A) no important structures lie between the skin covering the cricothyroid membrane and the airway.

100. A pathologic fracture occurs when: A) normal forces are applied to abnormal bone structures. B) abnormal forces are applied to abnormal bone structures. C) normal forces are applied to normal bone structures. D) abnormal forces are applied to normal bone structures.

A) normal forces are applied to abnormal bone structures.

132. The preferred IV fluid for Y-site tubing administration during a blood product transfusion is: A) normal saline. B) 5% dextrose in water. C) lactated Ringer's. D) 0.45% sodium chloride.

A) normal saline.

200. During ventilation with the LMA, the paramedic should: A) observe the patient for signs of inadequate ventilation. B) maintain the patient's head in a slightly flexed position. C) suction the patient's oropharynx at least every 2 minutes. D) hyperventilate the patient to maximize tidal volume delivery.

A) observe the patient for signs of inadequate ventilation.

67. The skin becomes _________ when red blood cell perfusion to the capillary beds of the skin is poor. A) pale B) flushed C) cyanotic D) mottled

A) pale

11. On most runs, the two MOST important pieces of patient history information that you need to obtain initially are the: A) patient's name and chief complaint. B) chief complaint and patient's address. C) patient's name and family physician. D) chief complaint and the patient's sex.

A) patient's name and chief complaint.

105. IO cannulation is contraindicated in all of the following situations, EXCEPT: A) penetrating thoracic trauma. B) bilateral knee replacements. C) known osteogenesis imperfecta. D) the presence of a peripheral IV line.

A) penetrating thoracic trauma.

61. Pulse oximetry is used to measure the: A) percentage of hemoglobin that is saturated with oxygen. B) exchange of oxygen and carbon dioxide at the cellular level. C) percentage of carbon dioxide that is eliminated from the body. D) amount of oxygen dissolved in the plasma portion of the blood.

A) percentage of hemoglobin that is saturated with oxygen.

94. A patient who is absolutely still and resists any movement should be suspected of having: A) peritonitis. B) kidney stones. C) a bowel obstruction. D) intra-abdominal bleeding.

A) peritonitis.

184. When preoxygenating an uninjured child prior to ET intubation, you should: A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes. B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at 40 breaths/min for at least 2 to 3 minutes. C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1 breath every 10 seconds for at least 3 minutes. D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately hyperventilate the child at 24 breaths/min for 30 seconds.

A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes.

49. The MOST effective way to obtain a medical history from a patient who is crying is to: A) place your hand on his or her shoulder (if appropriate for the patient) and reassure him or her that you are in control of the situation. B) tactfully advise the patient that you cannot effectively help him or her if he or she continues to cry. C) have one family member calm the patient as you gather the medical history from another family member. D) administer a sedative medication, which will calm the patient and facilitate your gathering of the medical history.

A) place your hand on his or her shoulder (if appropriate for the patient) and reassure him or her that you are in control of the situation.

107. Patients who take alpha-blocking medications at home are frequently prone to: A) postural hypotension. B) hypertensive crisis. C) narrow-angle glaucoma. D) vagal-induced bradycardia.

A) postural hypotension.

43. When dealing with a patient who has multiple symptoms, the MOST effective way to develop an appropriate care plan is to: A) prioritize the patient's complaints. B) perform a complete head-to-toe exam. C) address all complaints simultaneously. D) assume that all complaints are linked.

A) prioritize the patient's complaints.

119. The brachioradialis tendon is located: A) proximal to the wrist. B) in the antecubital fossa. C) on the distal humerus. D) directly over the elbow.

A) proximal to the wrist.

107. The MOST clinically significant indicator(s) of ischemia in a limb is/are: A) pulselessness. B) poikilothermia. C) parasthesias. D) pain and pallor.

A) pulselessness.

14. Tenting of the skin under the jaw often occurs when airway devices are inadvertently inserted into the: A) pyriform fossae. B) vallecular space. C) laryngopharynx. D) hypopharyngeal space.

A) pyriform fossae.

263. After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21-year-old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should: A) recognize that the patient's condition has improved. B) give another bronchodilator treatment and reassess. C) try another treatment modality to treat her wheezing. D) assist ventilations and be prepared to intubate her.

A) recognize that the patient's condition has improved.

285. You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves: A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea. B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind nasotracheal intubation. C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and intubating her trachea via direct laryngoscopy. D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing mask, and continuing suction attempts.

A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea.

113. The optic nerve is a _______ nerve, and controls _______. A) sensory, light perception and vision B) sensory, hearing and balance perception C) motor, eye movements and pupil dilation D) motor, pupil constriction and eye movement

A) sensory, light perception and vision

43. Certain antibiotics and antiseizure medications are known to cause Stevens-Johnson syndrome, which is a: A) severe, possibly fatal reaction that mimics a burn. B) rare condition characterized by painful neck spasms. C) condition in which the renal system acutely fails. D) nonfatal reaction characterized by a diffuse rash.

A) severe, possibly fatal reaction that mimics a burn.

33. It is appropriate to ask, "Would you say the pain is similar to or worse than with previous episodes?" when determining the _________ of a patient's pain. A) severity B) quality C) region D) progression

A) severity

4. The ________ are formed by the cranial bones and prevent contaminants from entering the respiratory tract. A) sinuses B) turbinates C) bony nasal shelves D) nasal mucous membranes

A) sinuses

180. When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade.

A) size 2 straight blade.

80. The MOST significant complication associated with the use of an oropharyngeal airway is: A) soft-tissue trauma with oral bleeding. B) mild bradycardia in pediatric patients. C) significant bruising of the hard palate. D) a tachycardic response in adult patients.

A) soft-tissue trauma with oral bleeding.

49. All of the following are peripheral veins, EXCEPT the: A) subclavian vein. B) external jugular vein. C) veins of the hand. D) lower extremity veins.

A) subclavian vein.

169. Medication routes, from slowest to fastest rates of absorption, are: A) subcutaneous, intramuscular, sublingual, inhalation, intravenous. B) intramuscular, sublingual, subcutaneous, intravenous, inhalation. C) intravenous, inhalation, sublingual, subcutaneous, intramuscular. D) subcutaneous, sublingual, inhalation, intramuscular, intravenous.

A) subcutaneous, intramuscular, sublingual, inhalation, intravenous.

58. A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of: A) synergism. B) summation. C) potentiation. D) antagonism.

A) synergism.

32. The Hering-Breuer reflex is a protective mechanism that: A) terminates inhalation and prevents lung overexpansion. B) decreases pneumotaxic function during severe hypoxia. C) sends messages to the diaphragm via the phrenic nerves. D) allows the apneustic center to influence the respiratory rate.

A) terminates inhalation and prevents lung overexpansion.

96. IO infusion is a technique of administering IV fluids and medications into: A) the IO space of a long bone. B) the diaphysis of the femur or humerus. C) the epiphysis of the proximal tibia. D) a large vein that lies deep within the neck.

A) the IO space of a long bone.

39. Once D5W is infused into the body: A) the body metabolizes the dextrose quickly and the solution becomes hypotonic. B) it causes fluid to shift from the intracellular space into the vascular space. C) cellular uptake of dextrose occurs and the solution quickly becomes isotonic. D) it rapidly expands the vascular space and effectively increases blood pressure.

A) the body metabolizes the dextrose quickly and the solution becomes hypotonic.

4. In prehospital care, the priorities of evaluation and treatment are based on: A) the degree of threat to the patient's life. B) your overall experience as a paramedic. C) the receiving physician's online orders. D) standard treatment guidelines and algorithms.

A) the degree of threat to the patient's life.

163. Digital intubation can be performed on trauma patients because: A) the head does not have to be placed in a sniffing position. B) most trauma patients have distortion of the airway anatomy. C) orotracheal intubation is unsafe to perform on trauma patients. D) the technique is easier to perform than other forms of intubation.

A) the head does not have to be placed in a sniffing position.

45. Intrapulmonary shunting is defined as: A) the return of unoxygenated blood to the left side of the heart. B) a decrease in the surface area of the alveoli caused by damage. C) a condition in which too much carbon dioxide is eliminated. D) failure of blood to bypass an obstruction in a pulmonary artery.

A) the return of unoxygenated blood to the left side of the heart.

138. Decreased ventilation compliance following intubation is LEAST suggestive of: A) gastric distention. B) left bronchus intubation. C) esophageal intubation. D) tension pneumothorax.

B) left bronchus intubation.

96. What part of the abdominal exam is of LEAST value in the prehospital setting? A) Percussion B) Auscultation C) Inspection D) Palpation

B) Auscultation

143. What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas? A) A-B B) B C) B-C D) D

B) B

144. What phase of the capnographic waveform is called the expiratory upslope? A) A-B B) B-C C) C-D D) D-E

B) B-C

128. What type of medication is used to eliminate certain toxins from the body? A) Inotrope B) Diuretic C) Vasopressor D) Vasodilator

B) Diuretic

187. Which of the following is NOT an appropriate method for confirming proper ET tube placement in a 15-kg child? A) Waveform capnography B) Esophageal bulb or syringe C) Bilateral auscultation of breath sounds D) Assessment of skin color and oxygen saturation

B) Esophageal bulb or syringe

57. __________ entails gently striking the surface of the body, typically where it overlies various body cavities. A) Palpation B) Percussion C) Inspection D) Auscultation

B) Percussion

41. The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called: A) internal respiration. B) external respiration. C) pulmonary ventilation. D) intrapulmonary shunting.

B) external respiration.

123. Documentation of your physical examination should be: A) subjective in all regards. B) factual and nonjudgmental. C) representative of your perceptions. D) reviewed by the EMS administrator.

B) factual and nonjudgmental.

123. The primary physiologic effect of dobutamine is: A) increased afterload. B) increased inotropy. C) profound vasoconstriction. D) increased chronotropy.

B) increased inotropy.

7. Which of the following statements regarding electrolytes is correct? A) Electrolytes are nonreactive and relatively harmless if they are left to circulate in the body. B) Electrolytes are also called ions and dissociate into charged components when placed in water. C) Electrolytes help to regulate muscular contraction, but have no effect on cardiac function. D) Electrolyte charges are stabilized by blood so that they can aid in the body's metabolic functions.

B) Electrolytes are also called ions and dissociate into charged components when placed in water.

32. Which of the following is an example of a leading question? A) "On a scale of 1 to 10, what number would you assign your pain?" B) "Do you think that you are experiencing a cardiac emergency?" C) "Has anything like this ever happened to you before today?" D) "Does the pain stay in your chest or does it move anywhere else?"

B) "Do you think that you are experiencing a cardiac emergency?"

119. To administer a drug, you must know the weight of the drug that is present in: A) 1 L. B) 1 mL. C) 100 mL. D) 0.1 mL.

B) 1 mL.

222. To prevent muscular fasciculations associated with the use of succinylcholine, you should administer: A) 0.5 mg of atropine sulfate via rapid IV push. B) 10% of the usual dose of a nondepolarizing paralytic. C) an infusion of potassium chloride set at 5 mEq per hour. D) 1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.

B) 10% of the usual dose of a nondepolarizing paralytic.

124. A hypoglycemic patient requires IV dextrose. Medical control orders you to administer 25 mL. You have a prefilled syringe of 50% dextrose that contains 25 g/50 mL. How much dextrose will you give? A) 500 mg B) 12.5 g C) 5,000 mg D) 50 g

B) 12.5 g

66. Through which of the following over-the-needle catheters can you infuse the greatest amount of fluid over the shortest period of time? A) 16 gauge, 1 ¼ B) 14 gauge, 1 ¼ C) 18 gauge, 2 ¼ D) 14 gauge, 2 ¼

B) 14 gauge, 1 ¼

183. Approximately how far should you insert a 5.0-mm ET tube in a 4-year-old child? A) 12 cm B) 15 cm C) 17 cm D) 19 cm

B) 15 cm

140. Vasopressin is supplied in 1-mL vials that contain 20 units. How many vials should you give to achieve the initial adult dose? A) 1 B) 2 C) 3 D) 4

B) 2

255. If the distance between the hyoid bone and the thyroid notch is at least ___ cm wide, the difficulty of intubation should be low. A) 1 B) 2 C) 3 D) 4

B) 2

142. Typically, ETCO2 is approximately: A) 2 to 5 mm Hg higher than the arterial PaCO2. B) 2 to 5 mm Hg lower than the arterial PaCO2. C) 5 to 10 mm Hg higher than the arterial PaCO2. D) 5 to 10 mm Hg lower than the arterial PaCO2.

B) 2 to 5 mm Hg lower than the arterial PaCO2.

118. When scoring a patient's deep tendon reflexes, normally active reflexes would be assigned a score of: A) 1+. B) 2+. C) 3+. D) 4+.

B) 2+.

110. 0.2 mg equals: A) 0.02 g. B) 200 µg. C) 0.02 µg. D) 2,000 µg.

B) 200 µg.

133. A unit of packed red blood cells contains approximately _____ to _____ mL of concentrated red blood cells. A) 125, 200 B) 225, 250 C) 250, 500 D) 500, 725

B) 225, 250

84. A full (2,000 psi) D cylinder will last approximately ______ minutes if you are administering oxygen at 12 L/min. A) 22 B) 24 C) 26 D) 28

B) 24

25. What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a dead space volume of 135 mL? A) 3,650 mL B) 3,780 mL C) 4,260 mL D) 5,400 mL

B) 3,780 mL

117. On the Fahrenheit scale, water freezes at: A) 0°. B) 32°. C) 40°. D) 45°.

B) 32°.

123. Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A) 0.5 mL B) 5 mL C) 0.25 mL D) 10 mL

B) 5 mL

65. The average peak expiratory flow rate in a healthy adult is approximately: A) 450 mL. B) 550 mL. C) 650 mL. D) 750 mL.

B) 550 mL.

33. The ideal body weight for a woman who is 5 ft 5 in tall is: A) 52 kg. B) 57 kg. C) 62 kg. D) 66 kg.

B) 57 kg.

182. During the attempted resuscitation of a man in V-Fib cardiac arrest, your protocols call for the administration of 1.5 mg/kg of lidocaine. You have prefilled syringes of lidocaine in a concentration of 100 mg/5 mL. The patient weighs 180 lb. How many milliliters will you administer? A) 5.5 B) 6.2 C) 6.5 D) 6.8

B) 6.2

116. A patient with a core body temperature of 35° on the Celsius scale has a core body temperature of ____ on the Fahrenheit scale. A) 94° B) 95° C) 96° D) 97°

B) 95°

39. Which of the following findings is LEAST indicative of abuse or domestic violence? A) Multiple injuries that are in various stages of healing B) A patient who refuses to allow a family member to speak for him or her C) Injuries that are inconsistent with the history that you are given D) A husband who towers over his wife and answers your questions for her

B) A patient who refuses to allow a family member to speak for him or her

179. In which of the following situations would ET intubation of a pediatric patient be LEAST necessary? A) Traumatic brain injury with unconsciousness B) Administration of certain resuscitative medications C) Cardiopulmonary arrest due to respiratory failure D) Difficulty effectively ventilating with a bag-mask

B) Administration of certain resuscitative medications

42. Which of the following statements regarding isotonic crystalloid solutions is correct? A) You should infuse 1 mL of isotonic crystalloid solution for every 3 mL of estimated blood loss. B) Approximately two thirds of infused isotonic crystalloid solution will leave the vascular space within 1 hour. C) Isotonic crystalloids, such as normal saline, have the ability to carry and deliver oxygen to the body's cells. D) The ability of isotonic crystalloids to cross membranes and alter fluid levels makes them dangerous to use for fluid replacement.

B) Approximately two thirds of infused isotonic crystalloid solution will leave the vascular space within 1 hour.

169. Which of the following represents the MOST correct technique for performing transillumination-guided intubation? A) Place the patient's head in a hyperflexed position and insert the tube-stylet combination into the left side of the mouth. B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth. C) Hyperextend the patient's head, pull the jaw down, and insert the tube-stylet combination into the right side of the patient's mouth. D) Place the patient's head in a neutral position, displace the tongue with a tongue blade, and insert the tube-stylet combination in the midline of the mouth.

B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth.

145. The ___________ route is the MOST commonly used medication route in the prehospital setting. A) IO B) IV C) percutaneous D) intramuscular

B) IV

283. While transporting an intubated 8-year-old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened? A) Tension pneumothorax B) Inadvertent extubation C) Obstruction of the tube D) Right mainstem intubation

B) Inadvertent extubation

72. Which of the following conditions would MOST likely cause laryngeal spasm and edema? A) Croup B) Inhalation injury C) Viral pharyngitis D) Mild asthma attack

B) Inhalation injury

66. Which of the following statements regarding your general survey of the patient is correct? A) Little information can be gained from the patient without a hands-on assessment. B) It is not uncommon for patients in severe pain to present with a quiet and still affect. C) The environment in which the patient is found is more significant than his or her appearance. D) The general patient survey begins as you perform the initial assessment of the patient.

B) It is not uncommon for patients in severe pain to present with a quiet and still affect.

110. Which of the following is NOT proper procedure when inserting a nasogastric tube in a responsive patient? A) Administering a topical alpha agonist to constrict the nasal vasculature B) Keeping the patient's head in an extended position while inserting the tube C) Injecting 40 mL of air into the tube while auscultating over the epigastrium D) Encouraging the patient to swallow or drink to facilitate passage of the tube

B) Keeping the patient's head in an extended position while inserting the tube

225. Which of the following medications has been shown to blunt the increase in intracranial pressure associated with suctioning and laryngeal stimulation? A) Atropine B) Lidocaine C) Amiodarone D) Furosemide

B) Lidocaine

6. Metoprolol has the brand name _____________, which may be a subtle reference to lowering the blood pressure. A) Cordarone B) Lopressor C) Vasotec D) Norpramin

B) Lopressor

19. Which of the following electrolytes plays the MOST active role in metabolism? A) Potassium B) Magnesium C) Bicarbonate D) Phosphorus

B) Magnesium

139. When is aspirin indicated for the treatment of a stroke? A) Within the first 15 minutes after the onset of symptoms B) Only after an intracranial hemorrhage has been ruled out C) Only if the patient is prescribed antiplatelet medications D) Immediately upon arrival at the emergency department

B) Only after an intracranial hemorrhage has been ruled out

124. Which of the following statements regarding orotracheal intubation is correct? A) Orotracheal intubation should be performed on any patient who is apneic. B) Orotracheal intubation is the most common method of performing ET intubation. C) You cannot perform orotracheal intubation on patients who are breathing. D) Orotracheal intubation is most commonly performed without a laryngoscope.

B) Orotracheal intubation is the most common method of performing ET intubation.

34. Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ______ and send signals to the respiratory centers via the _______________ nerves. A) PaO2, vagus and intercostal B) PaCO2, glossopharyngeal and vagus C) PaCO2, phrenic and glossopharyngeal D) PaO2, hypoglossal, vagus, and intercostal

B) PaCO2, glossopharyngeal and vagus

53. Which of the following factors would have the LEAST influence on the duration and effectiveness of a medication? A) Dose administered B) Patient's dietary habits C) Route of administration D) Patient's clinical status

B) Patient's dietary habits

48. Which of the following medications MOST often causes an immune-mediated medication response? A) Ibuprofen B) Penicillin C) Fentanyl D) Atropine

B) Penicillin

75. Which of the following statements regarding plasma-protein binding is correct? A) Plasma-protein binding is an irreversible process that decreases the amount of medication necessary for a desired clinical effect. B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action. C) If a patient has a safe level of a protein-bound medication, a second medication with a greater affinity greatly decreases the amount of the original medication. D) As plasma protein levels decrease, the introduction of another protein-bound medication causes the concentration of the original medication to remain unchanged.

B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action.

42. Which of the following conditions would make a patient the MOST susceptible to an adverse effect from a medication? A) Hypertension B) Renal failure C) Minor trauma D) Chronic pain

B) Renal failure

127. Which of the following actions would you likely NOT perform at the scene of a fall before engaging in the care of a conscious patient? A) Gathering dispatch information B) Speaking with immediate family C) Assessing the scene for safety D) Noting the mechanism of injury

B) Speaking with immediate family

153. Which of the following is NOT a contraindication for nasotracheal intubation? A) Apnea B) Spinal injury C) Frequent use of cocaine D) Patients taking an anticoagulant

B) Spinal injury

189. Which of the following clinical findings is LEAST suggestive of a pneumothorax in an intubated child? A) Decreased ventilation compliance B) Stronger breath sounds on the right side C) Persistent cyanosis despite ventilations D) Stronger breath sounds on the left side

B) Stronger breath sounds on the right side

221. Which of the following is NOT characteristic of a depolarizing neuromuscular blocking agent? A) Bradycardia B) Tachycardia C) Muscle fasciculations D) Short duration of action

B) Tachycardia

80. Which of the following describes first-order elimination? A) The more of a substance that is in the plasma, the less the body works to eliminate it. B) The rate of elimination is directly influenced by the plasma levels of the substance. C) A fixed amount of a substance is removed, regardless of the total amount in the body. D) Biotransformation in the liver converts a substance to an active or inactive metabolite.

B) The rate of elimination is directly influenced by the plasma levels of the substance.

47. Which of the following statements regarding synthetic blood substitutes is correct? A) Type O-negative blood is a synthetic blood substitute. B) They have the ability to carry oxygen to the body's cells. C) They do not possess the ability to carry and deliver oxygen. D) Hespan is the most commonly used synthetic blood substitute.

B) They have the ability to carry oxygen to the body's cells.

138. What is the mechanism of action of anticoagulant medications? A) They dissolve existing clots, thereby restoring distal blood flow. B) They prevent new clot formation and the growth of existing clots. C) They inhibit platelet aggregation during acute coronary syndrome. D) They promote hemostasis in patients with pulmonary emboli.

B) They prevent new clot formation and the growth of existing clots.

259. Which of the following patients has the lowest minute volume? A) Tidal volume of 400 mL; respiratory rate of 14 breaths/min B) Tidal volume of 350 mL; respiratory rate of 12 breaths/min C) Tidal volume of 400 mL; respiratory rate of 24 breaths/min D) Tidal volume of 300 mL; respiratory rate of 16 breaths/min

B) Tidal volume of 350 mL; respiratory rate of 12 breaths/min

73. Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption? A) Liver B) Urinary tract C) Bone marrow D) Vascular system

B) Urinary tract

15. The history of present illness is defined as: A) the reason why the patient called EMS in the first place. B) a chronologic account of the patient's signs and symptoms. C) your perception of the severity of the patient's condition. D) a past medical problem that is causing the chief complaint..

B) a chronologic account of the patient's signs and symptoms.

20. Atelectasis occurs when: A) the alveoli are overinflated and rupture. B) a deficiency of surfactant causes alveolar collapse. C) deoxygenated blood diffuses across the alveoli. D) surface tension on the alveolar walls is decreased.

B) a deficiency of surfactant causes alveolar collapse.

84. Percussion of the chest produces ____________ if the pleural space is full of blood. A) a hollow sound B) a dull sound C) a high-pitched note D) hyperresonance

B) a dull sound

226. If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should: A) stop and hyperventilate the patient at a rate of 24 breaths/min. B) abort the intubation attempt and ventilate with a bag-mask device. C) apply posterior cricoid pressure and continue the intubation attempt. D) continue the intubation attempt and monitor the cardiac rhythm closely.

B) abort the intubation attempt and ventilate with a bag-mask device.

140. If you give a medication via the oral route in the prehospital setting, you should give it early because: A) toxic levels are reached easily. B) absorption via this route is slow. C) its onset of action is unpredictable. D) the patient may aspirate the medication..

B) absorption via this route is slow.

54. The peak of a medication's effect depends on _____________, whereas the duration of effect depends on ______________. A) distribution, absorption B) absorption, metabolism C) elimination, absorption D) metabolism, distribution

B) absorption, metabolism

114. Massive doses of atropine may be required when: A) a patient strains to defecate and stimulates muscarinic-2 receptors. B) acetylcholine increases dramatically due to acetylcholinesterase inhibition. C) severe bradycardia is the result of a block in the cardiac conduction system. D) a patient's heart rate significantly increases and lowers the cardiac output.

B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.

104. Indications for CPAP include: A) cardiopulmonary arrest. B) acute pulmonary edema. C) severe opiate toxicity. D) acute bacterial pneumonia.

B) acute pulmonary edema.

288. A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves: A) vigorously suctioning her oropharynx for no longer than 15 seconds and then inserting a multilumen airway device. B) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway. C) suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present. D) providing positive-pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy.

B) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway.

19. A medication that initiates or alters a cellular activity by attaching to receptor sites and prompting a cell response is said to be: A) synergistic. B) an agonist. C) an antagonist. D) a competitive binder.

B) an agonist.

93. The signs and symptoms that occur when an IV catheter is sheared and becomes a free-floating segment in the circulatory system MOST closely resemble: A) pneumothorax. B) an air embolus. C) left-sided heart failure. D) right-sided heart failure.

B) an air embolus.

198. The LMA is: A) a suitable airway device for use in morbidly obese patients. B) an alternative to bag-mask ventilation when intubation is not possible. C) associated with a higher risk of damage to the vocal cords than intubation. D) especially effective for CHF patients who require high pulmonary pressures.

B) an alternative to bag-mask ventilation when intubation is not possible.

16. The paramedic should be MOST suspicious that a controlled substance has been tampered with if: A) repeated doses of the same drug are administered and the patient experiences an adverse reaction. B) an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely. C) the box that the drug is stored in is torn, even if the drug cartridge itself is structurally intact. D) there are any stray markings on the drug cartridge or vial, even if the contents are not discolored.

B) an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely.

71. Changes in hair growth or loss of hair are LEAST suggestive of: A) diabetes. B) an infection. C) the aging process. D) radiation therapy.

B) an infection.

82. Swollen lymph nodes in the anterior neck usually indicate: A) malignancy. B) an infection. C) viral replication. D) an allergic state.

B) an infection.

82. Vein irritation during IV therapy is usually caused by: A) the formation of a thrombus. B) an infusion rate that is too rapid. C) contaminants in the IV solution. D) IV solutions that are not warmed.

B) an infusion rate that is too rapid.

59. Biot respirations are characterized by: A) slow, shallow irregular respirations or occasional gasping breaths. B) an irregular pattern of breathing with intermittent periods of apnea. C) deep, gasping respirations that are often rapid but may be slow. D) increased respirations followed by apneic periods.

B) an irregular pattern of breathing with intermittent periods of apnea.

215. Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT: A) sedation. B) analgesia. C) anxiolysis. D) retrograde amnesia.

B) analgesia.

231. Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT: A) tracheal tumors or subglottic stenosis. B) any patient who is younger than 16 years of age. C) crushing laryngeal injuries or tracheal transection. D) inability to identify the correct anatomic landmarks.

B) any patient who is younger than 16 years of age.

245. Patients with a partial laryngectomy: A) have had their entire larynx removed and breathe through an opening in the neck called a stoma. B) are called partial neck breathers because they breathe through both a stoma and the nose and mouth. C) are easy to differentiate from patients who have had a total laryngectomy, especially when they are apneic. D) cannot be ventilated with the mouth-to-mask technique because there is no connection between the pharynx and lower airway.

B) are called partial neck breathers because they breathe through both a stoma and the nose and mouth.

126. Most of the complications caused by intubation-induced hypoxia: A) are easily reversible. B) are subtle and occur gradually. C) can be predicted with pulse oximetry. D) are dramatic and occur immediately.

B) are subtle and occur gradually.

20. The paramedic should address a patient: A) by using the patient's formal name. B) as the patient wishes to be addressed. C) by the patient's first name whenever possible. D) in a manner that the paramedic deems most professional.

B) as the patient wishes to be addressed.

188. A 60-year-old woman with acute chest discomfort requires 0.4 mg of sublingual nitroglycerin. Prior to administering the medication, you should: A) assess her mucous membranes to ensure they are dry. B) ask her if she wears a transdermal nitroglycerin patch. C) ensure that her systolic BP is greater than 120 mm Hg. D) determine to which hospital she wishes to be transported.

B) ask her if she wears a transdermal nitroglycerin patch.

90. To appreciate the S1 sound: A) the patient should be sitting upright and leaning slightly backward. B) ask the patient to breathe normally and hold his or her breath on expiration. C) the patient should be supine with his or her body tilted to the right. D) ask the patient to breathe normally and hold his or her breath on inhalation.

B) ask the patient to breathe normally and hold his or her breath on expiration.

128. If you receive a medication order from on-line medical control that seems inappropriate to you, you should: A) refuse to administer the medication. B) ask the physician to repeat the order. C) look up the correct dose in your field guide. D) administer the drug as ordered and document it.

B) ask the physician to repeat the order.

122. In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to: A) move the patient's tongue to the left. B) extend beneath the epiglottis and lift it up. C) fit into the vallecular space at the base of the tongue. D) indirectly lift the epiglottis to expose the vocal cords.

B) extend beneath the epiglottis and lift it up.

184. While consulting with the attending physician at the receiving facility about a patient with symptomatic bradycardia, the physician orders you to administer 0.5 mg/kg of atropine to the patient. After recognizing that this is an inappropriate dose of atropine, you should: A) contact your medical director at once. B) ask the physician to repeat the order. C) refuse to administer the ordered dose. D) confirm the correct dose in your field guide.

B) ask the physician to repeat the order.

116. All of the following are endogenous catecholamines, EXCEPT: A) dopamine. B) atropine. C) epinephrine. D) norepinephrine.

B) atropine.

238. Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, ___________ and ___________ may result. A) hypercarbia, hypoxia B) barotrauma, pneumothorax C) hypoventilation, hypocarbia D) esophageal rupture, hemorrhage

B) barotrauma, pneumothorax

30. In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist.

B) beta-2 agonist.

101. Beta blockers should be used with extreme caution in patients with reactive airway because: A) beta-1 receptor antagonism will result in profound bronchoconstriction. B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm. C) there are no beta-blockers that selectively target beta-1 receptors only. D) they inhibit catecholamine release, potentially causing bronchoconstriction.

B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.

89. Neuromuscular blocking agents achieve chemical paralysis by: A) agonizing muscarinic receptor sites and increasing acetylcholine production. B) binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine. C) inhibiting cerebellar activity, thereby decreasing voluntary muscle movement. D) blocking the action of the sodium-potassium pump, causing muscle paralysis.

B) binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine.

100. Lidocaine is an antidysrhythmic that works by: A) antagonizing beta-adrenergic receptors in the myocardium. B) blocking sodium channels in the Purkinje fibers and ventricle. C) displacing calcium at certain receptor sites in the myocardium. D) increasing the duration of phases 1, 2, and 3 of the cardiac cycle.

B) blocking sodium channels in the Purkinje fibers and ventricle.

109. ACE inhibitor medications lower blood pressure by: A) selectively binding to alpha-1 and alpha-2 receptors. B) blocking the conversion of angiotensin I to angiotensin II. C) increasing cardiac afterload and reducing cardiac output. D) blocking the release of angiotensin I from the renal system.

B) blocking the conversion of angiotensin I to angiotensin II.

144. Plasma protein fraction (Plasmanate) is especially useful for patients with: A) hyponatremia. B) burn shock. C) dehydration. D) blood loss.

B) burn shock.

128. Intubation of the trauma patient is MOST effectively performed: A) with a curved blade. B) by two paramedics. C) with a cervical collar in place. D) with the patient's head elevated.

B) by two paramedics.

116. A disadvantage of ET intubation is that it: A) is associated with a high incidence of vocal cord damage and bleeding into the oropharynx. B) bypasses the upper airway's physiologic functions of warming, filtering, and humidifying. C) does not eliminate the incidence of gastric distention and can result in pulmonary aspiration. D) is only a temporary method of securing the patient's airway until a more definitive device can be inserted.

B) bypasses the upper airway's physiologic functions of warming, filtering, and humidifying.

97. The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________. A) tibial, upper leg, diaphysis B) cancellous, epiphysis, diaphysis C) diaphyseal, epiphysis, proximal tibia D) epiphyseal, diaphysis, cancellous bone

B) cancellous, epiphysis, diaphysis

85. You would NOT expect to encounter decreased breath sounds in a patient with: A) opiate intoxication. B) cardiac tamponade. C) status asthmaticus. D) pulmonary edema.

B) cardiac tamponade.

265. A 40-year-old man fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A) insert a nasopharyngeal airway and assess his respirations. B) carefully open his airway with the head tilt-chin lift maneuver. C) assist his ventilations and prepare to intubate him immediately. D) suction his oropharynx and reattempt the jaw-thrust maneuver.

B) carefully open his airway with the head tilt-chin lift maneuver.

8. You will MOST likely develop your field impression of a patient based on the: A) medications the patient is taking. B) chief complaint and patient history. C) results of your secondary assessment. D) patient's perception of his or her problem.

B) chief complaint and patient history.

54. When your patient is a non-English-speaking person, his or her child is often able to function as an interpreter because: A) you can usually teach a child English quickly. B) children quickly absorb a new language in school. C) the child is usually not as scared as his or her parent is. D) most children of non-English-speaking parents speak English.

B) children quickly absorb a new language in school.

25. Making your patient aware that you perceive something inconsistent with his or her behavior is called: A) clarification. B) confrontation. C) facilitation. D) interpretation.

B) confrontation.

284. You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should: A) perform laryngoscopy to visualize placement of the Combitube. B) continue to ventilate and use additional confirmation techniques. C) continue ventilating the patient at a rate of 10 to 12 breaths/min. D) ventilate through the clear tube and auscultate all four lung fields.

B) continue to ventilate and use additional confirmation techniques.

90. Succinylcholine should not be used in patients with: A) a closed head injury. B) known hyperkalemia. C) a rapid heart rate. D) suspected hypokalemia.

B) known hyperkalemia.

217. Neuromuscular blocking agents: A) are most commonly used as the sole agent to facilitate placement of an ET tube. B) convert a breathing patient with a marginal airway into an apneic patient with no airway. C) induce total body paralysis within 10 to 15 minutes following administration via IV push. D) have a negative effect on both cardiac and smooth muscle and commonly cause dysrhythmias.

B) convert a breathing patient with a marginal airway into an apneic patient with no airway.

126. The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include: A) increased myocardial oxygen consumption. B) decreased preload and coronary vasodilation. C) coronary vasoconstriction and increased preload. D) increased afterload and peripheral vasodilation.

B) decreased preload and coronary vasodilation.

97. An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should: A) observe for full chest expansion. B) deliver 8 to 10 breaths per minute. C) allow partial exhalation between breaths. D) deliver one breath every 15 seconds.

B) deliver 8 to 10 breaths per minute.

55. A microdrip administration set: A) allows 10 or 15 drops per milliliter. B) delivers 1 mL for every 60 drops. C) should be used when patients need fluid replacement. D) does not contain a needlelike orifice in its drip chamber.

B) delivers 1 mL for every 60 drops.

13. Asking the patient about the date, time, location, and events surrounding the current situation will enable you to: A) rapidly formulate a working diagnosis and prepare a care plan. B) determine if the patient is alert to person, place, time, and event. C) quickly rule out a life-threatening cause of the patient's problem. D) determine if the patient's problem is medical or trauma in nature.

B) determine if the patient is alert to person, place, time, and event.

3. A key part of making your practice of prehospital care successful is for you to: A) let the patient guide the questions that you ask in order to build a cohesive rapport on which you can build. B) develop and cultivate your own style of assessment and an overall strategy for evaluating and providing care. C) approach every patient in the same fashion with the realization that patient assessment in the field is a static process. D) strictly adhere to your department's standard operating procedures so that they become a rote series of actions.

B) develop and cultivate your own style of assessment and an overall strategy for evaluating and providing care.

59. The residual pressure in the circulatory system while the left ventricle is relaxing is called the: A) pulse pressure. B) diastolic pressure. C) systolic pressure. D) mean arterial pressure.

B) diastolic pressure.

20. The movement of compounds or charges across a cell membrane to an area of lower concentration is called: A) osmosis. B) diffusion. C) filtration. D) selective permeability.

B) diffusion.

28. When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) _____________ effect. A) inotropic B) dromotropic C) chronotropic D) alpha agonistic

B) dromotropic

211. If used properly, and under the correct circumstances, sedation during airway management: A) chemically paralyzes the patient, thus facilitating placement of an advanced airway device. B) effectively increases patient compliance, thus making definitive airway management safer to perform. C) significantly reduces the pain and discomfort associated with laryngoscopy and ET intubation. D) minimizes the risks of bradycardia and hypotension that occasionally occur during advanced airway management.

B) effectively increases patient compliance, thus making definitive airway management safer to perform.

22. The ability of a medication to initiate or alter cell activity in a therapeutic or desired manner is referred to as: A) potency. B) efficacy. C) affinity. D) the threshold level.

B) efficacy.

232. In contrast to a needle cricothyrotomy, an open cricothyrotomy: A) involves the use of a high-pressure jet ventilator. B) enables the paramedic to provide greater tidal volume. C) is the preferred technique in patients with short, fat necks. D) is easier to perform in children younger than 8 years of age.

B) enables the paramedic to provide greater tidal volume.

266. A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should: A) perform abdominal thrusts until she becomes unconscious. B) encourage her to cough and closely monitor her condition. C) deliver positive-pressure ventilations via bag-mask device. D) look in her mouth and attempt to visualize a foreign body.

B) encourage her to cough and closely monitor her condition.

51. If your patient becomes seductive or makes sexual advances toward you, you should advise the patient that your relationship with him or her is strictly professional and then: A) continue providing care as usual. B) ensure that a witness is present at all times. C) ask your partner to assume care of the patient. D) threaten the patient with a sexual harassment lawsuit.

B) ensure that a witness is present at all times.

139. The ________ route of medication administration refers to any route in which medication is absorbed through some portion of the gastrointestinal tract. A) oral B) enteral C) rectal D) gastric tube

B) enteral

24. The net effect of osmosis is to: A) balance the concentration of water on both sides of the cell wall. B) equalize solute concentrations on both sides of the cell membrane. C) utilize ATP to actively move solutes across the cell membrane. D) maintain a higher concentration of solutes outside of the cell.

B) equalize solute concentrations on both sides of the cell membrane.

117. Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to occur: A) whether the tube is in the trachea or in the esophagus. B) even if the tip of the tube is occluded by blood or mucus. C) if the tube is inserted into the right mainstem bronchus. D) even if the ET tube does not enter the patient's trachea fully.

B) even if the tip of the tube is occluded by blood or mucus.

76. When assessing visual acuity in the prehospital setting, you should: A) use a Snellen chart. B) examine each eye in isolation. C) check both eyes simultaneously. D) remove any corrective lenses the patient is wearing.

B) examine each eye in isolation.

89. The MOST common cause of circulatory overload in the prehospital setting is: A) overestimating the patient's baseline hydration level and giving too much IV fluid.. B) failure to readjust the drip rate after flushing the IV line immediately after insertion. C) not using a Volutrol administration set when administering IV fluids to the elderly. D) administering excessive crystalloid solutions to patients with hypovolemic shock.

B) failure to readjust the drip rate after flushing the IV line immediately after insertion.

48. Normally, an adult at rest should have respirations that: A) are 20 to 24 breaths/min with adequate chest rise. B) follow a regular pattern of inhalation and exhalation. C) have a slightly reduced tidal volume and normal rate.. D) are adequate to sustain a heart rate of 80 beats/min.

B) follow a regular pattern of inhalation and exhalation.

5. The oropharynx: A) contains the adenoids on its posterior wall. B) forms the posterior portion of the oral cavity. C) is bordered superiorly by the hard palate only. D) consists of the anterior portion of the oral cavity.

B) forms the posterior portion of the oral cavity.

102. Structural integrity of the pelvis should be assessed by: A) carefully rocking the pelvis back and forth. B) gently pushing in and down on the iliac crests. C) applying firm upward pressure to the pelvic wings. D) placing the patient on his or her side to elicit pain.

B) gently pushing in and down on the iliac crests.

47. Patients who are genetically predisposed to an immune-mediated medication response: A) typically have a history of more than one autoimmune disorder. B) had an initial exposure and sensitization to a particular antigen. C) should be given an antihistamine before receiving the medication. D) will experience a minor reaction that is generally limited to hives.

B) had an initial exposure and sensitization to a particular antigen.

41. A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution: A) may cause the cells to expand and rupture due to the increased intracellular osmotic pressure exerted by the solution. B) has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. C) contains high concentrations of proteins and can result in fluid overloading in patients with impaired cardiac function or renal insufficiency. D) has a lower ionic concentration than serum and pulls fluid and electrolytes from the intravascular compartment into the intracellular and interstitial compartments.

B) has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.

82. It would be appropriate to insert a nasopharyngeal airway in patients who: A) are unresponsive with multiple facial bone fractures. B) have an altered mental status with an intact gag reflex. C) are semiconscious with active vomiting and cyanosis. D) have CSF leakage from the nose and are semiconscious.

B) have an altered mental status with an intact gag reflex.

177. After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first: A) fully deflate the distal cuff on the ET tube. B) have the patient sit up or lean slightly forward. C) suction the oropharynx to remove any secretions. D) insert an orogastric tube to ensure the stomach is empty.

B) have the patient sit up or lean slightly forward.

82. The paramedic can avoid technical errors in medication administration by: A) using a current, reliable medication reference source before administering the medication. B) having a partner confirm the volume in a syringe or a weight-based medication calculation. C) contacting medical control and confirming that the proposed dose is appropriate for the patient. D) evaluating a patient for medication allergies or hypersensitivity before administering the medication.

B) having a partner confirm the volume in a syringe or a weight-based medication calculation.

64. When the paramedic administers a medication via the IV route: A) bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation. B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. C) it is important for him or her to remember that the medication's onset of action is relatively slow. D) first-pass metabolism significantly alters the medication's effects, thereby requiring frequent dosing.

B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

35. It would MOST likely be necessary to ask a patient a direct question if: A) he or she is elderly and has more than one medical complaint. B) he or she is not giving you usable facts about himself or herself. C) he or she is having chest pain and a heart attack must be ruled out. D) there are numerous family members and friends present at the scene.

B) he or she is not giving you usable facts about himself or herself.

114. The vestibulocochlear nerve is responsible for the functions of: A) facial and eye movements. B) hearing and balance perception. C) swallowing and gland secretion. D) tongue and neck movements.

B) hearing and balance perception.

26. The internal environment's resistance to change is called: A) hemostasis. B) homeostasis. C) hypertonicity. D) hypotonicity.

B) homeostasis.

147. When using a vial of medication, you must FIRST determine: A) the needle gauge that you will need and the appropriate size syringe. B) how much of the drug is needed and how many doses are in the vial. C) if the medication has completely settled to the base of the container. D) the appropriate amount of air that you will need to inject into the vial.

B) how much of the drug is needed and how many doses are in the vial.

36. It is MOST important to exercise caution when administering isotonic solutions to patients with: A) hypotension and severe hypovolemia. B) hypertension and congestive heart failure. C) dehydration secondary to excessive diarrhea. D) a history of insulin-dependent diabetes mellitus.

B) hypertension and congestive heart failure.

50. The condition in which the body's tissues and cells do not receive enough oxygen is called: A) anoxia. B) hypoxia C) asphyxia. D) hypoxemia.

B) hypoxia

66. All of the following are common sites for emergency IO cannulation, EXCEPT the: A) proximal humerus. B) iliac crest. C) proximal tibia. D) manubrium.

B) iliac crest.

81. When determining whether an occluded IV line should be reestablished, you should: A) attempt to improve the IV flow rate by applying a pressure infuser device around the IV bag. B) infuse 10 mL of normal saline through the injection port to attempt to disrupt the occlusion. C) lower the IV bag below the level of the patient's heart and observe for blood return in the IV tubing. D) apply manual pressure to the IV bag while observing for a sudden increase in the IV flow rate.

B) infuse 10 mL of normal saline through the injection port to attempt to disrupt the occlusion.

26. When a patient's respirations are too rapid and too shallow: A) the majority of inhaled air lingers in areas of physiologic dead space. B) inhaled air may only reach the anatomic dead space before being exhaled. C) the increase in tidal volume will compensate for a rapid respiratory rate. D) minute volume increases because a larger amount of air reaches the lungs.

B) inhaled air may only reach the anatomic dead space before being exhaled.

271. A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The MOST appropriate airway management for this patient involves: A) inserting an oral airway and assisting ventilations with a bag-mask device. B) inserting a nasal airway and assisting ventilations with a bag-mask device. C) inserting an oral airway and administering oxygen via nonrebreathing mask. D) suctioning her airway, inserting an oral airway, and administering 100% oxygen.

B) inserting a nasal airway and assisting ventilations with a bag-mask device.

88. Pyrogenic reactions can be largely avoided by: A) determining if the patient has any allergies. B) inspecting the IV solution carefully before use. C) premedicating the patient with 1 gram of acetaminophen. D) keeping the piercing spike sterile after it is exposed.

B) inspecting the IV solution carefully before use.

3. Cerebrospinal fluid and intraocular fluid are types of: A) plasma. B) interstitial fluid. C) intracellular fluid. D) intravascular fluid.

B) interstitial fluid.

58. A patient with a suppressed cough mechanism: A) should be intubated at once. B) is at serious risk for aspiration. C) often requires ventilation support. D) will have a positive eyelash reflex.

B) is at serious risk for aspiration.

3. The nasal cavity: A) contains two bony shelves known as turbinates. B) is extremely delicate and has a rich blood supply. C) requires significant trauma to result in hemorrhage. D) is separated by a septum that is midline in all people.

B) is extremely delicate and has a rich blood supply.

129. When administering a medication, the paramedic: A) cannot be held legally accountable if a physician gives an inappropriate drug order and the paramedic follows the order. B) is just as responsible for the administration of the drug and its possible consequences as the physician giving the order. C) does not need the patient's consent to administer the medication, but must obtain consent for the dose that is ordered. D) should obtain a full set of vital signs within 15 minutes of administering the medication, regardless of the type of medication.

B) is just as responsible for the administration of the drug and its possible consequences as the physician giving the order.

13. The generic name of a medication: A) does not require FDA approval. B) is proposed by the manufacturer. C) is proprietary and cannot be reproduced. D) contains a string of letters and numbers.

B) is proposed by the manufacturer.

210. When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA): A) enters the esophagus and provides complete obturation. B) is proximal to the esophagus and seals the hypopharynx. C) is in almost perfect alignment with the esophageal opening. D) rests against the arytenoid cartilage and enters the glottis.

B) is proximal to the esophagus and seals the hypopharynx.

162. Digital intubation is absolutely contraindicated if the patient: A) has copious airway secretions. B) is unconscious but breathing. C) is trapped in a confined space. D) is extremely obese or has a short neck.

B) is unconscious but breathing.

94. A lavender-topped blood tube: A) contains a preservative to help determine blood-clotting factors. B) is used to determine a patient's hematocrit and hemoglobin levels. C) contains no additives and is intended to clot if blood typing is needed. D) is filled with heparin and is used to evaluate electrolyte and glucose levels.

B) is used to determine a patient's hematocrit and hemoglobin levels.

154. The IV route is the fastest route of medication administration because: A) veins do not collapse during hypoperfusion. B) it bypasses most barriers to drug absorption. C) medications immediately enter the right atrium. D) blood pressure expedites absorption of the drug.

B) it bypasses most barriers to drug absorption.

146. Fentanyl (Sublimaze) is the preferred opioid analgesic for patients in critical or unstable condition because: A) its effects last much longer than any other opioid. B) it is not as prone to causing hypotension as morphine. C) it only requires one small dose to achieve analgesia. D) it hyperstimulates mu () opioid receptor sites.

B) it is not as prone to causing hypotension as morphine.

48. The use of O-negative blood in the prehospital setting is impractical because: A) it expires in 24 hours. B) it requires refrigeration. C) not everyone can receive O-negative blood. D) the blood cannot be typed and cross-matched

B) it requires refrigeration.

111. Which of the following represents the appropriate metric units of weight from largest to smallest? A) g, kg, µg, mg B) kg, g, mg, µg C) mg, g, µg, kg D) kg, mg, g, µg

B) kg, g, mg, µg

31. A common cause of overhydration is: A) hypertension. B) kidney failure. C) gastrointestinal drainage. D) prolonged hyperventilation.

B) kidney failure.

79. If an unresponsive patient does not have a gag reflex, an oropharyngeal airway: A) should only be inserted if the patient is not breathing. B) should be inserted whether the patient is breathing or not. C) will effectively prevent aspiration if the patient vomits. D) must be inserted by depressing the tongue with a tongue blade.

B) should be inserted whether the patient is breathing or not.

74. The first step in discontinuing an IV line is to: A) stabilize the catheter as you remove the tape. B) shut off the flow of fluid with the roller clamp. C) remove the tubing from the hub of the catheter. D) ensure that all of the fluid has been administered.

B) shut off the flow of fluid with the roller clamp.

105. CPAP is NOT appropriate for patients with: A) acute or chronic bronchospasm. B) slow, shallow respiratory effort.. C) an oxygen saturation less than 90%. D) evidence of congestive heart failure.

B) slow, shallow respiratory effort..

14. The principal extracellular cation that regulates the distribution of water throughout the body is: A) calcium. B) sodium. C) chloride. D) phosphorus.

B) sodium.

15. Laryngospasm is defined as: A) aspiration of foreign material. B) spasmodic closure of the vocal cords. C) voluntary closure of the glottic opening. D) spontaneous collapsing of the trachea.

B) spasmodic closure of the vocal cords.

77. The diameter of a patient's pupils and their reactivity to light provide information about the: A) amount of vitreous humor. B) status of cerebral perfusion. C) intactness of the first cranial nerve. D) level of carbon dioxide in the brain.

B) status of cerebral perfusion.

152. When administering a medication via the intramuscular route, you should: A) pinch the skin over the injection site and insert the needle at a 45° angle. B) stretch the skin over the injection site and insert the needle at a 90° angle. C) use a 24- to 26-gauge ½ to 1 needle to inject medication into the muscle. D) use a 21-gauge needle to inject medication into the fatty tissue of the arm.

B) stretch the skin over the injection site and insert the needle at a 90° angle.

108. Stimulation of alpha-2 receptors: A) constricts the vascular smooth muscle. B) suppresses the release of norepinephrine. C) causes profound systemic hypertension. D) increases the release of norepinephrine.

B) suppresses the release of norepinephrine.

103. If the posterior aspect of the leg rapidly becomes edematous during IO infusion, you should: A) elevate the lower extremity. B) suspect extravasation of fluid. C) assume that the leg is fractured. D) carefully reposition the IO needle.

B) suspect extravasation of fluid.

276. After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should: A) slightly withdraw the tube as your partner auscultates breath sounds. B) suspect that the patient has a pneumothorax on the right side of the chest. C) immediately remove the ET tube and oxygenate the patient for 30 seconds. D) increase the force of your ventilations as your partner reauscultates the lungs.

B) suspect that the patient has a pneumothorax on the right side of the chest.

251. When replacing a dislodged tracheostomy tube, it is MOST important that you: A) insert the tube 2 cm beyond the cuff. B) take appropriate standard precautions. C) lubricate the tube before insertion. D) use a tracheostomy tube of the same size.

B) take appropriate standard precautions.

46. If a patient's family member is hostile and begins shouting at you, you should: A) remain professional and ignore the family member so that you can provide appropriate patient care. B) tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement. C) have your partner physically remove the family member from the patient care area and continue your assessment. D) firmly tell the patient that his or her behavior is unacceptable and childish, and that he or she is worsening the situation.

B) tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement.

22. EMS providers who read off a list of questions to the patient to fill in all the blanks on the run report: A) usually provide the most competent patient care. B) tend to make little or no eye contact with the patient. C) are in the best position to establish good patient rapport. D) are reassuring the patient that he or she is not being ignored.

B) tend to make little or no eye contact with the patient.

132. Cognitive function can be MOST accurately defined as: A) one's state of awareness. B) the ability to use reasoning. C) functional use of the extremities. D) general level of consciousness.

B) the ability to use reasoning.

26. Stimulation of beta-2 receptors will cause: A) bronchoconstriction. B) the airway diameter to dilate. C) vasoconstriction and hypertension. D) a decreased release of norepinephrine.

B) the airway diameter to dilate.

11. Paramedics must use extreme caution when accessing the airway via the cricothyroid membrane because: A) the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised. B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland. C) cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid artery. D) the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid membrane difficult to locate.

B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland.

45. The MOST negative immediate consequence of providing inappropriate reassurance to your patient in the prehospital setting is: A) a lawsuit lodged against you by the patient or his or her family. B) the patient's choice not to share as much information with you. C) causing the patient's family members severe emotional distress. D) emotional distress when the physician tells the patient otherwise.

B) the patient's choice not to share as much information with you.

36. During a study, a patient experiences measurable clinical improvement or unexplained adverse effects after receiving a medication with no pharmacologic properties. This is referred to as: A) an idiosyncrasy. B) the placebo effect. C) an untoward effect. D) the therapeutic ratio.

B) the placebo effect.

134. Medical asepsis is MOST accurately defined as: A) ensuring that all patient care supplies remain sterile. B) the practice of preventing contamination of the patient. C) the destruction of all living organisms using heat or gas. D) preventing infection of the patient by using clean supplies.

B) the practice of preventing contamination of the patient.

7. Common components of a medication profile include all of the following, EXCEPT: A) pregnancy risk factors. B) the weight of the drug. C) potential incompatibility. D) mechanism of action.

B) the weight of the drug.

160. Electromechanical infusion pumps are MOST beneficial when administering a medication maintenance infusion because: A) an alarm sounds if there is any air in the tubing. B) these devices allow for precise medication dosing. C) these devices totally eliminate the risk of infiltration of a vein. D) these devices will accommodate a needleless syringe.

B) these devices allow for precise medication dosing.

246. Patients with laryngectomies MOST commonly develop mucous plugs in their stoma because: A) they are at higher risk for pneumonia. B) they do not possess an efficient cough. C) the diameter of the stoma is small. D) their swallowing mechanism is suppressed.

B) they do not possess an efficient cough.

148. In hypovolemic shock, lactated Ringer's solution should be: A) mixed with normal saline solution. B) titrated to the patient's physiologic response. C) given until a systolic BP of 110 mm Hg is achieved. D) avoided if the patient's shock is caused by blood loss.

B) titrated to the patient's physiologic response.

59. Physiologic drug antagonism occurs when: A) the action of one medication increases or decreases the ability of another medication to be absorbed by the body. B) two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes. C) the effect of one medication is enhanced by the presence of another medication, which does not have the ability to produce the same effect. D) two medications, each producing identical effects, are present simultaneously, resulting in an enhanced physiologic response.

B) two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes.

194. The MOST significant complication associated with the use of multilumen airways is: A) laryngospasm or vomiting during insertion of the tube. B) unrecognized displacement of the tube into the esophagus. C) vocal cord damage if the tube inadvertently enters the trachea. D) pharyngeal or esophageal trauma secondary to poor technique.

B) unrecognized displacement of the tube into the esophagus.

172. You are transporting a 1-year-old child with moderate dehydration. Your estimated time of arrival at the hospital is 45 minutes. When administering an isotonic crystalloid solution to this child, you should: A) deliver the crystalloid fluid boluses with blood tubing and frequently ausculate the child's breath sounds. B) use a Volutrol administration set and fill the calibrated drip chamber with a precalculated volume of fluid. C) give 30 mL/kg crystalloid fluid boluses through a microdrip administration set until the child's condition improves. D) set the IV flow rate to KVO but be prepared to infuse 10 mL/kg boluses if the child's condition deteriorates.

B) use a Volutrol administration set and fill the calibrated drip chamber with a precalculated volume of fluid.

102. When infusing crystalloid solutions through an IO catheter in an unconscious adult, you should: A) give 200 mL at a time. B) use a pressure infuser device. C) deliver the solution via syringe. D) inject lidocaine prior to the infusion.

B) use a pressure infuser device

23. Stimulation of alpha-1 receptors results in: A) insulin secretion. B) vasoconstriction. C) arterial dilation. D) glucagon secretion.

B) vasoconstriction.

34. Patients with primary pulmonary hypertension may experience acute decompensation if they are given a: A) salicylate. B) vasopressor. C) diuretic. D) bronchodilator.

B) vasopressor.

133. The BEST way to be certain that the ET tube has passed through the vocal cords is to: A) feel the ridges of the tracheal wall with the ET tube. B) visualize the tube passing between the vocal cords. C) note the appropriate color change of the capnographer. D) ensure the presence of bilaterally equal breath sounds.

B) visualize the tube passing between the vocal cords.

158. When nasally intubating a patient, the ET tube is advanced: A) as the patient exhales. B) when the patient inhales. C) when the patient swallows. D) in between the patient's breaths.

B) when the patient inhales.

90. Oxygen that is entirely devoid of moisture: A) is less combustible than humidified oxygen. B) will dry the patient's mucous membranes quickly. C) is optimum for patients requiring long-term oxygen. D) should be given in conjunction with bronchodilators.

B) will dry the patient's mucous membranes quickly.

88. The nasal cannula is of MOST benefit to patients: A) who require high oxygen concentrations. B) with mild hypoxemia and claustrophobia. C) with an acute exacerbation of emphysema. D) who are hypoxic and are mouth-breathers.

B) with mild hypoxemia and claustrophobia.

53. Once an IV solution is removed from its protective sterile plastic bag, it must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.

B) within 24 hours.

18. The chemical sign for sodium bicarbonate is: A) NaCl. B) H2CO3. C) NaHCO3. D) KCl.

C) NaHCO3.

131. If unmatched blood is administered in the prehospital setting, it will almost always be: A) O, Rh-positive. B) AB, Rh-negative. C) O, Rh-negative. D) AB, Rh-positive.

C) O, Rh-negative.

178. Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct? A) An average-sized toddler would require a 4.5-mm cuffed ET tube to secure the airway adequately. B) When intubating an infant or small child, it is important to remember that the epiglottis is less floppy. C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times. D) Because the pediatric airway is smaller than an adult's, paramedics should routinely intubate children in the field.

C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times.

95. Which of the following blood tubes contains the preservative EDTA and is used to determine a patient's prothrombin time (PT) and partial thromboplastin time (PTT)? A) Red top B) Green top C) Blue top D) Lavender top

C) Blue top

145. On a capnographic waveform, point ___ is the maximal ETCO2 and is the best reflection of the alveolar CO2 level. A) B B) C C) D D) E

C) D

5. Which of the following is NOT a part of your overall job as a paramedic? A) Efficiently executing a patient care plan B) Quickly identifying your patient's problem C) Definitively diagnosing the patient's problem D) Establishing your priorities of patient care

C) Definitively diagnosing the patient's problem

161. Which of the following is NOT a step that is performed during nasotracheal intubation? A) Advancing the ET tube as the patient inhales B) Preoxygenating with a bag-mask as necessary C) Ensuring that the patient's head is hyperflexed D) Placing the patient's head in a neutral position

C) Ensuring that the patient's head is hyperflexed

100. Which of the following IO devices is NOT used in children? A) EZ-IO B) Jamshedi needle C) FAST1 D) Bone Injection Gun (BIG)

C) FAST1

136. Which of the following statements regarding fresh frozen plasma (FFP) is correct? A) FFP is the ideal volume expander for critically injured patients whose blood type is not known. B) FFP is contraindicated in patients with warfarin (Coumadin) toxicity due to the risk of hemolysis. C) FFP must be compatible with the recipient's blood type, but does not have to be Rh compatible. D) FFP should not be administered to patients who require large volumes of other blood products.

C) FFP must be compatible with the recipient's blood type, but does not have to be Rh compatible.

51. Which of the following questions does the paramedic generally NOT ask himself or herself when determining the most appropriate IV solution to use on a patient? A) Is the patient's condition critical? B) Will the patient need medications? C) Has the patient had IV therapy before? D) Will the patient need fluid replacement?

C) Has the patient had IV therapy before?

87. Which of the following statements regarding benzodiazepine medications is NOT correct? A) Benzodiazepines have potent anxiolytic, antiseizure, and sedative properties. B) A benzodiazepine may be used as the primary sedative for advanced airway care. C) High doses of a benzodiazepine may be needed to maintain a patient's blood pressure. D) Benzodiazepines are commonly used in the prehospital setting to terminate seizures.

C) High doses of a benzodiazepine may be needed to maintain a patient's blood pressure.

148. What type of medication is used to decrease gastric acid secretion? A) Histamine-1 receptor antagonist B) Alpha-2 receptor antagonist C) Histamine-2 receptor antagonist D) Phosphodiesterase-5 inhibitor

C) Histamine-2 receptor antagonist

257. When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class: A) I. B) II. C) III. D) IV.

C) III.

92. Which of the following statements regarding succinylcholine is correct? A) It has a rapid onset of action and long duration of action. B) It causes tachycardia, especially in small children. C) It has a rapid onset of action and short duration of action. D) It may induce or exacerbate existing hypokalemia.

C) It has a rapid onset of action and short duration of action.

60. Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia? A) Biot respirations B) Agonal respirations C) Kussmaul respirations D) Cheyne-Stokes respirations

C) Kussmaul respirations

192. Which of the following statements regarding multilumen airways is correct? A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful. B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy. C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal. D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation.

C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal.

165. Which of the following statements regarding the mucosal atomizer device (MAD) is correct? A) Narcan is the only emergency medication that can be administered intranasally with the MAD. B) The MAD is used to inject a straight stream of select emergency drugs directly into the nasal canal. C) When administering a drug with the MAD, you should spray half of the dose into each nostril. D) Drugs administered with the MAD have an onset of action that is slightly slower than the intramuscular route.

C) When administering a drug with the MAD, you should spray half of the dose into each nostril.

111. Patients taking ACE inhibitor medications commonly have: A) immunosuppression. B) thin and fragile skin. C) a chronic, dry cough. D) a reduced platelet count.

C) a chronic, dry cough.

40. A drug that possesses the same desired clinical effect in several smaller doses as it does in a larger single dose has demonstrated: A) an idiosyncratic reaction. B) the placebo effect. C) a cumulative action. D) cross-tolerance..

C) a cumulative action.

19. Surfactant is: A) produced by the mucous cells of the left and right mainstem bronchi. B) quickly destroyed in patients who have a severe upper airway obstruction. C) a phospholipid compound that decreases surface tension on the alveolar walls. D) a lubricating substance that increases alveolar surface tension during breathing.

C) a phospholipid compound that decreases surface tension on the alveolar walls.

70. A foreign-body airway obstruction should be suspected in a child who presents with: A) diffuse wheezing and nasal flaring.. B) a productive cough and flushed skin. C) acute respiratory distress without fever. D) progressive respiratory distress and hoarseness.

C) acute respiratory distress without fever.

224. Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to: A) administer 0.5 mg of atropine sulfate. B) hyperventilate the patient at 24 breaths/min. C) adequately preoxygenate with 100% oxygen. D) suction the oropharynx to clear any secretions.

C) adequately preoxygenate with 100% oxygen.

37. When assessing a patient who is under the influence of alcohol, it is MOST important to remember that: A) the amount of alcohol consumed is often overstated. B) the patient often gives a reliable and accurate history. C) alcohol can mask any number of signs and symptoms. D) suspicions of alcohol intoxication must be documented.

C) alcohol can mask any number of signs and symptoms.

144. Compared with enterally administered medications, parenterally administered medications: A) require the presence of a peripheral IV line. B) must pass through the gastrointestinal tract to be effective. C) are absorbed into the central circulation at a more predictable rate. D) achieve their therapeutic effects much more slowly and are less predictable.

C) are absorbed into the central circulation at a more predictable rate.

145. Dextran is classified as a(n): A) natural colloid. B) isotonic crystalloid. C) artificial colloid. D) hypertonic crystalloid.

C) artificial colloid.

13. The ____________ are pyramid-like structures that form the posterior attachment of the vocal cords. A) palatine tonsils B) pyriform fossae C) arytenoid cartilages D) hypoepiglottic ligaments

C) arytenoid cartilages

31. Before asking a patient about any mental health issues, the paramedic should: A) speak privately with a family member or trusted friend. B) move the patient to the ambulance, where it is more private. C) ask questions relating to his or her physical health. D) perform a comprehensive head-to-toe assessment.

C) ask questions relating to his or her physical health.

274. Approximately 10 seconds into an intubation attempt, you catch a glimpse of the patient's vocal cords, but quickly lose sight of them. You should: A) sweep the patient's tongue to the right side of the mouth and revisualize. B) abort the intubation attempt and ventilate the patient with a bag-mask device. C) ask your partner to apply backward, upward, rightward pressure to the thyroid. D) gently pry back on the laryngoscope to improve your view of the upper airway.

C) ask your partner to apply backward, upward, rightward pressure to the thyroid.

254. When ventilating a patient with facial injuries, it is MOST important to: A) ventilate with a higher-than-normal volume. B) suction the oropharynx every 2 to 3 minutes. C) be alert for changes in ventilation compliance. D) ensure that a cervical collar has been applied.

C) be alert for changes in ventilation compliance.

159. Although medications that are used for maintenance infusions are commonly premixed and prepackaged, you must still: A) add 100 mL of sterile saline to dilute the premixed medication. B) draw 20 mL of fluid from the premixed solution to use as a flush. C) be aware of the concentration of the drug in the premixed solution. D) use the drug within 36 hours after removing it from its foil covering.

C) be aware of the concentration of the drug in the premixed solution.

49. An adult patient with an abnormal respiratory rate should: A) be given oxygen at 4 L/min with a nasal cannula. B) be assessed immediately for heart rate abnormalities. C) be evaluated for other signs of inadequate ventilation. D) receive ventilatory assistance with a bag-mask device.

C) be evaluated for other signs of inadequate ventilation.

65. An appropriately sized blood pressure cuff should: A) completely encompass the entire upper arm.. B) cover at least one third of the patient's upper arm. C) be one half to two thirds the size of the upper arm. D) cover at least two thirds of the patient's upper arm.

C) be one half to two thirds the size of the upper arm.

113. Acetylcholinesterase is an enzyme that: A) decreases the heart rate. B) slows cardiac conduction. C) breaks down acetylcholine. D) promotes acetylcholine secretion.

C) breaks down acetylcholine.

33. IV fluids introduced into the circulatory system: A) are only effective if the patient is experiencing renal insufficiency. B) will always cause a fluid shift out of the intracellular compartment. C) can affect the tonicity of the extracellular fluid and can be harmful. D) usually do not cause a fluid shift into or out of the intracellular space.

C) can affect the tonicity of the extracellular fluid and can be harmful.

143. Verapamil hydrochloride (Isoptin, Calan) is classified as a(n): A) beta adrenergic blocker. B) alpha adrenergic agonist. C) selective beta antagonist. D) calcium channel blocker.

D) calcium channel blocker.

81. Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may: A) result in ventricular dysrhythmias secondary to intracranial pressure. B) cause acute herniation of the brainstem through the foramen magnum. C) cause the device to enter the brain through a hole caused by a fracture. D) result in acute hypertension and decreased cerebral perfusion pressure.

C) cause the device to enter the brain through a hole caused by a fracture.

157. Failure to pinch the tubing proximal to the injection port when administering a drug via the IV bolus route will: A) cause the medication to enter the patient's central circulation rapidly. B) result in too much of the medication entering the patient's circulation. C) cause the medication to flow up the tubing and away from the patient. D) negate the need to follow the IV bolus with a 20-mL normal saline flush.

C) cause the medication to flow up the tubing and away from the patient.

78. The paramedic should suspect altered medication metabolism in a patient with: A) hypertension. B) acute pancreatitis. C) chronic alcoholism. D) chronic renal failure.

C) chronic alcoholism.

116. If a patient's trigeminal nerve is intact, he or she should be able to: A) frown. B) maintain balance. C) clench his or her jaw. D) swallow without difficulty.

C) clench his or her jaw.

206. The King LT-D airway features a: A) straight tube with two inflatable cuffs that hold an equal amount of air. B) port through which gastric contents can be suctioned from the stomach. C) curved tube with ventilation ports located between two inflatable cuffs. D) universal size with two inflation ports and is used for patients of any age.

C) curved tube with ventilation ports located between two inflatable cuffs.

109. A gastric tube is MOST useful for: A) performing prehospital gastric lavage in patients with a toxic ingestion. B) blocking off the esophagus so that an ET tube can be placed. C) decompressing the stomach and decreasing pressure on the diaphragm. D) removing blood from the esophagus in patients with esophageal varices..

C) decompressing the stomach and decreasing pressure on the diaphragm.

101. Clinical signs of an inflamed joint include all of the following, EXCEPT: A) redness. B) swelling. C) deformity. D) increased heat.

C) deformity.

70. Poor skin turgor in an infant or child is MOST indicative of: A) shock. B) hypoxemia. C) dehydration. D) elastin deficiency.

C) dehydration.

93. When ventilating an apneic adult with a pulse with a bag-mask device, you should: A) deliver 8 to 10 breaths/min and make the chest wall rise visibly. B) make the chest rise visibly and deliver one breath every 8 seconds. C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min. D) squeeze the bag once every 3 seconds until the chest expands widely.

C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

52. The physical, emotional, or behavioral need for a medication in order to maintain a certain level of "normal" function is called: A) withdrawal. B) synergism. C) dependence. D) habituation.

C) dependence.

5. All of the following medications fall in the same classification, EXCEPT: A) captopril B) enalapril C) diazepam D) lisinopril

C) diazepam

75. A patient who complains of double vision has: A) ptosis. B) anisocoria. C) diplopia. D) hyperopia.

C) diplopia.

72. In the prehospital setting, saline locks are used primarily for patients who: A) have cancer and require continuous infusions of chemotherapy. B) are in compensated shock and only require small IV fluid boluses. C) do not need additional fluids but may need rapid medication delivery. D) have fragile veins that are easily infiltrated by rapid IV fluid boluses.

C) do not need additional fluids but may need rapid medication delivery.

31. Lipid-soluble medications require higher weight-based doses in elderly patients because: A) there are fewer barriers to absorption in elderly patients. B) elderly patients have a much faster basil metabolic rate. C) elderly patients have a higher body fat percentage and fat distribution. D) elderly patients have a higher overall percentage of body water.

C) elderly patients have a higher body fat percentage and fat distribution.

175. After starting an IV in an arm vein of a patient with chest pain and properly securing the catheter in place, you note that the IV is not flowing. You should: A) gently manipulate the catheter and reassess the flow. B) discontinue the IV and reestablish it in the other arm. C) ensure that the constricting band has been removed. D) use a pressure infuser device to improve the IV flow.

C) ensure that the constricting band has been removed.

19. Working to ensure a patient's privacy, confidentiality, and comfort level will: A) make the patient feel comfortable in disclosing personal information to you. B) leave no doubt in the patient's mind that you are truly a professional caregiver. C) establish positive patient rapport and encourage honest, open communication. D) help you gain the trust of the patient's family more than the trust of the patient.

C) establish positive patient rapport and encourage honest, open communication.

111. The Babinski sign, grasping, and sucking are: A) voluntary motor responses. B) abnormal findings in infants. C) examples of primitive reflexes. D) signs of nervous system dysfunction.

C) examples of primitive reflexes.

64. An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is: A) experiencing worsened hypoxemia. B) no longer experiencing bronchospasm. C) responding to bronchodilator therapy. D) in need of further bronchodilator therapy.

C) responding to bronchodilator therapy.

130. After correctly positioning the laryngoscope blade in the patient's mouth, you should: A) ask your partner to apply firm posterior pressure to the cricoid cartilage. B) gently pry back on the laryngoscope to obtain a view of the vocal cords. C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw. D) pull slightly back on the laryngoscope blade in order to view the epiglottis.

C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw.

24. Paying attention, making eye contact, and repeating key information from the patient's answers are examples of: A) reflection. B) clarification. C) facilitation. D) interpretation.

C) facilitation.

151. All of the following medications possess antiemetic properties, EXCEPT: A) ondansetron. B) dolasetron. C) famotidine. D) prochlorperazine.

C) famotidine.

101. The site MOST commonly used for inserting an IO needle is the: A) manubrium of the sternum. B) medial malleolus of the leg. C) flat bone of the proximal tibia. D) tibial tuberosity below the knee.

C) flat bone of the proximal tibia.

219. Paralytic medications exert their effect by: A) blocking the release of epinephrine and norepinephrine from the sympathetic nervous system. B) competitively binding to the motor neurons in the brain, thus blocking their ability to send messages. C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine. D) blocking the function of the autonomic nervous system and impeding the action of acetylcholinesterase.

C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine.

146. When drawing medication from an ampule, you should: A) cleanse the rubber stopper with an alcohol prep. B) always use a 14- or 16-gauge hypodermic needle. C) gently tap the ampule if medication is stuck in the neck. D) inject air into the ampule before withdrawing the medication.

C) gently tap the ampule if medication is stuck in the neck.

137. When performing an invasive procedure, such as starting an IV, minimum standard precautions include: A) gloves only. B) gloves and a mask. C) gloves and protective eyewear. D) gloves, gown, and full facial protection.

C) gloves and protective eyewear.

93. Compared to succinylcholine, rocuronium: A) has a rapid (30 to 60 seconds) onset of action and a relatively brief (3 to 8 minutes) duration of action. B) binds with nicotinic receptors on muscles and causes a brief activation known as fasciculation. C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects. D) does not bind with nicotinic receptor sites on muscle cells and does not antagonize acetylcholine.

C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.

52. A patient with orthopnea: A) has blood-tinged sputum. B) awakens at night with dyspnea. C) has dyspnea while lying flat. D) is breathing through pursed lips.

C) has dyspnea while lying flat.

47. If a hostile family member suddenly leaves the room, especially in the middle of a conversation with him or her, you should: A) immediately depart the scene and notify law enforcement personnel. B) ignore the family member's departure and continue to assess your patient. C) have your partner follow the person, while working to defuse the situation. D) ask the patient to follow the person in an attempt to reason with him or her.

C) have your partner follow the person, while working to defuse the situation.

154. The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because: A) the ET tube cannot be secured effectively when it is in the nose. B) most patients who are intubated nasally are extremely combative. C) he or she did not visualize the tube passing between the vocal cords. D) most nasotracheal intubation attempts result in esophageal placeme

C) he or she did not visualize the tube passing between the vocal cords.

40. Hypotonic solutions: A) include normal saline and lactated Ringer's solution. B) draw fluid from the cells and into the vascular space. C) hydrate the cells while depleting the vascular compartment. D) are the preferred solutions to use in patients with head trauma.

C) hydrate the cells while depleting the vascular compartment.

16. Hyperkalemia would MOST likely result in: A) abnormal gastrointestinal function. B) decreased skeletal muscle function. C) hyperstimulation of neural cell transmission. D) severe bradycardia due to increased vagal tone.

C) hyperstimulation of neural cell transmission.

90. Signs and symptoms of circulatory overload include: A) diarrhea. B) headache. C) hypertension. D) collapsed jugular veins.

C) hypertension.

44. An abnormal susceptibility to a medication that is peculiar to an individual patient is called an: A) untoward effect. B) adverse reaction. C) idiosyncratic reaction. D) exaggerated therapeutic effect.

C) idiosyncratic reaction.

168. Transillumination-guided intubation can be difficult or impossible to perform: A) in any patient with dentures. B) if the patient has oral secretions. C) in a brightly lit environment. D) in patients over 70 years of age.

C) in a brightly lit environment.

87. The fourth heart sound (S4): A) is normal in 25% of the population. B) occurs immediately before the S2 sound. C) indicates increased pressure in the atria. D) represents increased left ventricular stretching.

C) indicates increased pressure in the atria.

78. Edema at the IV catheter site and continued IV flow after occlusion of the vein above the insertion site are signs of: A) phlebitis. B) infection. C) infiltration. D) thrombophlebitis.

C) infiltration.

197. After inserting the Combitube to the proper depth, you should next: A) inflate the distal cuff with 5 mL of air. B) ventilate through the pharyngeal tube. C) inflate the pharyngeal cuff with 100 mL of air. D) apply a cervical collar to minimize head movement.

C) inflate the pharyngeal cuff with 100 mL of air.

273. You have been providing bag-mask ventilations to an unresponsive, apneic patient with facial trauma for approximately 10 minutes. After intubating the patient, you should: A) hyperventilate the patient with 100% oxygen. B) insert a nasogastric tube to decompress the stomach. C) insert an orogastric tube to relieve gastric distention. D) ventilate the patient at a rate of 12 to 20 breaths/min.

C) insert an orogastric tube to relieve gastric distention.

58. Blood tubing is a: A) special type of microdrip administration set that contains an inline filter designed to cleanse transfused blood of impurities. B) macrodrip administration set that is designed to be used exclusively with 1,000-mL bags of type O-negative blood. C) macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or a combination of IV fluids and blood. D) special administration set with dual piercing spikes that allows the paramedic to administer IV fluids to two critically ill or injured patients at the same time.

C) macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or a combination of IV fluids and blood.

131. If you receive orders to administer more than one drug to the same patient, it is MOST important to: A) start a second IV line. B) give a 100-mL saline bolus between drugs. C) make sure the drugs are compatible. D) wait 10 minutes before giving the second drug.

C) make sure the drugs are compatible.

264. You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to: A) insert an oral airway. B) suction his oropharynx. C) manually open his airway. D) begin ventilation assistance.

C) manually open his airway.

7. The anterior portion of the palate is formed by the: A) hyoid bone and mandible. B) union of the facial bones. C) maxilla and palatine bones. D) soft tissues of the posterior pharynx.

C) maxilla and palatine bones.

68. Transdermal medication patches: A) deliver a fluctuating dose of a medication over a relatively short period of time. B) should never be removed by the paramedic, even if he or she is administering a drug of the same type. C) may alter a patient's clinical presentation or interfere with medications administered by the paramedic. D) are a reliable medication delivery route because they are unaffected by the patient's perfusion status.

C) may alter a patient's clinical presentation or interfere with medications administered by the paramedic.

42. A patient who is overly talkative during your assessment: A) should be interrupted immediately. B) will not give a reliable medical history. C) may have abused methamphetamines. D) is usually an inherently antisocial person.

C) may have abused methamphetamines.

52. A patient who gives the emergency department physician completely different information than he or she gave to you in the field: A) clearly trusts the physician more than you. B) will cause the physician to question your competence. C) may have an organic condition, such as a brain tumor. D) should be questioned as to why the information was different.

C) may have an organic condition, such as a brain tumor.

135. The site on a patient's forearm that has been cleaned with iodine and alcohol before starting an IV is said to be: A) sterile. B) autoclaved. C) medically clean. D) disinfected

C) medically clean.

172. During tracheobronchial suctioning, it is MOST important to: A) apply suction for no longer than 5 seconds in the adult. B) avoid rotating the catheter as you are suctioning the trachea. C) monitor the patient's cardiac rhythm and oxygen saturation. D) inject 10 mL of saline down the ET tube to loosen secretions.

C) monitor the patient's cardiac rhythm and oxygen saturation.

114. All of the following are complications associated with orotracheal intubation, EXCEPT: A) laryngeal swelling. B) damage to the vocal cords. C) necrosis of the nasal mucosa. D) barotrauma from forceful ventilation.

C) necrosis of the nasal mucosa.

117. When assessing muscle strength, a score of 5/5 indicates: A) no muscle contraction or twitch. B) minimal movement against resistance. C) normal muscle tone and strength. D) active movement with evident fatigue.

C) normal muscle tone and strength.

11. The milliequivalent (mEq) represents the chemical combining power of the ion and is based on the: A) percentage of sodium in a given electrolyte solution. B) ability to unite with an electrolyte with the same charge. C) number of available ionic charges in an electrolyte solution. D) ratio of positively and negatively charged ions.

C) number of available ionic charges in an electrolyte solution.

141. The use of capnography in patients with prolonged cardiac arrest may be limited because: A) of an excess buildup of nitrogen in the blood. B) the paramedic often ventilates the patient too slowly. C) of acidosis and minimal carbon dioxide elimination. D) metabolic alkalosis damages the colorimetric paper.

C) of acidosis and minimal carbon dioxide elimination.

235. When performing an open cricothyrotomy, you should FIRST: A) maintain aseptic technique as you cleanse the area with iodine. B) slide your index finger between the thyroid and cricoid cartilages. C) palpate for the V notch of the thyroid cartilage and stabilize the larynx. D) hyperextend the patient's neck and then palpate the cricoid cartilage.

C) palpate for the V notch of the thyroid cartilage and stabilize the larynx.

87. When administering oxygen via a nonrebreathing mask, you must ensure that the: A) reservoir is half-filled first. B) one-way valves are disabled. C) patient has adequate tidal volume. D) flow rate is set to at least 6 L/min.

C) patient has adequate tidal volume.

62. Large protruding arm veins in an otherwise healthy adult can be difficult to cannulate because they often: A) are covered by thick skin that bends the IV catheter. B) constrict in response to insertion of the IV catheter. C) roll from side to side during the cannulation attempt. D) rupture spontaneously when punctured with the needle.

C) roll from side to side during the cannulation attempt.

286. A 36-year-old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to: A) ventilate with a demand valve. B) insert a LMA. C) perform a needle cricothyrotomy. D) perform an open cricothyrotomy.

C) perform a needle cricothyrotomy.

268. Several cycles of basic life support maneuvers have failed to relieve a severe airway obstruction in an unresponsive 44-year-old woman. You should: A) intubate the patient and attempt to push the foreign body into one of the mainstem bronchi. B) continue basic life support maneuvers and transport the patient to the hospital immediately. C) perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps. D) place the patient's head in a neutral position and perform an emergency cricothyrotomy.

C) perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps.

75. If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should: A) perform a blind finger sweep of the mouth. B) alternate chest compressions and abdominal thrusts. C) perform laryngoscopy and use Magill forceps. D) gain airway access via the cricothyroid membrane.

C) perform laryngoscopy and use Magill forceps.

17. The action of the body in response to a medication is called: A) pharmacology. B) biotransformation. C) pharmacokinetics. D) pharmacodynamics.

C) pharmacokinetics.

74. The process that the cells of large medication molecules use to ingest intracellular fluids and their contents is called: A) osmosis. B) filtration. C) pinocytosis. D) phagocytosis.

C) pinocytosis.

57. Medication X is given to increase the effects of medication Y, which provides more relief than if medication Y were given alone. This is an example of: A) synergism. B) summation. C) potentiation. D) antagonism.

C) potentiation.

119. In contrast to epinephrine, norepinephrine: A) specifically targets beta-1 receptors. B) has minimal effect on blood pressure. C) primarily stimulates alpha receptors. D) stimulates beta-1 and beta-2 receptors.

C) primarily stimulates alpha receptors.

134. You should insert the ET tube between the vocal cords until the: A) centimeter marking reads 15 cm at the patient's teeth. B) distal end of the cuff is 1 to 2 cm past the vocal cords. C) proximal end of the cuff is 1 to 2 cm past the vocal cords. D) tube meets resistance as it makes contact with the carina.

C) proximal end of the cuff is 1 to 2 cm past the vocal cords.

128. Whether your patient's problem is medical or traumatic in origin, you must: A) always begin transport within 10 minutes. B) contact medical control as soon as possible. C) qualify and quantify the patient's condition. D) perform a head-to-toe secondary assessment.

C) qualify and quantify the patient's condition.

150. 0.45% sodium chloride (½ normal saline) should NOT be used when: A) less than 250 mL of fluid is needed. B) your patient has renal impairment. C) rapid fluid rehydration is required. D) your patient has a diabetic disorder.

C) rapid fluid rehydration is required.

142. Verapamil hydrochloride (Isoptin, Calan) is indicated for patients with: A) stable wide-complex tachycardias. B) atrial flutter with a slow ventricular rate. C) re-entry supraventricular tachycardia. D) Wolff-Parkinson-White syndrome.

C) re-entry supraventricular tachycardia.

176. After inserting an 18-gauge over-the-needle catheter into the hand vein of a 30-year-old woman and securing the IV line in place, you note edema at the catheter site despite continued flow of the IV. The woman complains of pain and tightness around the IV site. You should: A) apply direct pressure to the venipuncture site and elevate her extremity. B) reapply the proximal constricting band to reduce edema at the catheter site. C) recognize that infiltration has occurred and immediately discontinue the IV. D) discontinue the IV and circumferentially wrap a dressing around the extremity.

C) recognize that infiltration has occurred and immediately discontinue the IV.

130. In critical care settings, mannitol is used to: A) manage hypothermia. B) lower the blood pressure. C) reduce cerebral edema. D) treat anaphylaxis.

C) reduce cerebral edema.

124. Hypotension may occur following initiation of a dobutamine infusion because it: A) is a direct vasodilator. B) blocks alpha-1 receptors. C) reduces cardiac afterload. D) has negative inotropic effects.

C) reduces cardiac afterload.

76. A whistle-tip suction catheter is MOST often used to: A) suction large debris from the oropharynx. B) rapidly remove large volumes of vomitus. C) remove secretions from an ET tube. D) suction an adult's mouth for 15 to 30 seconds.

C) remove secretions from an ET tube.

287. You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should: A) suspect that he has bilateral pneumothoraces. B) ventilate with a demand valve and transport at once. C) remove the bag-mask and suction his tracheostomy tube. D) remove his tracheostomy tube and replace it with a new one.

C) remove the bag-mask and suction his tracheostomy tube.

50. Cross-tolerance to a medication occurs when: A) the body's metabolism increases, resulting in a decreased concentration of the medication present near receptor sites. B) repeated doses of a medication within a short time rapidly cause tolerance, which renders the medication ineffective. C) repeated exposure to a medication causes an abnormal tolerance to the adverse or therapeutic effects of the medication.. D) repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.

C) repeated exposure to a medication causes an abnormal tolerance to the adverse or therapeutic effects of the medication..

181. What size ET tube would be MOST appropriate to use for a 4-year-old child? A) 3.5 mm B) 4.0 mm C) 4.5 mm D) 5.0 mm

D) 5.0 mm

38. Lactated Ringer's (LR) solution may be beneficial to patients who have lost large amounts of blood because: A) it takes less LR to effectively expand the intravascular compartment than any other isotonic solution. B) LR has the ability to carry oxygen and can maintain cellular perfusion until the patient receives definitive care. C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis. D) the likelihood of causing acute circulatory overload is minimal relative to other hypertonic solutions.

C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis.

242. You should turn the jet ventilator release valve off when: A) the audible alarm sounds. B) wide chest expansion is noted. C) the patient's chest visibly rises. D) you can auscultate breath sounds.

C) the patient's chest visibly rises.

131. When assessing an injured patient's mental status, the patient knows his name but is unable to recall the events that preceded the injury. From this, you can conclude that: A) the patient's long-term memory is not intact. B) the patient's Glasgow Coma Scale score is at least 13. C) the patient's short-term memory is not intact. D) the patient likely has an intracranial hemorrhage.

C) the patient's short-term memory is not intact.

85. Damage to nerves, tendons, or ligaments would MOST likely occur during venipuncture if: A) the patient has diabetes. B) the patient moves suddenly. C) the selected IV site is near a joint. D) a small vein in the hand is cannulated.

C) the selected IV site is near a joint.

186. When intubating a 3-year-old child, you should insert the ET tube until: A) the distal cuff is 1 to 2 cm beyond the vocal cords. B) you meet resistance, and then withdraw the tube 2 cm. C) the vocal cord mark is 2 to 3 cm beyond the vocal cords. D) the cm marking on the tube reads 15 cm at the child's lips.

C) the vocal cord mark is 2 to 3 cm beyond the vocal cords.

49. Decreased efficacy or potency of a medication when taken repeatedly by a patient is called: A) addiction. B) immunity. C) tolerance. D) habituation.

C) tolerance.

140. If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO2 detector should: A) not change colors. B) turn yellow during inhalation. C) turn yellow during exhalation. D) remain purple during ventilations.

C) turn yellow during exhalation.

29. The process of moving air into and out of the lungs is called: A) respiration. B) inhalation. C) ventilation. D) exhalation.

C) ventilation.

248. If a patient has a stoma and no tracheostomy tube in place: A) you should not seal the nose and mouth when ventilating. B) suctioning of the stoma must be performed before ventilating. C) ventilations can be performed by placing a mask over the stoma. D) you must perform a head tilt-chin lift maneuver before ventilating.

C) ventilations can be performed by placing a mask over the stoma.

1. The upper airway of an adult consists of all the structures above the: A) carina. B) bronchus. C) vocal cords. D) cricoid ring.

C) vocal cords.

23. Osmosis occurs when: A) water moves from an area of higher solute concentration to an area of lower solute concentration. B) solutes move from an area of lower water concentration to an area of higher water concentration. C) water moves from an area of lower solute concentration to an area of higher solute concentration. D) solutes move from an area of higher water concentration to an area of lower water concentration.

C) water moves from an area of lower solute concentration to an area of higher solute concentration.

146. According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is: A) pulse oximetry. B) the esophageal detector device. C) waveform capnography. D) colorimetric capnography.

C) waveform capnography.

125. Before performing orotracheal intubation, it is MOST important for the paramedic to: A) monitor the patient's cardiac rhythm. B) preoxygenate with a bag-mask device. C) wear gloves and facial protection. D) apply a pulse oximeter to the patient.

C) wear gloves and facial protection.

14. When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine: A) if the two complaints are related. B) when each of the complaints began. C) which complaint has a higher priority. D) the patient's past medical history.

C) which complaint has a higher priority.

202. A size 3 or 4 LMA: A) is most suitable for use in morbidly obese patients. B) is less likely to become dislodged than smaller sizes. C) will accommodate the passage of a 6.0-mm ET tube. D) is appropriate to use in children younger than 6 years of age.

C) will accommodate the passage of a 6.0-mm ET tube.

92. Distention of the jugular veins indicates: A) a state of hypovolemia. B) left-sided heart failure. C) decreased venous pressure.. D) increased venous capacitance.

D) increased venous capacitance.

107. A severely burned patient requires 4,500 mL of isotonic crystalloid solution over 8 hours, so medical control orders you to begin the infusion in the field. If your administration set allows 10 gtts/mL, at how many gtts/min will you set the IV flow rate in order to deliver the ordered amount of fluid? A) 76 B) 84 C) 88 D) 94

D) 94

142. Which of the following medications actually dissolves a clot? A) Plavix B) Aggrastat C) Warfarin D) Activase

D) Activase

95. Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia? A) Terbutaline B) Ipratropium C) Levalbuterol D) Albuterol

D) Albuterol

56. Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress? A) Fever of 102.5°F B) Productive cough C) Chest pain or pressure D) BP of 148/94 mm Hg

D) BP of 148/94 mm Hg

127. For which of the following conditions is sodium nitroprusside used? A) Severe refractory hypotension B) Vagal-induced bradycardia C) Intracerebral hemorrhage D) Unstable vascular aneurysm

D) Unstable vascular aneurysm

38. If studies in animals or human beings have demonstrated fetal abnormalities, or if there is evidence of fetal risk based on human experience, a pregnancy category ___ is assigned to a medication. A) B B) C C) D D) X

D) X

157. When performing nasotracheal intubation, you should use an ET tube that is: A) equipped with a stylet in order to make the tube formfitting. B) uncuffed so as to avoid unnecessary damage to the nasal mucosa. C) slightly larger than the nostril into which the tube will be inserted. D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.

D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.

122. A 1% lidocaine (Xylocaine) concentration contains: A) 1 mg/10 mL. B) 100 mg/100 mL. C) 500 mg/50 mL. D) 1,000 mg/100 mL..

D) 1,000 mg/100 mL..

127. A nonhypovolemic patient is severely hypotensive and requires a dopamine infusion at 5 µg/kg/min. The patient's estimated weight is 190 lb. You add 800 mg of dopamine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 10 B) 12 C) 14 D) 16

D) 16

183. An unconscious 4-year-old child with a blood glucose reading of 30 mg/dL requires 2 mL/kg of D50. The child's estimated weight is 35 lb. You have a prefilled syringe of D50 at a concentration of 25 g/50 mL. How many grams of dextrose will you administer to the child? A) 12,400 B) 13,800 C) 14,000 D) 16,000

D) 16,000

171. You are treating a 29-year-old man who was struck in the abdomen with a steel pipe. He is confused, has weak radial pulses, and has a blood pressure of 88/58 mm Hg. You should administer: A) 1 mL of isotonic crystalloid for every 3 mL of estimated internal blood loss. B) 1,000 mL of normal saline or lactated Ringer's solution and then reassess him. C) enough isotonic crystalloid to increase his systolic BP to at least 120 mm Hg. D) 20 mL/kg saline fluid boluses until his mental status and radial pulses improve.

D) 20 mL/kg saline fluid boluses until his mental status and radial pulses improve.

104. What class of medication is typically used to control the heart rate in patients with atrial fibrillation or atrial flutter? A) Sodium channel blocker B) Potassium channel blocker C) Beta-adrenergic blocker D) Calcium channel blocker

D) Calcium channel blocker

261. Which of the following patients is LEAST likely in need of positive-pressure ventilation? A) Confused 46-year-old woman with labored respirations, adventitious breath sounds, and pallor B) Conscious 41-year-old woman with two-word dyspnea, perioral cyanosis, and tachycardia C) Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea D) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

D) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

1. Which of the following statements regarding pharmacology is correct? A) The selection and administration of most medications are based largely on anecdotal research. B) The action of the human body in response to a particular medication is called pharmacology. C) Evidence-based guidelines, while helpful, are not the primary factor that drives medication administration. D) Despite the advanced science of pharmacology, adverse reactions are commonplace.

D) Despite the advanced science of pharmacology, adverse reactions are commonplace.

142. Which of the following medications is appropriate to administer via the rectal route? A) Aspirin B) Glucagon C) Furosemide (Lasix) D) Diazepam (Valium)

D) Diazepam (Valium)

2. Which of the following medications is derived from a plant source? A) Lithium B) Insulin C) Heparin D) Digoxin

D) Digoxin

216. Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia? A) Brevital B) Pentothal C) Sublimaze D) Etomidate

D) Etomidate

134. Which of the following statements regarding packed red blood cells (PRBCs) is correct? A) For every 3 mL of whole blood that is lost, the patient should be given 1 to 2 mL of PRBCs. B) PRBCs should not be given to patients with hemolysis, as this will cause a transfusion reaction.. C) In a patient with ongoing RBC loss, one unit of PRBCs will increase the hematocrit by about 5%. D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

167. Which of the following inhaled medications is NOT a beta2 agonist bronchodilator? A) Proventil B) Albuterol C) Isoetharine D) Ipratropium

D) Ipratropium

125. Which of the following actions will provide the BEST personal protection when caring for a patient on uneven terrain? A) Wearing a back brace whenever you lift B) Wearing boots that provide good traction C) Using at least four personnel when moving a patient D) Making lifts and moves as controlled as possible

D) Making lifts and moves as controlled as possible

63. Which of the following medications can be administered via the intranasal route? A) Atropine B) Diazepam C) Morphine D) Naloxone

D) Naloxone

69. Which of the following statements regarding the sublingual administration of nitroglycerin is correct? A) Large doses of IV nitroglycerin are required to achieve the same effect as a single sublingual nitroglycerin dose B) Sublingual nitroglycerin administration involves placing a tablet in between the patient's cheek and gum C) Sublingual nitroglycerin has a delayed onset of action, but nearly a 100% bioavailability D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

154. What classification of medication is ketorolac (Toradol)? A) Opioid analgesic B) Corticosteroid anti-inflammatory C) Histamine-1 receptor antagonist D) Non-steroidal anti-inflammatory

D) Non-steroidal anti-inflammatory

32. What term is used to describe a situation in which a patient experiences clinical effects from a medication that are opposite from the intended effects? A) Side effect B) Subtherapeutic effect C) Idiosyncrasy D) Paradoxical reaction

D) Paradoxical reaction

138. Which of the following statements regarding sharps containers is correct? A) There should be at least one sharps container in the back of the ambulance. B) A small sharps container is ideal for carrying in your cargo pants or pocket. C) Needles should be placed in a sharps container after patient care is complete. D) Sharps containers should be puncture-proof and should bear a biohazard logo.

D) Sharps containers should be puncture-proof and should bear a biohazard logo.

62. Which of the following statements regarding the endotracheal route of medication administration is correct? A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given. B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level. C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water. D) The endotracheal route is no longer considered a reliable method of medication administration.

D) The endotracheal route is no longer considered a reliable method of medication administration.

117. Which of the following statements regarding sympathomimetic chemicals is correct? A) They are not synthetically manufactured. B) They block the release of acetylcholine. C) They only stimulate alpha-1 receptors.. D) They are not found naturally in the body.

D) They are not found naturally in the body.

282. You are attempting to intubate a 5-year-old girl when you note that her heart rate has fallen from 120 beats/min to 80 beats/min. A patent IV line has been established. The MOST appropriate action is to: A) administer 0.02 mg/kg of atropine to increase her heart rate. B) abort the intubation attempt and begin chest compressions at 100/min. C) give a 20 mL/kg normal saline bolus and continue your intubation attempt. D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.

D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.

162. All of the following medications or preparations are commonly given via the transdermal route, EXCEPT: A) nicotine. B) analgesia. C) nitroglycerin. D) acetaminophen.

D) acetaminophen.

149. Phenothiazine medications exert their antiemetic properties by: A) promoting the secretion of hormones in the brain that depress the function of the medulla oblongata. B) antagonizing dopaminergic receptor sites in the brain, which suppresses the function of the hypothalamus. C) blocking histamine-2 receptors, which inhibits gastric acid production and slows peristalsis. D) activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

D) activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

46. All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT: A) lactic acidosis. B) increased metabolism. C) anaerobic metabolism. D) acute hyperventilation.

D) acute hyperventilation.

189. You are treating an unconscious 39-year-old man who overdosed on heroin. You are unable to establish an IV line because his veins are severely sclerosed, and your protocols do not allow for IO cannulation. You should: A) assist ventilations and transport immediately. B) use the subcutaneous route to administer Narcan. C) intubate the patient and give Narcan via the ET tube. D) administer naloxone via the mucosal atomizer device.

D) administer naloxone via the mucosal atomizer device.

41. An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n): A) side effect. B) idiosyncrasy. C) placebo effect. D) adverse effect.

D) adverse effect.

2. Gathering a patient's medical history and performing a secondary assessment should occur: A) immediately after you form your visual general impression of the patient. B) shortly after making patient contact and determining his or her complaint. C) after initial treatment has been rendered and you are en route to the hospital. D) after life threats have been identified and corrected in the primary assessment.

D) after life threats have been identified and corrected in the primary assessment.

40. In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when: A) the diaphragm contracts. B) air is drawn into the lungs. C) intrathoracic pressure falls. D) air is forced into the lungs.

D) air is forced into the lungs.

35. A solution of water with 0.9% sodium chloride is: A) hypotonic until it is introduced into the body. B) capable of carrying oxygen when it is infused. C) of minimal value in expanding the vascular space. D) also called normal saline and is an isotonic solution.

D) also called normal saline and is an isotonic solution.

86. To avoid inadvertently cannulating an artery, you should: A) routinely cannulate veins on the anterior aspect of the arm. B) refrain from attempting to cannulate an external jugular vein. C) recall that most patients' veins and arteries are transpositioned. D) always check for a pulse in any vessel you intend to cannulate.

D) always check for a pulse in any vessel you intend to cannulate.

7. You are in the BEST position to decide what, if any, care needs to be provided at the scene versus en route to the hospital once you: A) can qualify that a patient is indeed sick. B) determine how far away the hospital is. C) perform a detailed secondary assessment. D) are able to quantify how sick a patient is.

D) are able to quantify how sick a patient is.

17. The trachea and mainstem bronchi: A) constrict violently when their beta-2 receptors are stimulated excessively. B) are approximately 10 to 12 cm in length and are joined together at the hilum. C) do not contain mucous-producing cells in patients without a respiratory disease. D) are lined with beta-2 receptors that result in bronchodilation when stimulated.

D) are lined with beta-2 receptors that result in bronchodilation when stimulated.

260. After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should: A) intubate him at once. B) apply a nonrebreathing mask. C) suction his mouth for 15 seconds. D) begin positive-pressure ventilations.

D) begin positive-pressure ventilations.

88. If seizures occur following the administration of flumazenil (Romazicon): A) an opiate medication should be given immediately because of its potent antiseizure properties. B) the patient should receive half the normal dose of a benzodiazepine in order to control the seizure. C) the paramedic should give naloxone immediately in order to reverse the effects of the flumazenil. D) benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

D) benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

152. IV calcium is routinely used to treat: A) cardiopulmonary arrest. B) magnesium sulfate toxicity. C) sulfuric acid exposure. D) beta-blocker overdose.

D) beta-blocker overdose.

9. Major cations of the body include all of the following, EXCEPT: A) sodium. B) calcium. C) potassium. D) bicarbonate.

D) bicarbonate.

37. A drug is assigned a pregnancy category "A" if: A) there is evidence of fetal risk based on human experience, and the risk of using the drug in pregnant women clearly outweighs any possible benefit. B) there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the documented risk. C) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available. D) controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

D) controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

134. Streptokinase (Streptase) can stop an evolving acute myocardial infarction by: A) inhibiting platelet aggregation near a vascular occlusion. B) blocking certain clotting factors, which thins the blood. C) dilating the occluded vessel and improving blood flow. D) converting plasminogen to plasmin, which degrades fibrin.

D) converting plasminogen to plasmin, which degrades fibrin.

105. Intermittent claudication is defined as: A) transient swelling of the microvasculature of the extremities. B) bulging of the vessels in the legs while in a standing position. C) enlarged lower extremities due to reduced lymphatic drainage. D) cramplike pain in the lower extremities due to poor circulation.

D) cramplike pain in the lower extremities due to poor circulation.

21. Using casual nicknames can be especially problematic when: A) the patient is a male who was involved in an assault. B) assessing geriatric patients who fear losing their independence. C) the patient is critically ill or injured and is semiconscious. D) cultural differences exist between the patient and the paramedic.

D) cultural differences exist between the patient and the paramedic.

130. After performing your primary assessment of a patient, your next action should be to: A) transport the patient to the closest medical treatment facility. B) move the patient to the ambulance as expeditiously as possible. C) perform a secondary assessment to narrow your differential diagnosis. D) decide what care is needed at the scene versus en route to the hospital.

D) decide what care is needed at the scene versus en route to the hospital.

47. Hypoventilation causes a(n) __________ and leads to __________. A) increased minute volume, hypocarbia B) decreased minute volume, hypocarbia C) increased minute volume, hypercarbia D) decreased minute volume, hypercarbia

D) decreased minute volume, hypercarbia

24. Stimulation of beta-1 adrenergic receptors would produce all of the following effects, EXCEPT: A) an increase in heart rate. B) increased renin secretion. C) increased cardiac electrical conduction. D) decreased myocardial contractility.

D) decreased myocardial contractility.

62. The pulse oximeter would be LEAST useful when: A) identifying deterioration of the cardiac patient. B) assessing vascular status in orthopaedic trauma. C) monitoring oxygenation status during intubation. D) determining if a patient should receive oxygen.

D) determining if a patient should receive oxygen.

45. The therapeutic index of a medication is defined as the: A) plasma level at which the medication begins to exert its effect. B) period of time in which the medication is excreted from the body. C) duration of therapeutic action for a given medication on the body. D) difference between the median effective dose and the median toxic dose.

D) difference between the median effective dose and the median toxic dose.

27. A working hypothesis of the nature of a patient's problem is called the: A) chief complaint. B) field impression. C) history of present illness. D) differential diagnosis.

D) differential diagnosis.

92. A vasovagal reaction is the result of: A) acute bradycardia. B) sudden hypertension. C) massive vasoconstriction. D) dilation of the vasculature.

D) dilation of the vasculature.

188. If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to: A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid cartilage. B) insert a multilumen airway device and confirm placement by means of auscultation of breath sounds and capnography. C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve distension, and reattempt intubation. D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.

D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.

78. An artificial airway adjunct: A) effectively protects the airway from aspiration. B) is a suitable substitute for manual head positioning. C) should be inserted in any patient who is semiconscious. D) does not obviate the need for proper head positioning.

D) does not obviate the need for proper head positioning.

272. A 66-year-old woman is found to be unresponsive and apneic.. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver: A) each breath over 2 seconds at a rate of 8 to 10 breaths/min. B) one breath over 1 second every 3 to 5 seconds C) one breath over 2 seconds every 5 to 6 seconds. D) each breath over 1 second at a rate of 10 to 12 breaths/min.

D) each breath over 1 second at a rate of 10 to 12 breaths/min.

193. The major advantage of the multilumen airway is that: A) it can be used in children and adults as an alternative airway device. B) no mask seal is required to ventilate with either of the multilumen airways. C) intubating the trachea with the multilumen airway in place is extremely easy. D) effective ventilation is possible if the tube enters the esophagus or the trachea.

D) effective ventilation is possible if the tube enters the esophagus or the trachea.

258. With regard to intubation difficulty, neck mobility problems are MOST commonly associated with: A) female patients. B) tall, thin patients. C) small children. D) elderly patients.

D) elderly patients.

83. Supplemental oxygen given to a patient with an acute myocardial infarction: A) will prevent the patient from developing a lethal cardiac dysrhythmia. B) should not exceed 3 L/min in order to prevent oxidative injury. C) oxygenates the myocardium that is distal to the occluded coronary artery. D) enhances the body's compensatory mechanisms during the cardiac event.

D) enhances the body's compensatory mechanisms during the cardiac event.

122. Proper documentation of your physical examination of a patient is MOST important because it: A) becomes a permanent part of the patient's medical record and may be subjected to legal issues.. B) reflects your subjective findings and forms the basis for your working field diagnosis of the patient. C) facilitates the paramedic's definitive diagnosis of the patient, leading to the most appropriate care. D) ensures an accurate historical accounting of the patient's problems prior to entering the hospital.

D) ensures an accurate historical accounting of the patient's problems prior to entering the hospital.

73. Complications of aspiration include all of the following, EXCEPT: A) airway obstruction. B) intrapulmonary infection. C) bronchiolar tissue damage. D) excess surfactant production.

D) excess surfactant production.

16. The function of the lower airway is to: A) warm, filter, and humidify air. B) protect the lungs from aspiration. C) deliver oxygenated blood to the cells. D) exchange oxygen and carbon dioxide.

D) exchange oxygen and carbon dioxide.

21. The antidiuretic hormone (ADH) prevents the loss of water from the kidneys during the process of: A) osmosis. B) dialysis. C) diffusion. D) filtration.

D) filtration.

30. Overhydration occurs when: A) a patient experiences prolonged periods of severe hyperventilation. B) the left side of the heart fails and blood backs up into the systemic circulation. C) the intracellular compartment becomes engorged due to a decrease in vascular volume. D) fluid is forced from the engorged interstitial compartment into the intracellular compartment.

D) fluid is forced from the engorged interstitial compartment into the intracellular compartment.

62. A conscious patient's respiratory rate should be measured: A) by auscultating the lungs. B) by looking at the abdomen. C) with his or her prior knowledge. D) for a minimum of 30 seconds.

D) for a minimum of 30 seconds.

4. A(n) _________ medication typically includes a "stem" that links it to other medications in the same class. A) trade B) official C) brand D) generic

D) generic

209. If ventilation is difficult after inserting a King LT airway, you should: A) deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation. B) remove the King LT and immediately resume ventilation with a bag-mask. C) attach a manually triggered ventilator and observe for adequate chest rise. D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.

D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.

11. Compared to Schedule III drugs, Schedule IV drugs: A) include medications such as Vicodin and have a high potential for psychological dependence. B) have a moderate potential for physical dependence and include cough syrups that contain codeine. C) may lead to severe addiction and include short-acting barbiturates, amphetamines, and opiates. D) have a lower abuse potential and include medications such as diazepam (Valium) and lorazepam (Ativan).

D) have a lower abuse potential and include medications such as diazepam (Valium) and lorazepam (Ativan).

133. After administering Fentanyl, a controlled medication, to a patient for severe pain, you should: A) discard any medication that was not used and document the amount you wasted on the patient care report. B) ensure that any unused medication is disposed of properly and then have the patient's family member sign as a witness. C) properly dispose of any remaining medication and ask your partner to sign as the person who wasted the medication. D) have your partner or a supervisor witness you properly disposing of any of the unused medication and then sign as a witness.

D) have your partner or a supervisor witness you properly disposing of any of the unused medication and then sign as a witness.

12. All of the following are Schedule II substances, EXCEPT: A) Ritalin. B) fentanyl. C) cocaine. D) heroin.

D) heroin.

171. Once you have confirmed that the lighted stylet-ET tube combination has entered the trachea, you should: A) secure the tube manually, remove the stylet, and attach a bag-mask device. B) slightly withdraw the stylet and tube to ensure placement above the carina. C) remove the lighted stylet and inflate the distal cuff with 5 to 10 mL of air. D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.

D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.

70. After observing a flash of blood in the IV catheter's flash chamber, you should: A) remove the proximal constricting band and then slide the catheter off the needle and into the vein. B) carefully raise the angle of the catheter to approximately 45° and thread the catheter off of the needle. C) apply pressure to the vein just proximal to the end of the indwelling catheter and remove the needle. D) immediately drop the angle of the catheter to about 15° and advance the catheter a few more centimeters.

D) immediately drop the angle of the catheter to about 15° and advance the catheter a few more centimeters.

115. Paradoxical bradycardia may occur if atropine is given: A) too rapidly. B) in doses greater than 2 mg. C) for acetylcholinesterase inhibition.. D) in doses less than 0.1 mg.

D) in doses less than 0.1 mg.

156. When administering a drug via IV bolus, you are giving the drug: A) slowly. B) rapidly. C) over time. D) in one mass.

D) in one mass.

127. Orotracheal intubation should be performed with the patient's head: A) slightly flexed. B) hyperextended. C) in a neutral position. D) in the sniffing position.

D) in the sniffing position.

95. Complications associated with the one-person bag-mask ventilation technique are MOST often related to: A) hyperinflation of the lungs. B) unrecognized rescuer fatigue.. C) improper manual head positioning. D) inadequate tidal volume delivery.

D) inadequate tidal volume delivery.

43. Administering large amounts of an isotonic crystalloid solution to a patient with internal bleeding would MOST likely: A) expand the vascular space and improve systemic perfusion. B) cause acute hypotension as fluid is drawn from the vascular space. C) change the ratio of hemoglobin and red blood cells. D) increase the severity of internal bleeding by interfering with hemostasis.

D) increase the severity of internal bleeding by interfering with hemostasis.

108. Signs of clinical improvement during CPAP therapy include: A) a decrease in systolic BP. B) an increase in the heart rate. C) increased ETCO2. D) increased ease of speaking.

D) increased ease of speaking.

203. Proper insertion of the LMA involves: A) inserting the LMA into the patient's mouth by following the curvature of the patient's tongue. B) lifting the patient's jaw upward and blindly inserting the LMA until you meet resistance. C) flexing the patient's neck, depressing the tongue with a tongue blade, and blindly inserting the LMA. D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

56. Medications administered by the ___________ route, by definition, have 100% bioavailability. A) sublingual B) intramuscular C) endotracheal D) intravenous

D) intravenous

12. After determining that the scene is safe, the FIRST step in approaching a patient is to: A) determine the chief complaint. B) ask the patient his or her name. C) ascertain the age of the patient. D) introduce yourself to the patient.

D) introduce yourself to the patient.

56. Objective patient information: A) is observed by the patient. B) is perceived by the patient. C) cannot be quantified. D) is based on fact or observation.

D) is based on fact or observation.

67. It would NOT be appropriate to place a patient in the recovery position if he or she: A) is tachycardic. B) is semiconscious. C) has not been injured. D) is breathing shallowly.

D) is breathing shallowly.

52. In the prehospital setting, the MOST commonly used IV solutions are: A) colloid solutions. B) hypotonic crystalloids. C) hetastarch and saline. D) isotonic crystalloids.

D) isotonic crystalloids.

250. In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device: A) it should have a stylet that can be removed easily. B) it should have an internal diameter of at least 6.0 mm. C) the patient's head must be in a hyperextended position. D) it must be equipped with a 15/22-mm proximal adaptor.

D) it must be equipped with a 15/22-mm proximal adaptor.

6. From an airway management perspective, the MOST important anatomic consideration regarding an adult's tongue is: A) that it is easily lacerated, but bleeds minimally. B) that it attaches directly to the mandible and hyoid bone. C) its proportionately large size compared to a child's tongue. D) its tendency to fall back and occlude the posterior pharynx.

D) its tendency to fall back and occlude the posterior pharynx.

69. Regardless of the technique you use to start an IV, you should always: A) apply a tight constricting band proximal to the selected vein for approximately 5 minutes. B) use an over-the-needle catheter that features an automatic needle retraction system for added safety. C) obtain blood samples for emergency department staff by attaching a syringe to the hub of the IV catheter. D) keep the beveled side of the catheter up during insertion and maintain adequate traction on the vein during cannulation.

D) keep the beveled side of the catheter up during insertion and maintain adequate traction on the vein during cannulation.

46. All of the following are examples of colloid solutions, EXCEPT: A) dextran. B) hetastarch. C) Plasmanate. D) lactated Ringer's.

D) lactated Ringer's.

2. The ______________ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly. A) oropharynx B) nasopharynx C) hyperpharynx D) laryngopharynx

D) laryngopharynx

121. The procedure in which the vocal cords are visualized for placement of an ET tube is called direct: A) bronchoscopy. B) tracheostomy. C) pharyngoscopy. D) laryngoscopy.

D) laryngoscopy.

132. The BURP maneuver usually involves applying backward, upward, and rightward pressure to the: A) upper third of the cricoid cartilage. B) lower third of the cricoid cartilage. C) upper third of the thyroid cartilage. D) lower third of the thyroid cartilage.

D) lower third of the thyroid cartilage.

96. When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should: A) apply posterior cricoid pressure. B) manually position the patient's head. C) continually auscultate breath sounds. D) maintain an adequate mask-to-face seal.

D) maintain an adequate mask-to-face seal.

41. If a patient does not respond to a question within a couple of seconds, he or she: A) must be assumed to have an altered mental status until proven otherwise. B) should immediately be asked another question to facilitate gathering data. C) should have the question repeated back to him or her using different terms. D) may be deciding if he or she can trust you enough to answer the question.

D) may be deciding if he or she can trust you enough to answer the question.

44. The paramedic must always keep in mind that the information he or she fails to obtain: A) is usually the result of the patient's failure to divulge. B) will be obtained by the emergency department physician. C) will usually lead to the provision of substandard treatment. D) may be the information needed to provide appropriate care.

D) may be the information needed to provide appropriate care.

76. As a medication undergoes biotransformation, it becomes a(n): A) compound. B) molecule. C) electrolyte. D) metabolite.

D) metabolite.

113. To convert 2.5 liters to milliliters, you should: A) divide 2.5 by 500. B) multiply 2.5 by 500. C) divide 2.5 by 1,000. D) multiply 2.5 by 1,000.

D) multiply 2.5 by 1,000.

78. Asymmetry of the pupils: A) is a normal finding in up to 40% of the population. B) indicates a significant ocular or neurologic pathology. C) is normal when a light is shone into one of the pupils. D) must be correlated with the patient's overall presentation.

D) must be correlated with the patient's overall presentation.

151. Before securing the ET tube in place with a commercial device, you should: A) remove the bag-mask device from the ET tube. B) hyperventilate the patient for 30 seconds to 1 minute. C) move the ET tube to the center of the patient's mouth. D) note the centimeter marking on the ET tube at the patient's teeth.

D) note the centimeter marking on the ET tube at the patient's teeth.

110. Under normal conditions, the renin-angiotensin system functions by: A) dilating the systemic vasculature and reducing cardiac afterload when arterial blood pressure increases. B) stimulating alpha-1 receptors, thereby increasing the blood pressure in response to acute blood loss. C) blocking alpha-2 receptors, thereby increasing the release of norepinephrine and raising blood pressure. D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion.

D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion.

104. Lower extremity shortening and/or internal or external rotation are findings often associated with: A) pelvic fractures. B) mid-shaft femur fractures. C) pathologic fractures of the hip. D) proximal lower extremity injury.

D) proximal lower extremity injury.

153. After inserting the needle during an intramuscular or subcutaneous injection, but before delivering the medication, you should: A) ensure that you stretch the skin taut. B) inquire about any medication allergies. C) look in the barrel of the syringe for blood. D) pull back on the plunger to aspirate for blood.

D) pull back on the plunger to aspirate for blood.

22. Physiologic dead space increases with: A) tachypnea. B) deep breathing. C) alveolar inflation. D) pulmonary obstructions.

D) pulmonary obstructions.

174. After tracheobronchial suctioning is complete, you should: A) visualize the vocal cords to ensure the tube is still in the correct position. B) hyperventilate the patient at 24 breaths/min for approximately 3 minutes. C) instill 3 to 5 mL of saline down the tube to loosen any residual secretions. D) reattach the bag-mask device, continue ventilations, and reassess the patient.

D) reattach the bag-mask device, continue ventilations, and reassess the patient.

71. The rectal route is preferred over the oral route for certain emergency medications because: A) rectal medications are altered significantly by first-pass metabolism. B) bioavailability of rectal medications does not exceed 50 percent. C) the vasculature of the rectal mucosa allows for slow drug absorption. D) rectal medications are usually not subject to first-pass metabolism.

D) rectal medications are usually not subject to first-pass metabolism.

135. Fresh frozen plasma is used to: A) increase the hematocrit. B) increase circulating volume. C) replace red blood cells. D) replace critical clotting factors.

D) replace critical clotting factors.

99. If a manually inserted IO needle is placed properly in an adult, it should: A) not require a pressure infuser. B) be easily movable in the bone. C) rest at a 45° angle to the bone. D) rest at a 90° angle to the bone.

D) rest at a 90° angle to the bone.

110. At its worst, kyphosis can become a source of: A) extremity paralysis. B) complete immobility. C) pathologic fractures. D) restrictive lung disease.

D) restrictive lung disease.

159. If you must insert the ET tube into the patient's left nostril, you should: A) insert the tube straight back without rotating it.. B) insert the tube with the beveled tip facing upward. C) ensure that the bevel is facing away from the septum. D) rotate the tube 180° as its tip enters the nasopharynx.

D) rotate the tube 180° as its tip enters the nasopharynx.

132. A drug that is contraindicated for a particular patient: A) will likely result in immediate death. B) is usually given at half its usual dose. C) should be given with extreme caution. D) should not be administered to the patient.

D) should not be administered to the patient.

163. Medication absorption through a nitroglycerin patch would be increased if the patient has: A) scar tissue under the patch. B) peripheral vascular disease. C) a low systolic blood pressure. D) skin that is thin or nonintact.

D) skin that is thin or nonintact.

115. If a patient is able to shrug his or her shoulders and turn his or her head from left to right, the ____________ nerve is likely intact. A) trigeminal B) abducens C) vestibulocochlear D) spinal accessory

D) spinal accessory

61. When initiating an IV line in the upper extremity of a stable patient, you should: A) always use the antecubital vein. B) look at the anterior forearm first. C) start proximally and work distally. D) start distally and work proximally.

D) start distally and work proximally.

220. Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT: A) vecuronium bromide. B) rocuronium bromide. C) pancuronium bromide. D) succinylcholine chloride.

D) succinylcholine chloride.

102. Toxic effects from beta blockers include all of the following, EXCEPT: A) hypotension. B) bradycardia. C) conduction delays. D) tachycardia.

D) tachycardia.

277. You are transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should: A) hyperventilate the patient to see if the ETCO2 reading increases. B) slow your ventilation rate to see if the ETCO2 reading decreases. C) promptly extubate the patient and ventilate with a bag-mask device. D) take immediate measures to confirm proper placement of the ET tube.

D) take immediate measures to confirm proper placement of the ET tube.

137. If the ET tube has been positioned properly in the trachea: A) breath sounds should be somewhat louder on the right side and the epigastrium should be silent. B) you should not see vapor mist in the ET tube during exhalation when ventilating with a bag-mask. C) breath sounds should be loud at the apices of the lungs but somewhat diminished at the bases. D) the bag-mask device should be easy to compress and you should see corresponding chest expansion.

D) the bag-mask device should be easy to compress and you should see corresponding chest expansion.

228. When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if: A) the patient's head is hyperextended. B) you incise the cricothyroid membrane at a transverse angle. C) the patient's head is in a neutral position. D) the cricothyroid membrane is incised vertically.

D) the cricothyroid membrane is incised vertically.

6. Solutes are defined as: A) atoms that carry an electrical charge. B) solutions that exclusively carry electrolytes. C) solutions that contain dissolved components. D) the dissolved particles contained in a solvent.

D) the dissolved particles contained in a solvent.

147. When administering naloxone to a patient who overdosed on an opioid, it is important for the paramedic to remember that: A) small doses of naloxone often cause severe withdrawal symptoms in long-term opioid users. B) complete reversal of the opioid is essential if the patient receives opioids on a long-term basis. C) an IV infusion of naloxone should be used for patients who are addicted to opioids. D) the duration of action of naloxone in the body is less than that of many opioid chemicals.

D) the duration of action of naloxone in the body is less than that of many opioid chemicals.

17. More often than not, the paramedic will form his or her general impression of a patient based on: A) baseline vital signs and SAMPLE history. B) a rapid, systematic head-to-toe assessment. C) conditions found in the primary assessment. D) the initial presentation and chief complaint.

D) the initial presentation and chief complaint.

64. When selecting the most appropriate IV catheter, you should routinely consider all of the following, EXCEPT: A) the age of the patient. B) the purpose of the IV. C) the location of the IV. D) the patient's gender.

D) the patient's gender.

240. The MOST significant disadvantage associated with needle cricothyrotomy is: A) air leakage around the insertion site. B) the inability to exhale via the glottis. C) local infection due to poor technique. D) the potential for pulmonary aspiration.

D) the potential for pulmonary aspiration.

166. Rigorous tube confirmation protocol must be followed after performing digital intubation because: A) inadvertent extubation of the patient is very common. B) capnography is unreliable in digitally intubated patients. C) ET tubes that are placed digitally do not have a pilot balloon. D) the procedure of digital intubation is truly a blind technique.

D) the procedure of digital intubation is truly a blind technique.

10. Anatomically, the ________ is directly anterior to the glottic opening. A) thyroid gland B) vallecular space C) cricoid cartilage D) thyroid cartilage

D) thyroid cartilage

244. A surgical opening into the trachea is called a: A) stoma. B) laryngectomy. C) laryngectomee. D) tracheostomy.

D) tracheostomy.

89. A bruit indicates _________ blood flow and is MOST significant in the _________ arteries. A) turbulent, femoral B) laminar, carotid C) laminar, brachial D) turbulent, carotid

D) turbulent, carotid

68. A patient who does not respond to verbal or tactile stimuli is: A) lethargic. B) semiconscious. C) disoriented. D) unresponsive.

D) unresponsive.

139. Vasopressin is given for its physiologic effects of: A) increased inotropy. B) bronchodilation. C) decreased chronotropy. c

D) vasoconstriction.

69. Flushed skin is commonly seen as a result of all the following, EXCEPT: A) fever. B) heat exposure. C) superficial burns. D) vasoconstriction.

D) vasoconstriction.

83. All of the following are adventitious breath sounds, EXCEPT: A) rales. B) rhonchi. C) wheezes. D) vesicular sounds.

D) vesicular sounds.

9. The Comprehensive Drug Abuse Prevention and Control Act of 1970: A) regulated the import, manufacture, prescription, and sale of several nonnarcotic medications and cocaine, opium, and their derivatives. B) was aimed at protecting the public from mislabeled, poisonous, or otherwise harmful food, medications, and alcoholic beverages. C) increased the penalties for violation of the Harrison Narcotic Act, made the possession of heroin illegal, and outlawed the acquisition and transportation of marijuana. D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.