Medic prep scenarios

An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n):

D. Premature atrial complex

What type of pain has its origin in a particular location but is described by the patient as pain in a different location?

D. Referred pain

Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT:

D. Succinycholine

What does pulse oximetry measure?

D. The percentage of hemoglobin saturation

A pH of 7.30 indicates:

D. acidosis.

During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient's end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should:

D. assess for a pulse for up to 10 seconds.

After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should:

D. begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive pressure ventilation.

A medication that possesses a negative chronotropic effect will:

D. cause a decrease in the heart rate.

A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called____activity.

D. clonic

Because stimulation of the parasympathetic nervous system can occur during intubation of a child, you should:

D. closely monitor the child's cardiac rhythm.

A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:

D. decreases in stroke volume and ventricular filling.

A microdrip administration set:

D. delivers 1 mL for every 60 drops.

A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include:

D. diphenhydramine, 25 mg.

All of the following are Schedule Il substances, EXCEPT:

D. heroin.

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT:

D. metabolic alkalosis.

A vertical plane that is parallel to the median plane and divides the body into unequal left and right parts is called the:

D. midsagittal plane.

Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:

D. peptic ulcer disease.

The outflow catheter of a cerebrospinal fluid shunt is MOST commonly placed into the patient's:

D. peritoneal cavity.

A patient with status asthmaticus commonly presents with:

D. physical exhaustion and inaudible breath sounds.

When asking a patient to supinate his or her hand, you would expect him or her to:

D. place the hand palm up.

A return to an earlier age level of behavior or emotional adjustment during a crisis situation is called:

D. regression.

During a frontal collision, MOST pneumothoraces occur when:

D. the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact.

Vagal tone remains intact following a spine injury because:

D. the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries.

After delivering a baby and clamping and cutting the umbilical cord, you note that the end of the umbilical cord attached to the baby is bleeding. You should:

D. tie or clamp the cord proximal to the first clamp and reexamine it.

A positive Babinski reflex is observed when the:

D. toes move upward in response to stimulation of the sole of the foot.

A 55-year-old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain?

Difference in blood pressure between the two arms

Ignoring one's circadian rhythms may result in all of the following, EXCEPT:

Enhanced social functioning

A delta wave is identified on a cardiac rhythm strip as a(n):

Slurring of the upstroke of the first part of the QRS complex

A 30-year-old woman who is 35 weeks pregnant is pulseless and apneic. As CPR is initiated, you or another team member should:

manually displace her uterus to the left.

Naloxone is NOT indicated for use in newborns:

who are born to narcotic-addicted mothers

The ECG of a patient clearly indicates that he is experiencing a heart attack. The paramedic advises the patient of this, but the patient states, "No, I don't care what your machine says; it's not my heart." This is an example of:

B. denial.

In the newborn, hypoglycemia is defined as a blood glucose level less than ____ mg/dL.

A. 40

Chest compressions are indicated in the newborn if its heart rate remains less than ___beats/min despite effective positive pressure ventilations for ____seconds.

A. 60, 30

In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of:

A. 80 to 90 mm Hg

Any time a patient with end-stage renal disease is found in cardiac arrest, the paramedic should strongly consider which of the following as the cause?

A. Hyperkalemia

A dialysis patient requires pharmacologically assisted intubation. Which of the following medications should be avoided?

A. Succinylcholine

Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to:

A. adequately preoxygenate with 100% oxygen.

A 17-year-old woman presents with acute abdominal pain while at a party with her husband. You arrive at the scene, assess the patient, and advise her of the need for EMS treatment and transport. However, the patient, who is conscious and alert, refuses EMS treatment and transport and states that her husband will transport her in his car. You should:

A. advise her of the potential risks of refusing EMS treatment and transport.

Ascites is defined as:

A. an abnormal accumulation of fluid in the peritoneal cavity.

Autoregulation is defined as:

A. an increase in mean arterial pressure to maintain cerebral blood flow.

Biot respirations are characterized by:

A. an irregular pattern of breathing with intermittent periods of apnea.

An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called:

A. asthma.

The National Emergency Medical Services Information System (NEMSIS):

A. collects relevant data from each state and uses it for research.

Stimulation of the sympathetic nervous system causes:

A. diaphoresis.

A woman having a possible heart attack redirects her anger away from her condition and towards the paramedic. This is called

A. displacement.

When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) effect.

A. dromotropic

General treatment for a 40-year-old patient with a significant head injury and signs of Cushing triad includes:

A. elevating the head 15 to 30 degrees.

If a burn patient presents with a hoarse voice and states, "I'm cold," your MOST immediate concern should be:

A. inhalation injury.

Unlike the patient with hypoglycemia, the patient with severe hyperglycemia:

A. is tachypneic and hyperpneic.

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the:

A. liver.

The BURP maneuver usually involves applying backward, upward, and rightward pressure to the:

A. lower third of the thyroid cartilage.

Patients with decompensated asthma or COPD who require positive- pressure ventilation:

A. may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.

Specific functions that the paramedic should perform prior to contacting medical control are called:

A. standing orders.

Intrapulmonary shunting is defined as:

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

Implied consent is based on the premise that a patient:

A. would consent to care because of the seriousness of his or her injury.

A DNR order is MOST accurately defined as a:

A. written order designed to tell health care providers when resuscitation is or is not appropriate.

A patient taking__would MOST likely experience a delay in the healing of a wound.

B. corticosteroids

Hypoventilation causes a(n) ___and leads to___.

B. decreased minute volume, hypercapnia

The work-of-breathing component of the Pediatric Assessment Triangle includes all of the following, EXCEPT:

Auscultating the lungs for adventitious sounds

The greatest amount of kinetic energy would be created if a -pound driver struck a tree while traveling at ___mph.

B. 140, 50

According to the rule of nines, an adult with partial- and full-thickness burns to his or her head, face, and anterior chest has burns to____% of his total body surface area.

B. 18

How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/50 mL?

B. 500

Thousands of fibrils that are distributed throughout the inner surfaces of the ventricles, which represent the end of the cardiac conduction system, are called the:

B. Purkinje fibers.

Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT:

B. a decreased expiratory phase.

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:

B. administer a sedative medication.

Approximately 5 minutes following ascent from the water, a 30-year-old diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should suspect:

B. an arterial gas embolism.

Hemoglobin functions by:

B. binding to oxygen that is absorbed in the lungs and transporting it to the tissues.

The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT:

B. bronchospasm.

A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to three puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should:

B. give nebulized ipratropium.

A hyperventilating patient:

B. may be acidotic and trying to decrease her or his pH level.

Patients with type 1 diabetes mellitus:

B. need exogenous insulin to survive.

A loss of normal sympathetic nervous system tone causes:

B. neurogenic shock.

Cor pulmonale is a term used to describe:

B. right ventricular failure caused by pulmonary disease.

A patient with quiet tachypnea suggests:

B. shock.

Stimulation of the parasympathetic nervous system:

B. slows SA nodal discharge and decreases conduction through the AV node.

Any time you encounter jugular venous distention in a patient, you should determine:

B. where the venous obstruction is that is impeding blood return to the heart,

Premature ventricular complexes (PVCS) that originate from different sites in the ventricle:

B. will appear differently on the ECG.

Alcohol predisposes a patient to hypothermia due to:

C. widespread cutaneous vasoconstriction.

_____is a term used to describe changes in a person's ability to perform coordinated motions, such as walking.

C. Ataxia

How can you tell if bleeding from the ears or nose contains cerebrospinal fluid (CSF)?

C. CSF has a high glucose content.

A right ventricular infarction is characterized by:

C. ST-segment elevation greater than 1 mm in lead V,R and ST- segment elevation in leads II, III, and aVF.

The catecholamine epinephrine (adrenaline) has an affinity for:

C. alpha and beta receptors.

When oxygen does not reach the cell, the cell reverts to:

C. anaerobic metabolism and produces lactic acid.

Hyperventilating a patient who has increased intracranial pressure (ICP) will:

C. constrict the cerebral vasculature and decrease cerebral perfusion.

In pregnancy, magnesium sulfate is used principally for:

C. eclamptic seizures.

In contrast to adults, young children are more prone to liver and spleen injuries because the organs:

C. extend well below the rib cage.

A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience:

C. increased CO2 retention.

Accumulating acids and other waste products in the blood:

C. inhibit hemoglobin from binding with and carrying oxygen.

Allergies are acquired following:

C. initial exposure to an allergen.

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, heart rate of 56 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves:

C. intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

Disseminated intravascular coagulation is defined a(n):

C. pathological condition in which the proteins that normally control blood clotting become inappropriately active.

If administered in conjunction with nitrates, sildenafil would MOST likely cause:

C. severe hypotension.

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should:

C. suction the blood from his mouth and assist ventilations with a bag-mask device.

During the refractory period:

C. the cell is depolarized or in the process of repolarizing.

A bruit indicates ___ blood flow and is MOST significant in the____arteries.

C. turbulent, carotid

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?

D. 0.1 mg

A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V, through V4. What should you suspect?

D. Left anterior descending artery occlusion

A middle-aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of:

Tolerance

After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus bradycardia at 30 beats per minute. In addition to continuing ventilations, what should be done next?

Transcutaneous pacing

If patient with severe hypothermia is pulseless and apneic, you should:

attempt a single shock for V-fib or V-tach.