EMT Quiz 19
While treating a seizing patient, it is LEAST important for the EMT to determine:
A.* the cause of the seizure. This is the correct answer. B. if the area is free from objects that may injure the patient. C. if the patient is breathing adequately. D. if the airway is patent.
You have been called to a public bus station for a behavioral emergency. On scene you find a disheveled male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he suddenly began to stumble around, shouting obscenities, and then fell to the ground spitting and shaking. From this description, the EMT should be suspicious of what condition?
. Alcohol intoxication B. Syncopal episode C.* Generalized seizure This is the correct answer. D. Absence seizure
You have been called to an alcoholic rehabilitation center for a 56-year-old male patient whose left arm suddenly began to shake uncontrollably. He is alert and oriented, and he is terrified that he cannot stop his arm from moving. What type of seizure should you suspect?
A. Generalized B. Psychomotor C. Complex partial D.* Simple partial
Which patient would benefit the most from an ALS intercept?
. A 24-year-old female who is complaining of pain and swelling in the right wrist after a bystander attempted to restrain her during a seizure B. A 55-year-old postictal female with an SpO 2 2 of 95% on 2 lpm of oxygen C.* A 22-year-old postictal male who is lethargic with a blood glucose level of 46 mg/dL This is the correct answer. D. An 18-year-old male with a history of seizures who is lethargic but well oriented and refuses transport Since hypoglycemia may trigger a seizure, assess the blood glucose level (BGL) by using a glucose meter if protocol permits. If the blood glucose is less than 60 mg/dL, you may suspect that the seizure is due to a low blood glucose level. Contact medical direction and request an ALS backup if the patient remains unresponsive or if you are unable to administer oral glucose because of the patient's inability to maintain an airway.
You are called to a residence to assess a child. The panicked parents state that their 3-year-old son was playing with his brother when he suddenly "blanked out" and would not respond to them for several seconds. When asked, they deny any convulsing-like movement as well as a history of medical problems. Based on this description, you would be suspicious of what type of seizure?
. Grand mal B. Simple partial C. Febrile D.* Absence This is the correct answer.
Which type of seizure primarily occurs in children and is caused by a fever?
. Idiopathic B. Hypoglycemic C. Eclamptic D.* Febrile
A young male with a seizure history is postictal in his bed. His airway is patent, breathing labored and forced, and radial pulse strong and fast. Vital signs are pulse 140, respirations 20, blood pressure 158/92 mmHg, and SpO2 96% on room air. At this time, what action would be most appropriate?
. Insert an oropharyngeal airway. B. Provide high-concentration oxygen. C.* Place in a side-lying position. This is the correct answer. D. Start positive pressure ventilation.
You are dispatched to a local mall and are met by bystanders who state that the patient was talking to a customer representative and "passed out." You find an alert and oriented 55 dash -year dash -old female lying supine on the tile floor. The patient tells you that the back of her head is hurting. Which one of the following actions should you perform first?
. Open her airway with a jaw dash -thrust. B. Obtain a full set of vital signs. C. Assess the back of the patient's head for injury. D.* Take manual in dash -line spinal stabilization.
What type of seizure is most commonly found in children aged 6 months to 6 years?
. Primary seizures B. Complex partial seizures C.* Febrile seizure This is the correct answer. D. Simple partial seizures
What may a syncopal patient do after becoming supine that a seizure patient typically does NOT do?
. Suffer arrhythmias B.* Become responsive This is the correct answer. C. Experience paralysis D. Stop breathing
As you approach a female patient, she appears unresponsive with her arms and legs jerking violently. On the prehospital care report, you would document that the patient was found in what phase of a generalized seizure?
. Tonic B.* Clonic This is the correct answer. C. Absence D. Syncopal
One common neurologic sign of a postictal patient is:
. a compromised airway. B. inadequate circulation. C. inadequate breathing. D.* disorientation.
The initial part of a generalized seizure experienced by some patients is called the:
. clonic phase. B. syncopal stage. C. postictal state. D.* aura.
After a lengthy response, you arrive at the home of a 62-year-old female who is still seizing. Your immediate action would be to:
. determine the total duration of the seizure. B.* assess the patient's airway and breathing. This is the correct answer. C. move her to the ambulance for assessment and transport. D. determine if the patient has a seizure history.
Seizure patients who are in the postictal state and are displaying signs of severe hypoxia should be treated with oxygen using a:
. nonrebreather mask at 8 lpm. B. nasal cannula at 10 lpm. C.* nonrebreather mask at 15 lpm. This is the correct answer. D. nasal cannula at 4 lpm.
Status epilepticus is best differentiated from a generalized seizure by the:
. preexisting seizure history. B. presence of an aura prior to seizing. C. length of the postictal period. D.* duration of the seizure.
A person who remains unconscious for 15 minutes after a generalized seizure is said to be:
. preictal. B. in status epilepticus. C.* postictal. This is the correct answer. D. in a secondary seizure. The postictal state is the recovery phase. The patient's mental status is altered and may range from complete unresponsiveness to confusion and disorientation. The mental status progressively improves over time. The patient is exhausted and weak. A headache and temporary weakness in one side of the body (hemiparesis) may be present. The postictal phase generally lasts from 10 to 30 minutes but could last much longer. A patient who suffers generalized motor seizures that last more than 5 minutes or seizures that occur consecutively without a period of responsiveness between them is considered to be in status epilepticus. This is a dire medical emergency that requires aggressive airway management, positive pressure ventilation with supplemental oxygen, and immediate transport to a medical facility. The longer the delay in treatment, the greater is the chance that the patient will suffer permanent brain damage. Secondary or reactive seizures do not result from a genetic cause but occur as the result of an insult to the body, such as fever, infection, hypoxia, hypoglycemia, hyperglycemia, drug intoxication, drug withdrawal, eclampsia in pregnancy, degenerative brain diseases, or imbalances in the electrolytes in the body.
A postictal patient is awake but has trouble answering your questions correctly. Given this presentation, the EMT would recognize that:
. the patient has a seizure history. B.* the airway is open. This is the correct answer. C. high-concentration oxygen is indicated. D. another seizure is coming.
When treating a patient who has had a seizure, the most important aspect of providing care is to:
A.* assess for and manage any life-threatening condition found. This is the correct answer. B. provide high-concentration oxygen to ensure adequate oxygenation of the brain. C. identify the type and duration of seizure, as well as a history of seizures. D. ensure that the patient does not bite his or her tongue.
You are by the side of an alert but confused 41-year-old woman who is diaphoretic and appears exhausted. She informs you that she has a history of seizures and just had a generalized seizure. Despite your urging, she refuses transport to the hospital. Your safest action would be to:
. transport her despite her refusal to consent. B.* advise medical direction of the situation. This is the correct answer. C. recognize a seizure history and have patient sign a refusal form. D. contact law enforcement so transport is legal.
Pediatric absence seizures:
. usually progress to tonic-clonic seizures by the age of 20. B. are usually precipitated by congenital tumors. C.* do not typically require emergency care. This is the correct answer. D. are normally cause for significant concern.
When obtaining a medical history from the family of a seizure patient, what question is most important for the EMT to ask first?
. "How long has he had his seizure condition?" B. "Was he grunting and breathing hard during the seizure?" C.* "Does he take his seizure medications as prescribed?" This is the correct answer. D. "Why do you think that his tongue is bleeding?"
Which patient statement reinforces your suspicion of syncope?
. "I have had a low-grade fever for the past three days." B.* "Once I hit the floor, I was only out for a few seconds." This is the correct answer. C. "I think that I may have had a seizure." D. "I was lying on the bed when I passed out."
Which statement, made by a patient who experienced a syncopal episode, should MOST concern the EMT?
. "The doctor told me to get out of bed slowly, but I didn't." B. "I seemed to get very warm just before passing out." C. "I remember feeling faint right before I passed out." D.* "My chest felt funny right before I passed out."
You have been called for a 47-year-old female who has "passed out." As you enter the patient's apartment, you find her supine on the living room floor with a cool wash cloth on her forehead. She states that she was standing and talking on the telephone when everything went dark. When she came to, she was on the floor. What should be your first action?
.* Assess and obtain vital signs while she is supine. This is the correct answer. B. Move her to the ambulance for immediate transport. C. Immediately sit her upright. D. Insert a nasopharyngeal airway.
When performing the secondary assessment on a confused patient, which one of the following signs would be most suggestive of a seizure?
.* Bleeding tongue This is the correct answer. B. Bruises to the arms C. Warm skin D. Pinpoint pupils
A 72-year-old male with a history of depressed thyroid function and a brain tumor is suffering a psychomotor seizure. As you enter the room, you find him to be standing up and walking in a circle. He is awake but does not respond to your questions. Family members state that he has had three similar episodes over the past six months, which his physician diagnosed as complex partial seizures. Vital signs are pulse 112, respirations 16, blood pressure 166/68, and SpO2 at 98%. Which one of the following actions would be most appropriate in the care of this patient?
.* Proceed with a nonemergency transport. This is the correct answer. B. Insert a nasopharyngeal airway to ensure airway patency. C. Restrain the patient and apply high-concentration oxygen. D. Determine if a durable power of attorney exits
Which statement related to the pathophysiology of seizures is CORRECT?
.* "A seizure occurs when there is a massive and uncoordinated electrical discharge in the brain." This is the correct answer. B. "All seizures are caused by epilepsy, which describes a problem somewhere in the body." C. "A seizure condition describes a muscle problem that causes the arms and legs to jerk." D. "A seizure occurs when the heart beats irregularly, causing a decreased amount of oxygen minus −rich blood to reach the brain."
Which statement about seizures is TRUE?
.* "Seizures may be caused by a variety of medical conditions." This is the correct answer. B. "If the cause of a seizure is unknown, it is classified as status epilepticus." C. "Patients who have seizures are at increased risk for stroke." D. "All seizures are caused by some form of brain injury."
A patient who suffered an apparent syncopal episode refuses transport to the hospital. Prior to the patient signing a refusal, you should make which one of the following statements?
.* "Syncope indicates a serious underlying condition, so please follow up with a doctor." This is the correct answer. B. "People who experience a syncopal episode are not allowed to drive unless they go on medication." C. "Syncope is not dangerous and affects almost everyone, but it is still important to follow up with your doctor." D. "The most common cause of syncope is diabetes, so follow up with your doctor."
You are to transport a 46-year-old male who has had multiple seizures throughout the morning. Currently, he is on your stretcher and is postictal. He has a history of seizures for which he takes anticonvulsant medications. He also suffers from diabetes and kidney failure. Of the equipment listed below, which one is most essential to have ready during transport of this patient?
A. Oral glucose B.** Suction device This is the correct answer. C. Automated external defibrillator D. Padded tongue blade
It is important that the EMT recognize that a complex partial (psychomotor) seizure can easily be mistaken for a(n):
A.* alcohol intoxication. This is the correct answer. B. asthma exacerbation. C. left-sided stroke. D. absence (petit mal) seizure.
An EMT would recognize a focal motor seizure when he observes:
A.* jerky muscular activity of a single extremity. This is the correct answer. B. abrupt personality changes including fits of rage. C. repetitive actions like lip smacking or finger rolling. D. blank staring which begins and ends abruptly
While placing a 52-year-old female on the stretcher, she begins to seize. Your immediate action would be to:
A.* loosely apply the straps and raise the side rails. This is the correct answer. B. perform a jaw-thrust maneuver and insert an oropharyngeal airway. C. remove her from the stretcher and place her on the ground. D. quickly move her to the ambulance for rapid transport.
What is the BEST explanation of why a patient who experiences a syncopal episode regains consciousness after falling?
A. *** The supine position allows more blood to perfuse the brain. This is the correct answer. B. The act of falling causes the heart rate to decrease. C. The trauma of falling causes the blood glucose level to increase. D. The seizure stops once the patient is supine.
You arrive on the scene of a 24-year-old male seizure patient and find his wife performing CPR. What should your first action be?
A. Apply oxygen. B. Apply the AED. C. Take over providing compressions. D.* Verify the pulse. Because seizure activity may mimic a heart attack and can result in short periods of apnea, you may find a bystander performing CPR on the patient on your arrival. Quickly verify a pulse first, and immediately stop any unnecessary care. Some cardiac arrests are preceded by seizure activity because of a lack of oxygen and blood to the brain. You should proceed with CPR, application of the automated external defibrillator (AED), and emergency care for cardiac arrest if no pulse is found.
Which patient medication is most consistent with a history of seizures?
A. Celexa B.* Depakote This is the correct answer. C. Xopenex D. Prozac
Which statement about seizures is true?
A. Complex partial seizures involve both cerebral hemispheres. B. Generalized seizures last longer than partial seizures. C. The cause of most seizures is easily identified. D.* Simple partial seizures do not cause an alteration in mental status.
A 20-year-old patient is unresponsive with snoring respirations. She is in a public restroom with no family or friends with her. After addressing the airway, breathing, and circulation, you begin the secondary assessment. Which one of the following signs best indicates the patient experienced a seizure?
A. Constricted pupils B.* Urinary incontinence This is the correct answer. C. Snoring respirations D. Altered mental status
An 86-year-old male has had a sudden change in mental status and is repeatedly striking a fist against his leg. When you question him, he does not respond. This presentation is most consistent with what condition?
A. Dementia B. Stroke C. Delirium D.* Seizure
What question would be most appropriate to ask the parent of a 4-year-old child who had a generalized seizure but no history of previous seizures?
A. Does the child have a history of a brain tumor? B.* Did the child have a fever? This is the correct answer. C. Did the child take his seizure medication? D. Does the child have a history of heart disease? Febrile seizures, caused by high fever, are most common in children between 6 months and 6 years of age. About 5 percent of children who have a fever will develop febrile seizures. These secondary or reactive generalized seizures are often very short and may not require emergency care; however, always assume that the seizures are serious. The diagnosis cannot be made without a medical evaluation. Lacking a history of seizures, the child would not be on seizure medicine at all. Children also rarely have a history of heart disease, and a seizure resulting from a tumor would typically present as a focal seizure initially.
You are treating a known epileptic, who is in her second trimester of pregnancy, for a generalized seizure. Your patient's seizure is normal for her condition, and on your arrival, she is postictal, regaining consciousness, and reluctant to be transported. What should you do?
A. Place her on oxygen at 2 lpm. B.* Point out to her that the seizure may have compromised her fetus and she is a high priority for transport and further care. This is the correct answer. C. Have her sign a release. D. Notify children's services of the endangerment. The seizure patient should be categorized as a priority for transport if any of the following occurs: the patient remains unresponsive after the seizure; the airway, breathing, or circulation is inadequate after the seizure activity; a second generalized motor seizure occurs without a period of responsiveness between the seizure episodes; a generalized motor seizure lasts more than 5 minutes; the patient is pregnant, has a history of diabetes, or is injured; the seizure has occurred in water, such as a swimming pool or lake; there is evidence of head trauma leading to the seizure; there is no history of epilepsy or other seizure disorder; or the seizure is the result of drug or alcohol withdrawal.
A female patient with a history of seizures has suffered a seizure in a public area and is now refusing further assessment and transport. As you leave, a witness to the entire event tells you that he thinks the patient is "crazy in the head" because right before she seized, she looked up toward the ceiling and kept repeating, "Do you see the birds?" As a knowledgeable EMT, you should recognize that the bystander is describing what condition?
A. Postictal confusion B. Side effects of seizure medications C. Syncopal episode D.* An aura This is the correct answer.
Which of the following statements is CORRECT when discussing a seizure that is unusually long in duration?
A. Prolonged seizures mean that the patient has a history of seizures. B.* Prolonged seizures can be life threatening. This is the correct answer. C. Patients with prolonged seizures should be suspected of being off their anti-seizure medication. D. Patients with prolonged seizures have a history of epilepsy, and often require no medical care.
You find an adult male on his living room floor. The scene size-up reveals a very cluttered home that smells of urine. On an end table, you find a container of phenytoin (Dilantin) with the patient's name on it. When you pinch his shoulder, the patient responds by moaning and trying to remove your hand from his neck. On the basis of this information, you should suspect which one of the following conditions?
A. Syncope B. Behavioral emergency C. Allergic reaction D.* Seizure
You are transporting a patient who has a history of simple partial seizures. During transport she experiences a simple partial seizure involving her right arm. Her pulse is 92, respirations 14 and adequate, blood pressure 168/88 mmHg, and SpO2 at 98%. Your primary concern would be:
A. administering oxygen by nonrebreather. B. placing the arm tightly in a sling to prevent injury. C. loss of bowel or bladder control. D.* progression to a generalized seizure.
A 36-year-old diabetic male with hypertension has suffered a secondary seizure. The patient responds to verbal stimuli with garbled speech and his airway, breathing, and circulation are intact. Vital signs are: pulse 128, respirations 20 and adequate, blood pressure 158/96 mmHg, and SpO2 97% on room air. At this time, it is important that the EMT:
A. administer high-concentration oxygen. B. administer oral glucose. C. position the patient supine on the stretcher and transport. D.* check the patient's blood sugar.
You have been called for a 71-year-old male with seizure activity. At the patient's side, you find him lying motionless on the floor of his bedroom with a family member performing chest compression only CPR. In this situation, your immediate action would be to:
A. take over CPR and attach the automated external defibrillator. B. open the airway and begin positive pressure ventilation. C. continue CPR and call for advanced life support assistance. D.* stop CPR and feel for a carotid pulse.
Friends of a male patient who suffered a generalized seizure are worried because he cannot remember the seizure. You should inform them that this is a(n):
A. unrelated event to the seizure and may indicate a more serious medical problem. B. important piece of information that warrants immediate transport to the hospital. C. concern since most people can remember the seizure. D.* normal finding common among those who suffer this type of seizure.
A man comes into your station and tells you that he was just diagnosed by his physician as having a syncopal episode the previous week. More specifically, he asks you to explain why he fainted. Which one of the statements that follow would be your best response?
A. "A small clot formed in a blood vessel in your brain, but was quickly broken down by the body." B.* "For some reason, there was a temporary decrease in the flow of blood to your brain." This is the correct answer. C. "A syncopal episode is a small seizure that runs its course very quickly." D. "Your blood sugar most likely dropped very quickly, causing you to faint."
As a general rule, a postictal patient should be placed on the stretcher and transported in what position?
A. Semi-Fowler's B.* Lateral recumbent This is the correct answer. C. Prone D. Supine
How would you transport a seizure patient who may have a spinal-cord injury?
A.* Immobilized on a spine board with a cervical collar in place This is the correct answer. B. Supine on the stretcher with straps loosely applied C. Semi minus −sitting position with a cervical collar in place D. In the lateral recumbent position with a cervical collar in place
A patient has been actively seizing for 17 minutes. He is cyanotic with shallow respirations. What immediate care should you provide to this patient?
A.* Open the airway and begin positive pressure ventilation. This is the correct answer. B. Determine if he has a history of seizures. C. Apply the automated external defibrillator. D. Place him in the lateral recumbent position.
While you are transporting a 41 dash -year dash -old woman who is not feeling well, she begins having a generalized tonic dash -clonic seizure. She has no history of seizures. The seizure lasts approximately 90 seconds. After 30 seconds of being postictal and unresponsive, the woman seizes again for the remainder of the 12 dash -minute transport. You recognize which one of the following conditions?
A.* Status epilepticus This is the correct answer. B. Partial-motor seizure C. Hypoglycemic-induced seizures D. Undiagnosed epilepsy
You arrive on scene and find Emergency Medical Responders with a seizing patient. What question should the EMT ask first?
A.* "How long has the patient been seizing?" This is the correct answer. B. "Did the patient lose control of his bladder?" C. "Do you know what medications the patient is taking?" D. "What are the patient's vital signs?"
You believe that a patient suffered a simple partial (focal motor) seizure. What statement made by the patient would reinforce this suspicion?
A.* "My left arm would not stop shaking. I did not know what was happening." This is the correct answer. B. "I cannot remember anything that happened. I must have passed out!" C. "I think that I may have lost control of my bladder and bit my tongue." D. "I remember my arms and legs shaking, and then I can't remember anything else!"
Which one of the following patients should be classified as suffering from status epilepticus?
A.* 57-year-old female who seized during the entire news program This is the correct answer. B. 16-year-old male experiencing a partial motor seizure for 7 minutes C. 89-year-old who seized immediately upon getting out of bed D. 19-year-old female who briefly seized but has been postictal for 20 minutes
What do untrained bystanders sometimes attempt to do to the actively seizing patient prior to EMS arrival?
A.** Place a spoon in the patient's mouth to keep him from swallowing his tongue. This is the correct answer. B. Place the patient on a couch or chair so he does not fall down. C. Put a pillow under the patient's back to keep him from rolling over. D. Give the patient a sip of water to stop the seizure.
You are caring for a postictal male patient with a known history of seizures. He is confused and cannot remember his 8-year-old son's name. His son tearfully asks you if his father will ever remember him. Your response would be:
A.** "Although he is confused now, he should remember your name in a little bit." This is the correct answer. B. "I do not feel comfortable in telling you yes, since there is a chance he may not." C. "I do not know. We will have to let the doctor help him first." D. "I am not sure, but at least your mother remembers your name."