CH.45 Patients w/Special Challenges

4. Which of the following types of maltreatment is perhaps the MOST common? A) Neglect B) Physical abuse C) Sexual abuse D) Abandonment

A) Neglect

40. Which of the following vascular access devices is "tunneled" under the skin and placed into the superior vena cava? A) Midline catheter B) Broviac catheter C) Dialysis catheter D) Double lumen catheter

B) Broviac catheter

23. Which of the following factors complicates airway management in an obese patient? A) Larger upper airway B) Limited neck mobility C) Smaller patient head size D) Proportionately small tongue

B) Limited neck mobility

59. Hydrocephalus may occur if: A) too much cerebrospinal fluid is forced into the spinal canal. B) cerebrospinal fluid absorption into the bloodstream is reduced. C) bleeding in the brain causes an increase in intracranial pressure. D) the brain produces less than 500 mL of cerebrospinal fluid per day.

B) cerebrospinal fluid absorption into the bloodstream is reduced.

27. The inner cannula of a tracheostomy tube: A) should be equipped with a cuff if used in pediatric patients. B) has a 15-mm port that can be attached to a ventilator circuit. C) is the larger tube that passes directly into the patient's trachea. D) should only be removed during tracheostomy tube replacement.

B) has a 15-mm port that can be attached to a ventilator circuit.

5. Which of the following types of maltreatment involves isolating the victim from others, resulting in a substantial change in the victim's behavior or cognitive function? A) Neglect B) Abandonment C) Emotional abuse D) Sexual exploitation

C) Emotional abuse

55. Which of the following statements regarding peritoneal dialysis is correct? A) A patient undergoing peritoneal dialysis will have an AV shunt. B) Peritoneal dialysis can only be performed in a hospital setting. C) In peritoneal dialysis, fluid is instilled into the abdominal cavity. D) Peritoneal dialysis involves filtering the blood through a machine.

C) In peritoneal dialysis, fluid is instilled into the abdominal cavity.

21. Morbid obesity is defined as a body mass index that is: A) greater than 30 kg/m2. B) between 30 and 39.9 kg/m2. C) between 40 and 49.9 kg/m2. D) greater than 50 kg/m2.

C) between 40 and 49.9 kg/m2.

81. Rheumatoid arthritis: A) is more common in the elderly. B) does not respond to analgesia. C) can affect other body systems. D) occurs secondary to an infection.

C) can affect other body systems.

26. Adult patients who have a tracheostomy tube in place and are ventilator-dependent should receive: A) cool, dry air through the ventilator circuit. B) deep tracheal suctioning every other day. C) humidification and heating of inspired air. D) ventilation at a rate of 20 to 24 breaths/min.

C) humidification and heating of inspired air.

60. The outflow catheter of a cerebrospinal fluid shunt is MOST commonly placed into the patient's: A) right atrium. B) pulmonary cavity. C) peritoneal cavity. D) left ventricle.

C) peritoneal cavity.

46. Following removal of an ostomy device and cleansing the stoma, you should: A) apply the new device over the stoma. B) flush the inside of the stoma with saline. C) place a clean gauze pad over the stoma. D) cover the stoma with the provided wafer

C) place a clean gauze pad over the stoma.

48. What should you do prior to inserting an indwelling urinary catheter if a home health care patient has sensation in the penile area? A) Inject 10 mL of lidocaine into the urethra. B) Administer a mild sedative prior to catheterization. C) Minimize any pain by allowing the patient to sit up. D) Coat the end of the catheter with an anesthetic gel.

D) Coat the end of the catheter with an anesthetic gel.

80. During your assessment of a patient with paraplegia, you touch the patient's leg and he screams in pain. This is an example of: A) parasthesias. B) hypoplasia. C) hyperplasia. D) hyperasthesia.

D) hyperasthesia.

34. You are assessing a patient and discover that he has a ventricular assist device because of severe left heart failure. In this case, the device is MOST likely connected to the: A) left atrium. B) right atrium. C) right ventricle. D) left ventricle.

D) left ventricle.

79. Which of the following statements regarding paralysis is correct? A) A paralyzed patient has lost the ability to voluntarily move a body part. B) Paralysis always entails the loss of both sensory and motor functions. C) Injuries to the thoracic or lumbar spine generally result in quadriplegia. D) Most patients who are paralyzed have normal sensation or hyperesthesia.

A) A paralyzed patient has lost the ability to voluntarily move a body part.

41. Which of the following is a proper technique when accessing an implantable venous access device? A) Aspirate 5 mL of blood and then block the flow in the line with the crimping device. B) Stabilize the implantable device and insert the needle at a 45-degree angle to the skin. C) Flush the device with 20 mL of normal saline as soon as you are able to aspirate blood. D) Remove the syringe from the needle and then block the flow in the line with the crimping device.

A) Aspirate 5 mL of blood and then block the flow in the line with the crimping device.

22. Which of the following would be considered a primary cause of obesity? A) Lack of exercise B) Hormonal changes C) Genetic predisposition D) Low basal metabolic rate

A) Lack of exercise

29. Which of the following interventions is especially important when caring for a patient with a tracheostomy tube? A) Suctioning B) Mask ventilation C) Hyperventilation D) Head positioning

A) Suctioning

10. Which of the following statements regarding Mongolian spots is correct? A) They resemble bruises and are found most commonly on the back and buttocks. B) They are abnormal bruising patterns on the back and are an indicator of abuse. C) They indicate abnormal bleeding and are associated with a high mortality rate. D) They are bruiselike patterns that most often appear in severely premature infants.

A) They resemble bruises and are found most commonly on the back and buttocks.

86. Multiple sclerosis is: A) a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord. B) most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons. C) a progressive disease in 90% of patients who have it, and is characterized by unrelenting pain, weakness, and visual impairment. D) chronic in most cases, and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density.

A) a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.

67. Characteristic physical features of Down syndrome include: A) a protruding tongue. B) an excessively long neck. C) bulging of the nose and face. D) downward slanting eyes.

A) a protruding tongue.

58. You respond to a dialysis center for a patient with shortness of breath. When you arrive, you find the patient, an older male, still receiving dialysis. He is conscious and alert and is experiencing mild respiratory distress. As your partner administers oxygen, you should: A) ask the dialysis technician how long the patient has been on the dialysis machine. B) start an IV in the arm opposite the AV shunt and set the flow rate to 25 mL/hr. C) instruct the dialysis technician to remove the patient from the dialysis machine. D) administer a beta-2 agonist medication and contact medical control for guidance.

A) ask the dialysis technician how long the patient has been on the dialysis machine.

90. When assessing a patient who is disabled from a previous brain injury, you should: A) ask the patient's family what is normal for him or her. B) be prepared to hyperventilate the patient if apnea occurs. C) consider asymmetric pupils to be the result of the past injury. D) recall that most disabled patients are unable to communicate with you.

A) ask the patient's family what is normal for him or her.

74. When troubleshooting a hearing aid that is not working, you should: A) avoid attempting to clean the device. B) soak the device in hydrogen peroxide. C) ensure the device is set to telephone mode. D) carefully clean the device with an alcohol prep.

A) avoid attempting to clean the device.

11. You are assessing a 6-year-old Asian child who presents with a fever. During your assessment, you note red, flat, rounded lesions on the child's torso. This finding is MOST indicative of: A) cupping. B) coining. C) physical abuse. D) phytophotodermatitis.

A) cupping.

72. Sensorineural hearing loss is caused by: A) decreased sound uptake through tiny hairs within the cochlea. B) an inability of sound to travel from the outer ear to the inner ear. C) destruction of the acoustic nerve from the use of certain drugs. D) failure of the brainstem to transmit messages via the acoustic nerve.

A) decreased sound uptake through tiny hairs within the cochlea.

31. Upon arriving at the residence of a 27-year-old man who has a tracheostomy tube and is being mechanically ventilated, you note that he is breathing shallowly, is cyanotic, and is diaphoretic. You should: A) disconnect the patient from the mechanical ventilator and begin bag-mask ventilations. B) immediately check the settings on the mechanical ventilator to ensure that it is working properly. C) remove the ventilator tubing from the tracheostomy tube and suction the tube for 10 to 15 seconds. D) assess his oxygen saturation level and auscultate his breath sounds to determine if he is moving adequate air.

A) disconnect the patient from the mechanical ventilator and begin bag-mask ventilations.

16. A terminal illness is MOST accurately defined as a(n): A) disease process that is expected to cause death within 6 months, verified by a physician. B) disease that will ultimately cause death due to a lack of effective medical treatment. C) disease that is fatal in greater than 50% of a given population, even with timely treatment. D) disease process that will ultimately require ongoing treatment in order to prevent death.

A) disease process that is expected to cause death within 6 months, verified by a physician.

52. When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a female, you should: A) insert the catheter another 1 to 3 inches. B) pull back on the catheter about 2 inches. C) carefully secure the catheter to the leg. D) inflate the balloon with the prefilled syringe.

A) insert the catheter another 1 to 3 inches.

30. When suctioning and cleaning the tracheostomy of a ventilator-dependent patient, it is MOST important to: A) keep the patient well oxygenated. B) have a new tube readily available. C) suction for no longer than 5 seconds. D) soak the inner cannula in sterile water.

A) keep the patient well oxygenated.

38. Unlike a midline venous catheter, a peripherally inserted central catheter can be used for: A) long-term drug therapy. B) the delivery of antibiotics. C) chemotherapy in cancer patients. D) narcotic analgesia administration.

A) long-term drug therapy.

83. Cerebral palsy is a: A) nonprogressive, bilateral neuromuscular disorder in which voluntary muscles are poorly controlled. B) degenerative, unilateral neuromuscular disorder in which control of autonomic functions is impaired. C) chronic dysfunction of the endocrine system that primarily targets the respiratory and digestive systems. D) progressive weakening of the body's voluntary muscles that leaves the patient confined to a wheelchair.

A) nonprogressive, bilateral neuromuscular disorder in which voluntary muscles are poorly controlled.

45. The purpose of the wafer that is included in an ostomy kit is to: A) protect the skin from irritation. B) seal the ostomy bag to the skin. C) maintain sterility of the ostomy bag. D) cover the stoma until the bag is attached.

A) protect the skin from irritation.

63. You are performing an interfacility transfer of a patient who received a cardiac catheterization and has a sheath in his femoral artery. During transport, it is important that the patient: A) remain in a supine position with his legs straight. B) be placed onto his left side with his head elevated. C) receive IV fluid boluses to keep the sheath patent. D) remain in a sitting position to prevent an embolism.

A) remain in a supine position with his legs straight.

33. Phrenic nerve stimulators function by: A) sending electrical impulses to the diaphragm, causing it to contract and passively relax. B) keeping the upper airway patent in patients who experience frequent occurrences of sleep apnea. C) sending electrical impulses to the respiratory centers in the brain that stimulate inhalation. D) sending electrical impulses to the intercostal muscles, causing them to contract and expand the thorax.

A) sending electrical impulses to the diaphragm, causing it to contract and passively relax.

24. Bag-mask ventilation of the obese patient would MOST likely be ineffective when the patient is: A) supine. B) apneic. C) semisitting. D) in reverse Trendelenburg.

A) supine.

78. Dysarthria is: A) the inability to make speech sounds correctly. B) a speech disorder that primarily affects adults. C) the loss of ability to communicate in speech or writing. D) caused by damage to the language center of the brain.

A) the inability to make speech sounds correctly.

15. Which of the following statements would be appropriate when documenting a case of suspected abuse? A) "The patient's injury is not consistent with an accident." B) "The injury was reported to have occurred at 1420 hours." C) "The abdominal exam of the patient was within normal limits." D) "There was a gross discrepancy between the caregivers' stories."

B) "The injury was reported to have occurred at 1420 hours."

85. What is the pathophysiology of cystic fibrosis? A) Acquisition of a virus or bacterium that takes residence inside the parenchyma of the lungs, resulting in the production of thin but copious secretions B) A defective gene that makes it difficult for chloride to move through the cells, which causes unusually high sodium loss and abnormally thick mucus secretions C) An underproduction of pulmonary surfactant, which causes chronic respiratory distress, thick pulmonary secretions, and severe intrapulmonary shunting D) Delayed lung growth and development that is typically caused by a variety of congenital cardiovascular defects, most notably a ventriculoseptal defect

B) A defective gene that makes it difficult for chloride to move through the cells, which causes unusually high sodium loss and abnormally thick mucus secretions

68. Which of the following statements regarding patients with emotional or mental impairment is correct? A) Repeating the patient's statements often causes him or her to become agitated. B) A person's mental status can influence his or her physical well-being, and vice versa. C) Most patients with a mental impairment must be spoken to in a firm, direct tone of voice. D) Agitated speech is common in this patient population and generally does not suggest a potential for violence.

B) A person's mental status can influence his or her physical well-being, and vice versa.

8. Which of the following injury patterns is MOST suggestive of child abuse? A) Burns with splash marks B) Bruises on the abdomen C) Bruises on the lower leg D) Laceration to the chin

B) Bruises on the abdomen

3. Which of the following patient populations is at GREATEST risk for abuse or neglect? A) Females between 6 and 12 years of age B) Children with chronic medical conditions C) Adolescents who rebel against their parents D) Males between 2 and 14 years of age

B) Children with chronic medical conditions

70. Which of the following statements regarding autism is correct? A) The vast majority of patients with autism are mute and have an IQ of less than 20. B) Some patients with autism are able to easily solve complex mathematical problems. C) Common causes of autism include traumatic brain injury and severe emotional trauma. D) You should expect that a patient with autism will respond favorably to physical contact.

B) Some patients with autism are able to easily solve complex mathematical problems.

61. Which of the following clinical presentations is MOST consistent with a malfunctioning cerebrospinal fluid shunt? A) Tachycardia, tinnitus, and a narrowing pulse pressure B) Visual disturbances, headache, and altered mental status C) Hypotension, sudden loss of hearing, and severe nausea D) Tachypnea, fluid drainage from the ears, and restlessness

B) Visual disturbances, headache, and altered mental status

77. A patient presents with a sudden onset of unilateral eye pain and blurred vision. You should suspect: A) acute optic nerve hypoplasia. B) acute angle-closure glaucoma. C) central retinal arterial occlusion. D) spontaneous retinal detachment.

B) acute angle-closure glaucoma.

91. You are caring for an elderly woman with terminal sarcoma. She is conscious, extremely weak, and in severe pain. Her son tells you that she has a living will and an out-of-hospital do not resuscitate order, and produces the appropriate documentation. The patient is on home oxygen at 2 L/min via nasal cannula. You should: A) recognize that the patient's death is imminent and remain at the scene to provide any needed emotional support. B) administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son. C) apply high-flow oxygen via nonrebreathing mask, establish vascular access, and transport her to the hospital. D) leave the patient on her nasal oxygen, keep her warm, and transport her safely to the hospital for further palliative care.

B) administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son.

14. Your assessment of an elderly man gives you reason to suspect that he has been abused. The patient does not appear to have any life-threatening injuries. His son, who is the only family member present at the scene, asks you if he can accompany his father in the back of the ambulance during transport. You should: A) ask the son why he wants to accompany his father in the ambulance. B) allow the son to accompany his father in the back of the ambulance. C) advise the son to follow the ambulance in his own personal vehicle. D) remain at the scene until law enforcement arrives and questions the son.

B) allow the son to accompany his father in the back of the ambulance.

53. The fistula used for hemodialysis is a surgical connection between: A) two large veins. B) an artery and a vein. C) two large arteries. D) a vein and the peritoneum.

B) an artery and a vein.

82. While transporting a cancer patient who is receiving chemotherapy, you should recall that: A) it is likely that the patient's condition is terminal. B) chemotherapy weakens a patient's immune system. C) prophylactic antiemetic medications are often needed. D) chemotherapy is only used to treat metastatic cancer.

B) chemotherapy weakens a patient's immune system.

17. Some patients with a terminal illness will continue aggressive medical treatment, hoping for a statistically improbable recovery or attempting to prolong life as much as possible. This is called: A) hospice care. B) curative care. C) palliative care. D) investigational care.

B) curative care.

32. Several attempts to clear a plugged tracheostomy tube with suction have failed. The patient, who is on a mechanical ventilator, has a pulse rate of 150 beats/min and is making exaggerated attempts to breathe. You should: A) remove the tracheostomy tube, place a mask over the stoma, and ventilate with a bag-mask device. B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device. C) administer high-flow oxygen via nonrebreathing mask as you prepare to replace the tracheostomy tube. D) provide free-flow oxygen as you remove the tracheostomy tube and replace it with a similarly sized endotracheal tube.

B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.

1. When determining the optimal method to communicate with, assess, treat, and transport a patient with a special health care challenge, the paramedic should: A) routinely call medical control before talking to a caregiver. B) demonstrate confidence and enlist the expertise of the patient. C) recall that caregivers are often upset and therefore unreliable. D) remain professional and obtain initial information from a caregiver.

B) demonstrate confidence and enlist the expertise of the patient.

50. Unlike the insertion of an indwelling urinary catheter, insertion of an intermittent (straight) urinary catheter: A) is necessary when the patient is bedridden for prolonged periods. B) does not involve inflation of a balloon to hold the catheter in place. C) is associated with a greater risk for damage to the urinary sphincter. D) generally does not require catheter lubrication with a water-soluble gel.

B) does not involve inflation of a balloon to hold the catheter in place.

65. The transducer or drainage system of an intracranial pressure monitor is typically aligned at the same height as the patient's: A) forehead. B) ear canal. C) eyebrow. D) temporal bone.

B) ear canal.

75. By placing one hand on your forehead and your other hand over your abdomen, you are asking a hearing-impaired person if he or she: A) is hurt. B) feels sick. C) needs help. D) is in pain.

B) feels sick.

51. The female urinary meatus is located: A) superior to the clitoris. B) just above the vaginal opening. C) inferior to the vaginal opening. D) between the vagina and perineum.

B) just above the vaginal opening.

20. The purpose of hospice care is to: A) render quality care to patients with a debilitating but temporary disease. B) provide quality end-of-life care through pain and symptom management. C) restore a person to his or her maximum physical and emotional potential. D) render around-the-clock intensive care to prevent cardiopulmonary arrest.

B) provide quality end-of-life care through pain and symptom management.

9. Difficulty walking or sitting, nightmares, and bedwetting are MOST suggestive of: A) neglect. B) sexual abuse. C) physical abuse. D) emotional abuse.

B) sexual abuse.

88. Spina bifida occurs when: A) hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord. B) the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed. C) trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. D) growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.

B) the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

36. You respond to a residence where an infant's apnea monitor has alarmed several times within the last 30 minutes. When you assess the infant, you note that she is alert, she has strong peripheral pulses, and her skin is pink, warm, and dry. You should: A) expect that her oxygen saturation will be below 90%. B) transport the infant and monitor her breathing en route. C) administer blow-by oxygen to the infant and reassess her. D) advise the parents to contact the apnea monitor manufacturer.

B) transport the infant and monitor her breathing en route.

89. Which of the following statements regarding poliomyelitis (polio) is correct? A) Any warm-blooded animal can serve as a host for the polio virus. B) Patients with nonparalytic polio usually have permanent neurologic injury. C) Polio initially presents with a headache, sore throat, fever, and vomiting D) Subclinical polio is characterized by symptoms that last less than a month.

C) Polio initially presents with a headache, sore throat, fever, and vomiting

66. Down syndrome is a condition in which: A) chromosome 23 fails to separate. B) the ovum contains 21 chromosomes. C) a triplication of chromosome 21 occurs. D) the human somatic cell contains 24 chromosomes.

C) a triplication of chromosome 21 occurs.

6. A man leaves his 4-year-old child home alone while he plays golf with his friends. This is an example of: A) assault. B) neglect. C) abandonment. D) emotional abuse.

C) abandonment.

28. A fenestrated tracheostomy tube: A) should be used for patients who require constant support from a ventilator. B) is not equipped with an inflatable cuff and is secured in place with sutures. C) allows the patient to speak, breathe, or clear secretions from the upper airway. D) requires a special adapter in order to be compatible with a ventilation device.

C) allows the patient to speak, breathe, or clear secretions from the upper airway.

12. During your assessment of a 4-year-old female, you find injury patterns that are highly suggestive of abuse. The child's mother is present; she is apprehensive and is hesitant to allow you to transport her daughter. Your MOST appropriate action should be to: A) ask the mother to leave the room so that you can ask the girl if the injuries that she has were intentionally inflicted by someone else. B) advise the mother that the child's injuries are inconsistent with accidental trauma and let her know that the child needs to be transported. C) ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police. D) act as though you are not suspicious, but call the child's father and inquire about the relationship between the child and her mother.

C) ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police.

56. When treating a dialysis patient, it is especially important to: A) keep the patient in a supine position. B) elevate the arm with the AV fistula. C) carefully titrate any IV fluids given. D) treat acidosis with sodium bicarbonate.

C) carefully titrate any IV fluids given.

49. When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male, you should: A) connect the indwelling catheter to the urine drainage system, unclamp the tubing, and allow urine to drain. B) inflate the balloon with the prefilled syringe and gently pull back on the catheter until you feel resistance. C) continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis. D) insert the catheter approximately 1 inch farther, inflate the balloon, and then pull back on the catheter until you feel resistance.

C) continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis.

18. When a patient is receiving palliative care, medical care: A) ceases, and the disease process is allowed to continue until the point of death. B) ceases, and efforts focus on relieving pain until the point at which the patient dies. C) continues, although aggressive, invasive, and uncomfortable interventions cease. D) continues, and only minimally invasive procedures are performed to prolong life.

C) continues, although aggressive, invasive, and uncomfortable interventions cease.

71. The majority of acquired hearing loss in children and adults is the result of: A) a tumor on the acoustic nerve. B) frequent middle ear infections. C) excessive exposure to loud noise. D) long-term use of salicylates.

C) excessive exposure to loud noise.

47. Patients with a colostomy: A) require a collection bag to collect solid fecal material after a section of large intestine is surgically removed. B) have a stoma that directs the small intestine to the outside of the abdomen where a collection bag is attached. C) have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall. D) have a temporary surgical opening in the abdomen that collects waste material and allows the bowel to rest and heal.

C) have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall.

64. An intra-aortic balloon pump functions by: A) deflating a balloon during systole, which pushes blood into the central circulation. B) deflating a balloon during diastole, which creates a vacuum and decreases afterload. C) inflating a balloon during diastole, which pushes blood into the systemic circulation. D) inflating a balloon during systole, which creates a vacuum and decreases afterload.

C) inflating a balloon during diastole, which pushes blood into the systemic circulation.

35. You would MOST likely encounter the presence of a ventricular assist device in a patient who: A) has severe emphysema. B) has pulmonary hypertension. C) is awaiting a heart transplant. D) has transient right heart failure.

C) is awaiting a heart transplant.

76. A person with amblyopia has: A) difficulty visualizing object from afar. B) an area missing from his or her visual field. C) partial or complete vision loss in one eye. D) difficulty visualizing objects that are close.

C) partial or complete vision loss in one eye.

42. A 66-year-old man with severe left heart failure is receiving an inotropic medication via an infusion pump. He presents with an altered mental status, increased breathing difficulty, and hypotension. You should: A) administer oxygen and discontinue the medication infusion by turning the pump off. B) assist his breathing, slowly increase the dose of his inotropic medication, and transport. C) support his breathing, continue his medication infusion, and contact medical control. D) administer oxygen, discontinue the medication infusion, and establish a peripheral IV.

C) support his breathing, continue his medication infusion, and contact medical control.

37. A patient with a long-term vascular access device is in cardiac arrest and requires epinephrine. In order to remove any heparin from the device, the paramedic should: A) follow the epinephrine with a 10-mL saline flush. B) briskly flush the device with 20 mL of saline. C) withdraw up to 10 mL of blood and discard it. D) slowly inject 3 to 5 mL of sodium bicarbonate.

C) withdraw up to 10 mL of blood and discard it.

7. Which of the following behaviors or actions should make you the MOST suspicious that a caregiver has abused his or her child? A) Asking other siblings to leave the room while the child is examined B) Demanding that you take the child to the hospital as soon as possible C) Difficulty recalling the last time the child was seen by a physician D) Offering unsolicited explanations for abnormal physical exam findings

D) Offering unsolicited explanations for abnormal physical exam findings

19. Which of the following are often the primary tasks for paramedics who are caring for a patient with a terminal illness? A) Airway care and thermal management B) ECG monitoring and antidysrhythmic therapy C) Antibiotic and antipyretic therapy D) Pain assessment and management

D) Pain assessment and management

57. A dialysis patient requires pharmacologically assisted intubation. Which of the following medications should be avoided? A) Midazolam B) Etomidate C) Vecuronium D) Succinylcholine

D) Succinylcholine

84. Common complications associated with cerebral palsy include all of the following, EXCEPT: A) seizures. B) visual impairment. C) mental retardation. D) cardiovascular disease.

D) cardiovascular disease.

62. The majority of current hemodynamic monitoring involves placement of different types of catheters into areas within the: A) central nervous system. B) brain and spinal cord. C) pulmonary circulation. D) cardiovascular system.

D) cardiovascular system.

73. A person is able to hear, but is unable to interpret speech when other background noises are present. This is consistent with: A) auditory neuropathy. B) conductive hearing loss. C) sensorineural hearing loss. D) central auditory processing disorder.

D) central auditory processing disorder.

54. In contrast to an AV fistula, an AV graft: A) is used for patients who are undergoing peritoneal dialysis. B) can be palpated as a pulsating bulge on an upper extremity. C) is typically found on the lower extremity of a dialysis patient. D) creates a raised area beneath the skin that resembles a large vessel.

D) creates a raised area beneath the skin that resembles a large vessel.

43. An unresponsive woman with diabetes is wearing an insulin pump. Her blood glucose level is 24 mg/dL. You should: A) give a 20-mL/kg crystalloid bolus. B) administer 0.1 mg of glucagon IM. C) give her half the usual dose of dextrose. D) ensure that the insulin pump is turned off.

D) ensure that the insulin pump is turned off.

87. Muscular dystrophy can be defined as a(n): A) autoimmune disease in which the skeletal muscles are rapidly destroyed. B) nonprogressive neuromuscular disorder caused by fetal brain hypoxia. C) birth defect caused by improper development of the fetal neural tube. D) genetic disease that causes a slow, progressive degeneration of muscle fibers.

D) genetic disease that causes a slow, progressive degeneration of muscle fibers.

69. Mental retardation is MOST accurately defined as: A) the inability to provide adequate self-care because of intense emotional abuse during childhood. B) a substandard intelligence quotient secondary to a congenital infection or complications at birth. C) a genetic condition in which the patient is unable to interact normally and acts younger than his or her peers. D) insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate.

D) insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate.

25. Assumptions by the paramedic based on stereotypes of a particular communicable disease: A) will maximize the paramedic's safety. B) are a violation of the patient's privacy. C) will expose the paramedic to legal action. D) serve only to undermine patient care efforts.

D) serve only to undermine patient care efforts.

39. Triple lumen central catheters are usually placed in the: A) external jugular vein. B) internal carotid artery. C) antecubital vein in the arm. D) subclavian or femoral vein.

D) subclavian or femoral vein.

2. Approximately 70% of all child abuse or neglect cases involve: A) females over 8 years of age. B) an otherwise healthy child. C) males under 6 years of age. D) substance abuse by the perpetrator.

D) substance abuse by the perpetrator.

13. When caring for a patient with suspected abuse or neglect, your FIRST priority should be to: A) summon law enforcement personnel to the scene. B) provide an immediate assessment of the patient. C) remove the patient from the abusive environment. D) take deliberate action to ensure your own safety.

D) take deliberate action to ensure your own safety.

44. Prior to replacing an ostomy device in a patient, it is MOST important to: A) ensure that the patient is in a comfortable position. B) wash the area around the stoma with soap and water. C) use sterile technique when opening the new ostomy kit. D) wash your hands and apply personal protective equipment.

D) wash your hands and apply personal protective equipment.