Chapter 17

When assessing for arm drift of a patient with a suspected stroke, you should: observe movement of the arms for approximately 2 minutes. expect to see one arm slowly drift down to the patient's side. ask the patient to hold his or her arms up with the palms down. ask the patient to close his or her eyes during the assessment.

ask the patient to close his or her eyes during the assessment

Interruption of cerebral blood flow may result from all of the following, EXCEPT: cerebral vasodilation. an acute arterial rupture. a thrombus. an embolism.

cerebral vasodilation

An absence seizure is also referred to as a: generalized motor seizure. grand mal seizure. petit mal seizure. total body seizure.

petit mal seizure

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of: 9 7 8 6

8

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score? A. 9 B. 8 C. 11 D. 12

9

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? A 35-year-old female in the later stages of AIDS An 88-year-old male with chronic renal problems A 17-year-old male with anxiety A 3-month-old female who was born prematurely

a 17-year-old male with anxiety

An acute ischemic stroke is caused by: A. a ruptured cerebral artery. B. increased intracranial pressure. C. an acute rise in a person's blood pressure. D. a blocked cerebral artery.

a blocked cerebral artery

You are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. His blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. His wife tells you that he has hypertension and diabetes. He has MOST likely experienced: acute hypoglycemia. a complex partial seizure. an occluded cerebral artery. a ruptured cerebral artery.

a ruptured cerebral artery

When caring for a patient with documented hypoglycemia, you should be MOST alert for: an acute stroke. a febrile convulsion. respiratory distress. a seizure.

a seizure

A transient ischemic attack (TIA) occurs when: medications are given to dissolve a cerebral blood clot. signs and symptoms resolve spontaneously within 48 hours. a small cerebral artery ruptures and causes minimal damage. a small clot in a cerebral artery causes temporary symptoms.

a small clot in a cerebral artery causes temporary symptoms

Febrile seizures: are usually benign but should be evaluated. often result in permanent brain damage. occur when a child's fever rises slowly. are also referred to as absence seizures.

are usually benign but should be evaluated

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His airway is patent and his breathing is adequate. His wife is present and is very upset. Which of the following has the MOST immediately priority? Administering glucose to rule out hypoglycemia Documenting all of his current medications Obtaining a complete set of baseline vital signs Asking his wife when she noticed the symptoms

asking his wife when she noticed the symptoms

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the: A. brain stem. B. hypothalamus. C. cerebrum. D. cerebellum.

brain stem

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as: A. aphasia. B. dysphasia. C. dysphagia. D. dysarthria.

dysarthria

The anterior aspect of the cerebrum controls: vision. movement. emotion. touch.

emotion

During the primary assessment of a semiconscious 70-year-old female, you should: ask family members if the patient has a history of stroke. ensure a patent airway and support ventilation as needed. insert a nasopharyngeal airway and assist ventilations. immediately determine the patient's blood glucose level.

ensure a patent airway and support ventilation as needed

Which of the following are components of the Cincinnati Prehospital Stroke Scale? A. Arm drift, blood pressure, speech B. Speech, pupil response, arm drift C. Facial symmetry, speech, arm drift D. Pupil response, facial droop, speec

facial symmetry, speech, arm drift

A type of seizure that is characterized by severe twitching of all the body's muscles and lasts for several minutes or longer is called a(n): A. partial seizure. B. absence seizure. C. tonic-clonic seizure. D. generalized seizure.

generalized seizure

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n): A. hemorrhagic stroke. B. acute ischemic stroke. C. severe migraine headache. D. transient ischemic attack.

hemorrhagic stroke

The MOST significant risk factor for a hemorrhagic stroke is: hypertension. severe stress. diabetes mellitus. heavy exertion.

hypertension

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: kidneys. pancreas. brain. liver.

liver

The MOST important reason for promptly transporting a stroke patient to the hospital is: A. a transient ischemic attack can be ruled out. B. medications may be given to reverse the stroke. C. the clot in the coronary artery may be dissolved. D. he or she needs close blood pressure monitoring.

medications may be given to reverse the stroke

You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should: give her small cups of water to drink and observe for further seizure activity. monitor her airway and breathing status and assess her blood glucose level. administer one tube of oral glucose and prepare for immediate transport. place her in the recovery position and transport her with lights and siren.

monitor her airway and breathing status and assess her blood glucose level

You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes topiramate (Topamax). When obtaining further medical history from the girlfriend, it is MOST important to: determine when he was last seen by his physician. determine if the patient is a known alcohol abuser. ask her how long the patient has been taking his medication. obtain a description of how the seizure developed.

obtain a description of how the seizure developed

When transporting a stable stroke patient with a paralyzed extremity, place the patient in a: recumbent position with the paralyzed side down. supine position with the legs elevated 6″ to 12″. sitting position with the head at a 45° to 90° angle. recumbent position with the paralyzed side up.

recumbent position with the paralyzed side down

You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should: repeat the arm drift test, but move the patient's arms into position yourself. defer this part of the test and assess her for facial droop and slurred speech. repeat the arm drift test and ensure that her palms are facing downward. instruct the patient to keep her eyes open and then repeat the arm drift test.

repeat the arm drift test, but move the patients arms into position yourself

Which of the following conditions would MOST likely affect the entire brain? Reduced blood supply to the left hemisphere Respiratory failure or cardiopulmonary arrest Ruptured cerebral artery in the occipital lobe Blocked cerebral artery in the frontal lobe

respiratory failure or cardiopulmonary

Unlike an ischemic stroke, a transient ischemic attack is characterized by all of the following, EXCEPT: A. symptoms that resolve within 24 hours. B. symptoms that persist for longer than 24 hours. C. weakness or paralysis to one side of the body. D. an acute onset of confusion and slurred speech.

symptoms that persist for longer than 24 hours

Successful treatment of a stroke depends on whether: medications are given to restore the function of infarcted cells. thrombolytic therapy is given within 3 hours of symptoms beginning. surgical intervention is performed to remove obstructive clots. the stroke occurs within the left or right hemisphere of the brain.

thrombolytic therapy is given within 3 hours of symptoms beginning

A patient who is experiencing aphasia is: unable to produce or understand speech. usually conscious but has slurred speech. not able to swallow without choking. experiencing a right hemispheric stroke.

unable to produce or understand speech

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia: usually have an altered mental status or decreased level of consciousness. always take oral medications to maintain normal blood glucose levels. do not present with slurred speech or weakness to one side of the body. are typically alert and attempt to communicate with health care providers.

usually have an altered mental status or decreased level of consciousness

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: the patient's overall medication compliance. if there is a family history of a stroke. if the patient has been hospitalized before. when the patient last appeared normal.

when the patient last appeared normal

If a patient complains of a severe migraine, how should she be transported? A. In a brightly lit ambulance so she can see while her vision is impaired B. With loud sirens so she can get to the hospital as soon as possible C. Without lights and sirens D. This patient should not be transported.

without lights and sirens

Muscle control and body coordination are controlled by the: cerebellum. cerebral cortex. brain stem. cerebrum.

cerebellum

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? Hypoglycemia A postictal state Intracranial bleeding Hypovolemia

hypovolemia

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport? He has experienced seizures since he was 20 His Glasgow Coma Scale (GCS) score is 15 He is currently not prescribed any medications His wife states that this was his "usual" seizure

he is currently not prescribed any medications

Which of the following conditions is NOT a common cause of seizures? Hypotension Acute hypoglycemia Acute alcohol withdrawal Poisoning or overdose

hypotension

Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache? Slow onset of symptoms Sinus congestion History of migraines Neck stiffness or pain

neck stiffness or pain

A patient with an altered mental status is: typically alert but is confused as to preceding events. not thinking clearly or is incapable of being aroused. completely unresponsive to all forms of stimuli. usually able to be aroused with a painful stimulus.

not thinking clearly or is incapable of being aroused

Status epilepticus is characterized by: prolonged seizures without a return of consciousness. generalized seizures that last less than 5 minutes. profound tachycardia and total muscle flaccidity. an absence seizure that is not preceded by an aura.

prolonged seizures without a return of consciousness

A generalized (tonic-clonic) seizure is characterized by: severe twitching of all the body's muscles. unconsciousness for greater than 30 minutes. a blank stare and brief lapse of consciousness. a core body temperature of greater than 103°F (40°C).

severe twitching of all the body's muscles