Module 3 Study guide

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:

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

You should insert the ET tube between the vocal cords until the:

proximal end of the cuff is 1 to 2 cm past the vocal cords.

When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if:

the cricothyroid membrane is incised vertically.

Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT:

the esophageal detector device.

You should turn the jet ventilator release valve off when:

the patient's chest visibly rises.

The MOST significant disadvantage associated with needle cricothyrotomy is:

the potential for pulmonary aspiration.

Rigorous tube confirmation protocol must be followed after performing digital intubation because:

the procedure of digital intubation is truly a blind technique.

When intubating a 3-year-old child, you should insert the ET tube until:

the vocal cord mark is 2 to 3 cm beyond the vocal cords.

Typically, ETCO2 is approximately:

2 to 5 mm Hg lower than the arterial PaCO2.

The average depth of ET tube insertion for adult patients is:

21 to 25 cm.

What is the percentage of inspired oxygen?

21%

The trachea is approximately how many inches long in most adults?

4

Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because:

A) it must be performed on spontaneously breathing patients.

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.

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 1/4" B. 18 gauge, 2 1/4" C. 16 gauge, 1 1/4 D. 14 gauge, 2 1/4

A. 20 gauge, 1 1/4"

The administration set most appropriate for administration of intravenous solutions for fluid replacement is the: A. macrodrip administration set. B. microdrip administration set. C. measured volume administration set. D. blood tubing set. E. none of the above

A. macrodrip administration set.

The volume of air that is inhaled or exhaled during a single respiratory cycle is called A. tidal volume B. alveolar volume C. minute volume D. inspiratory reserve volume

A. tidal volume

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

You are on scene with a 19-year-old male patient who has been in an auto accident. You estimate that he has lost approximately 1000 mL of blood. Which of the following is an accurate statement regarding this patient's condition? A) Death is imminent. B) This amount of blood loss is well tolerated. C) This is considerable hemorrhage. D) The location of the hemorrhage determines severity.

B) This amount of blood loss is well tolerated.

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

B) analgesia.

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.

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.

A serious systemic bacterial infection most commonly causes what type of shock? A) Anaphylactic shock B) Septic shock C) Hypovolemic shock D) Psychogenic shock

B) septic shock

A venous constricting band should be left in place no longer than: A. 1 minute. B. 2 minutes. C. 3 minutes. D. 5 minutes. E. 10 minutes.

B. 2 minutes.

What type of shock can be caused by carbon monoxide poisoning? A. Cardiogenic B. Dissociative C. Distributive D. Obstructive

B. Dissociative

The three classic signs of cardiac tamponade include JVD, muffled heart sounds, and: A. Hypertension B. Hypotension C. Pulmonary embolism D. Tension pneumothorax

B. Hypotension

While starting an IV on a patient complaining of abdominal pain, you inadvertently get stuck with the needle before you can place it in the sharps container, you should A. continue with patient care, report the incident to your infection control officer and schedule an appointment with your physician B. complete your care of the patient, wash the affected area as soon as you reach the hospital, and report the incident to your supervisor C. ask the driver to pull over, assume the role of the driver, continue on to the hospital, and see a physician in the emergency department D. immediately clean the affected area with isopropyl alcohol, ask the patient if he has any infectious diseases, and report the incident to your supervisor

B. complete your care of the patient, wash the affected area as soon as you reach the hospital, and report the incident to your supervisor

As you are preparing to start an IV on a young man, he sees the needle, becomes acutely diaphoretic, and passes out. Your FIRST action should be to A. administer 100% oxygen B. place him in the shock position C. start the IV in case he needs fluids D. obtain a complete set of vital signs

B. place him in the shock position

Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct?

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

Atrial Kick

Blood forced into the ventricle during atrial contraction Remaining 20%-30%

What are the 3 main causes of anemia?

Blood loss Underproduction of RBC's destruction of RBC's.

You initiated an IV in the antecubital space of an unconscious hypoglycemic diabetic patient. You notice that the fluids are running very slowly and the skin in the arm above the IV site is cool and pale. What should you do? a. Discontinue the IV and restart it in the other arm. b. Flush the line with normal saline and see if the infusion rate increases. c. Push D50W 25 g IV slowly. d. Start another IV below the first one.

a. Discontinue the IV and restart it in the other arm.

Which of the following is used as a portable cylinder for the on-scene administration of oxygen? a. E cylinder b. K cylinder c. L cylinder d. M cylinder

a. E cylinder

What complication may develop when diaphragmatic breathing is impeded in a 4-year-old child? a. Effective breathing may be compromised. b. Effective circulation may be compromised. c. Effective communication may be compromised. d. There is no complication for this patient.

a. Effective breathing may be compromised.

The use of a face shield is indicated when administering: a. Endotracheal (ET) medications b. Intramuscular (IM) medications c. Intravenous (IV) medications d. Subcutaneous (Sub-Q) medications

a. Endotracheal (ET) medications

Medications administered and absorbed through the gastrointestinal tract are called: a. Enteral medications b. IM medications c. Oral medications d. Parenteral medications

a. Enteral medications

After placing an endotracheal tube, you cannot hear any lung sounds but you hear gurgling over the epigastrium. The endotracheal tube is most likely placed in the: a. Esophagus b. Left mainstem c. Right mainstem d. Trachea

a. Esophagus

Which IV site joins the subclavian vein and passes above the sternocleidomastoid? a. External jugular b. Femoral c. Saphenous d. Subclavian

a. External jugular

A patient takes in a deep breath. The oxygen and carbon dioxide molecules transfer across the capillary in the alveoli. Which of the following terms best describes this type of respiration? a. External respiration b. External ventilation c. Internal respiration d. Pulmonary diffusion

a. External respiration

The minimum level of standard precautions that should be used on every call is: a. Gloves b. Gloves and gown c. Gloves, gown, and mask d. Gown and mask

a. Gloves

The metric unit for weight is the: a. Gram b. Liter c. Meter d. Yard

a. Gram

To locate the jugular vein, position the patient: a. Head down, head turned away from you b. Head down, head turned toward you c. Head up, head turned away from you d. Head up, head turned toward you

a. Head down, head turned away from you

Which of the following is the most appropriate method of opening the airway of an adult patient with no apparent traumatic injuries? a. Head tilt/chin lift b. Head tip/neck lift c. Jaw thrust d. No mechanical method is needed

a. Head tilt/chin lift

"Butterfly" needles are: a. Hollow needles b. Indwelling plastic needles c. Over-the-catheter needles d. Plastic needles

a. Hollow needles

When intubating an adult patient with a curved (MAC) blade, the tip of the blade should be placed: a. In the vallecula, at the base of the tongue b. In the vallecula, at the opening of the vocal cords c. To the right of the epiglottis d. Under the epiglottis

a. In the vallecula, at the base of the tongue

Hypoxemia is defined as a. Inadequate blood oxygen levels b. Inadequate hemoglobin levels c. Inadequate tissue oxygen levels d. Inadequate tissue perfusion

a. Inadequate blood oxygen levels

alveolar (lung) collapse

atelectasis

The standard location for tibial insertion of an IO device is: a. 1 to 3 cm above the tibial tuberosity b. 1 to 3 cm below the tibial tuberosity on the medial flat surface of the anterior tibia c. 1 to 3 cm inferior to the patella d. 1 to 3 inches below the tibial tuberosity of the lateral flat surface of the anterior tibia

b. 1 to 3 cm below the tibial tuberosity on the medial flat surface of the anterior tibia

A patient weighs 220 lb. What is her weight in kilograms? a. 100 g b. 100 kg c. 120 kg d. 440 kg

b. 100 kg

You are ordered to administer lidocaine (1 mg/kg) to your patient. The patient weighs 150 lb and you vial contains 100 mg in 5 mL. How many milliliters will you administer? a. 3.2 b. 3.4 c. 3.9 d. 4.7

b. 3.4

You are ordered to administer calcium chloride (450 mg) to your patient. Your vial contains 1 gram in 10 mL. How many milliliters will you administer? a. 0.45 b. 4.5 c. 44.5 d. 45

b. 4.5

Oxygen concentrations of _____ can be delivered using a simple face mask at a flow rate of 10 L/min. a. 20% to 40% b. 40% to 60 % c. 80% to 90% d. 100%

b. 40% to 60 %

A nasal cannula delivers _____ % oxygen at a flow rate of 6 L/min in optimal conditions. a. 35 b. 44 c. 58 d. 66

b. 44

You are instructed to administer 40 mg of Lasix. You have a prefilled syringe containing 80 mg Lasix in 10 mL. You should administer: a. 4 mL b. 5 mL c. 8 mL d. 10 mL

b. 5 mL

The maximum acceptable flow rate for a nasal cannula is _____ L/min. a. 4 b. 6 c. 8 d. 10

b. 6

You are treating a 9-year-old child in need of intubation. Which of the following best describes the appropriate tube size? a. 5.0 to 5.5 mm internal diameter b. 6.0 to 6.5 mm internal diameter c. 7.0 to 7.5 mm internal diameter d. 8.0 to 8.5 mm internal diameter

b. 6.0 to 6.5 mm internal diameter

Which of the following is a normal PaO2? a. 70 mm Hg b. 90 mm Hg c. 110 mm Hg d. 140 mm Hg

b. 90 mm Hg

Your partner asks for a Yankauer suction tip to help clear the patient's upper airway. Which of the following should you provide? a. A hard but flexible catheter with a whistle tip b. A hard plastic device angled to suction the upper airway c. A large straw attached to the suction device d. A soft, flexible catheter without a whistle tip

b. A hard plastic device angled to suction the upper airway

The patient has been sedated and paralyzed in preparation for rapid sequence intubation. After the procedure, you notice that the sedative has worn off. What should you do next? a. Administer additional paralytic. b. Administer additional sedative. c. Calm and reassure the patient. d. Continue with airway control.

b. Administer additional sedative.

While ventilating the lungs of a nonbreathing, medical patient with a bag-mask device, you notice that the patient's chest is not rising adequately, and there is a low pulse oximetry, suggesting that the patient is not oxygenating adequately. What do you suspect? a. Airway obstruction caused by the patient's tongue b. An inadequate tidal volume with each breath c. Tension pneumothorax with increased dead space d. The mask size is too small for the patient

b. An inadequate tidal volume with each breath

The most common IO site for children is the: a. Anterior fibula b. Anterior tibia c. Posterior fibula d. Posterior tibia

b. Anterior tibia

"Clean" technique is also known as: a. Antiseptics b. Aseptic c. Disinfectant d. Sterile

b. Aseptic

A respiratory pattern characterized by an irregular pattern, rate, and volume, with intermittent periods of apnea is: a. Agonal b. Biot's c. Central neurogenic hyperventilation d. Cheyne-Stokes

b. Biot's

You are attempting to intubate an apneic patient. As you pass the tube through the vocal cords, the patient begins to cough. Which of the following changes in the vital signs would be expected with this symptom? a. Bradycardia, hypertension, and increased ventilation b. Bradycardia, hypotension, and decreased ventilation c. Tachycardia, hypotension, and decreased ventilation d. Tachycardia, hypotension, and increased ventilation

b. Bradycardia, hypotension, and decreased ventilation

You are attempting to intubate an apneic patient. As you pass the tube through the vocal cords, the patient begins to cough. Which of the following changes in the vital signs would be expected with this symptom? a. Bradycardia, hypertension, and increased ventilation b. Bradycardia, hypotension, and decreased ventilation c. Tachycardia, hypotension, and decreased ventilation d. Tachycardia, hypotension, and increased ventilation

b. Bradycardia, hypotension, and decreased ventilation

Upon arrival on scene, you find a 23-year-old female who is having difficulty breathing. You hear wheezes and notice urticaria on her arms and chest. The patient is in moderate to severe respiratory distress. The patient also states she was stung by a bee about 10 minutes earlier and she has a history of allergic reactions to bee stings. You contact medical control and are ordered to administer epinephrine 1/1000 solution. Medical control further advises the dose to be administered is 0.3 mg dose Sub-Q. Your package contains 1mg in 1 mL. Your partner hands you the epinephrine out of the drug box, and it is packaged in a small all-glass container with a narrow neck. He also hands you a 3-cc syringe with a needle attached to it. What should you do as you prepare to administer the epinephrine medication? a. Attempt to administer the medication along the IV route. b. Check the "six rights." c. Inform the patient you are concerned about administering the medication. d. Question medical control.

b. Check the "six rights."

A patient has an altered level of consciousness after a head injury. The patient has a breathing pattern in which he speeds up his breathing and then it slows down and almost stops. Which of the following describes this type of breathing? a. Bradypnea b. Cheyne-Stokes respirations c. Hyperpnea d. Kussmaul respirations

b. Cheyne-Stokes respirations

What should be done to help ensure aseptic technique? a. Always use a new vial. b. Cleanse the top of the vial with an alcohol pad. c. No cleansing is necessary. d. Wash the top of the vial with soap and water.

b. Cleanse the top of the vial with an alcohol pad.

Phenylephrine spray is used during nasotracheal intubation to: a. Anesthetize the nasal passages b. Constrict the blood vessels c. Lubricate the nasal passages d. Sedate the patient before the procedure

b. Constrict the blood vessels

A 15-year-old male patient is unresponsive after choking at the dinner table. Abdominal thrusts have not cleared the airway. What equipment is appropriate to use next? a. Laryngoscope and large diameter endotracheal tube b. Laryngoscope and Magill forceps c. Laryngoscope and suction catheter d. Scalpel and large surgical cricothyrotomy needle

b. Laryngoscope and Magill forceps

Which of the following structures prevents foreign matter from entering the trachea? a. Cricoid ring b. Larynx c. Nasopharynx d. Oropharynx

b. Larynx

You are working on a patient who has had a full cardiac arrest. You have attempted an IV in the right antecubital fossa. Multiple attempts on the right arm have resulted in the vein blowing. Which of the following is an appropriate site for the next attempt? a. Femoral artery b. Left antecubital fossa c. Right forearm d. Right hand

b. Left antecubital fossa

The laryngoscope should be held in the _____ hand and inserted on the _____ side of the mouth. a. Left, left b. Left, right c. Right, left d. Right, right

b. Left, right

The metric unit for volume is the: a. Gram b. Liter c. Meter d. Yard

b. Liter

Choose the correct statement pertaining to a major difference between endotracheal intubation and the use of other advanced airways such as the Combitube, LMA, or King airway. a. Endotracheal intubation does not permit suctioning of the lower airways. b. Endotracheal intubation does not require visualization of the vocal cords. c. The other airways can be used on all and any patient group. d. The other airways do not require visualization of the vocal cords for insertion.

d. The other airways do not require visualization of the vocal cords for insertion.

You are ordered to administer 1 mg/kg of Lasix to your patient. You are supplied with 16 mL at 10 mg/mL. The patient weighs 220 lb. How many milliliters will you administer? a. 4 b. 6 c. 10 d. 16

c. 10

One liter equals: a. 10 mL b. 100 mL c. 1000 mL d. 1,000,000 mL

c. 1000 mL

In ideal circumstances, suctioning of an adult patient should not exceed _____ seconds. a. 2 b. 5 c. 15 d. 20

c. 15

You mix 400 mg of dopamine into a 250-mL bag of D5W. What is your concentration per milliliter? a. 400 mcg/mL b. 400 mg/mL c. 1600 mcg/mL d. 1600 mg/mL

c. 1600 mcg/mL

The approximation of the correct depth of insertion in centimeters for a 10-year-old child when placing an endotracheal tube is: a. 10 cm b. 12 cm c. 17 cm d. 22 cm

c. 17 cm

If you want to administer 200 mL/hour of normal saline with a 10 drops/mL administration set, the flow rate will be: a. 10 drops/minute b. 20 drops/minute c. 33 drops/minute d. 66 drops/minute

c. 33 drops/minute

You are ordered to administer 80 mg of lidocaine to you patient. You vial contains 100 mg in 5 mL. How many milliliters will you administer? a. 2 b. 3 c. 4 d. 5

c. 4

Which of the following would be considered a normal tidal volume for a patient at rest? a. 1 to 2 mL/kg b. 3 to 5 mL/kg c. 5 to 7 mL/kg d. 7 to 9mL/kg

c. 5 to 7 mL/kg

You are ordered to administer adenosine (6 mg rapid IV push). Your vial contains 10 mg in 10 mL. How many milliliters will you administer? a. 0.6 b. 4 c. 6 d. 10

c. 6

What is the total minute volume of a patient with a tidal volume of 300ml breathing 24 times a minute? a. 12.5 mL/min b. 324 mL/min c. 7200 mL/min d. 12,000 mL/min

c. 7200 mL/min

Which of the following best describes the purpose of the whistle tip catheter? a. Allows gastric lavage while suctioning the airway b. Allows positive pressure ventilation while suctioning c. Allows suctioning of the lower airway d. Permits endotracheal intubation during suctioning

c. Allows suctioning of the lower airway

What is the bifurcation of the trachea called? a. Alveoli b. Arytenoids c. Carina d. Cartilaginous

c. Carina

A respiratory pattern characterized by deep, rapid respirations is: a. Agonal b. Biot's c. Central neurogenic hyperventilation d. Cheyne-Stokes

c. Central neurogenic hyperventilation

The six patient rights of drug administration are right patient, right dose, right medication, right route, right time, and right: a. Amount b. Concentration c. Documentation d. Orders

c. Documentation

Which of the following best describes the role of atropine in rapid sequence intubation? a. Decreases the heart rate b. Dilates the pupils c. Dries airway secretions d. Increases the blood pressure

c. Dries airway secretions

Suctioning (application of negative pressure) should be activated upon: a. Both insertion and extraction b. Either insertion or extraction (it makes no difference) c. Extraction of the suction catheter d. Insertion of the suction catheter

c. Extraction of the suction catheter

What is the primary function of the alveoli? a. Air flow b. Blood flow c. Gas exchange d. Nutrient exchange

c. Gas exchange

You are treating a 65-year-old male who has had a "substantial cough" for 3 days. You are preparing to administer medication to the patient. What minimum level of standard precautions should be used? a. Gloves b. Gloves and gown c. Gloves and mask d. Shoe covers

c. Gloves and mask

You are on scene with multiple patients. Each patient requires medication administration through IV access. Which of the following is an accurate statement regarding standard precautions? a. Gloves are not necessary for medication administration. b. Gloves are required only during initial IV access. c. Gloves should be changed between each patient's treatment. d. It is not necessary to change gloves between treating patients.

c. Gloves should be changed between each patient's treatment.

A bag-mask device for infants and children should: a. Be equipped with a fish-mouth-operated outlet valve b. Be used with an oxygen flow rate of 6 to 8 L/min c. Have a minimum volume of 450 mL d. Have a pop-off valve to prevent overinflation of the lungs

c. Have a minimum volume of 450 mL

Which of the following is a complication of suctioning? a. Hypertension b. Hypoglycemia c. Hypoxia d. Tachycardia

c. Hypoxia

Hypoxia is defined as: a. Inadequate blood oxygen levels b. Inadequate hemoglobin level c. Inadequate tissue oxygen levels d. Inadequate tissue perfusion

c. Inadequate tissue oxygen levels

You are on scene to treat a 3-month-old infant who has no pulse and no spontaneous respirations. CPR has been initiated. You are attempting to gain intravenous access. Which of the following would be an appropriate access site if IV access is delayed? a. Arterial b. Central c. Intraosseous d. No access is necessary

c. Intraosseous

Proper application of a tourniquet for use in establishing an IV should result in tamponade of: a. Both the venous and the arterial vessels b. Neither the venous nor the arterial vessel c. The arterial vessel without occlusion of the venous vessel d. The venous vessel without occlusion of the arterial vessel

d. The venous vessel without occlusion of the arterial vessel

Which of the following best describes the risk of infection to the paramedic when performing endotracheal intubation? a. In spite of personal protective equipment, exposure is highly likely. b. The paramedic is at a lower risk of infection because of isolating the airway. c. The risk of infection is similar to all other risks during patient contact. d. There is a higher risk of infection because of close proximity with the airway.

d. There is a higher risk of infection because of close proximity with the airway.

A patient is in shock. He is tachycardic and hypotensive. Which of the following statements is true regarding his response to this hypoperfusion? a. The kidneys excrete additional water b. The parasympathetic response increases c. There is a decreased in ADH production d. There is decreased cardiac output

d. There is decreased cardiac output

Which of the following is the largest of the cartilages that comprise the larynx? a. Arytenoid b. Cricoid c. Cricothyroid d. Thyroid

d. Thyroid

As air passes the larynx, which of the following is the next structure that the air should pass as it enters the lungs? a. Alveoli b. Bronchi c. Oropharynx d. Trachea

d. Trachea

Which of the following is the most appropriate location for a Miller blade to be placed during intubation? with direct laryngoscopy? a. Into the carina b. Into the vallecula c. Through the vocal cords d. Under the epiglottis

d. Under the epiglottis

The site most commonly used in the prehospital setting to start a peripheral IV is the: a. External jugular vein b. Lower extremity c. Subclavian vein d. Upper extremity

d. Upper extremity

You have just performed a needle cricothyrotomy. What is the next step? a. Attach the needle to a special bag-mask device. b. Connect a very small endotracheal tube. c. Use a bag-mask device adapter. d. Use a jet ventilator device.

d. Use a jet ventilator device.

Which of the following terms best describes the process of breathing? a. Diffusion b. Insufflation c. Respiration d. Ventilation

d. Ventilation

A patient with COPD is having difficulty breathing. He has an O2 saturation of 92%. You have a prolonged transport time. Which of the following would be the most appropriate for this patient? a. Nonrebreather mask b. Partial rebreather mask c. Simple face mask d. Venturi mask

d. Venturi mask

You are called to the scene of a 4-year-old male who was struck by a van. The child is in cardiopulmonary arrest. You have attempted peripheral IV access three times without success. Your best course of action for administration of fluids and medications in this situation is with a(n): a. Fourth attempt to establish peripheral IV access b. Internal jugular IV line c. Intraosseous infusion d. Subclavian IV line

c. Intraosseous infusion

If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to:

discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.

An artificial airway adjunct:

does not obviate the need for proper head positioning.

The quickest method for getting fluids and medications into the bloodstream is by: a. Intradermal injection b. Intramuscular injection c. Intravenous injection d. Subcutaneous injection

c. Intravenous injection

Which of the following is an accurate description of the visceral pleura of the lung? a. It cannot be penetrated. b. It does not move with the chest wall. c. It is adhered to the lung surface. d. It is the layer that is tightly adhered to the chest wall.

c. It is adhered to the lung surface.

Which of the following is the most appropriate method of opening the airway of a child with a traumatic injury? a. Head tilt/chin lift b. Head tip/neck lift c. Jaw thrust d. No mechanical method is needed

c. Jaw thrust

Which of the following is considered a structure of the upper airway? a. Alveoli b. Bronchi c. Larynx d. Trachea

c. Larynx

The acronym BURP describes how to: a. Confirm tube placement following intubation visualization during intubation b. Correct a right mainstem intubation c. Maneuver the larynx for vocal cord visualization d. Prepare equipment for intubation

c. Maneuver the larynx for vocal cord visualization

Which of the following best describes the conditions found in the ambulance? a. Asepsis b. Free of microorganisms c. Medical asepsis d. Sterile

c. Medical asepsis

The metric unit for linear measurement is the: a. Gram b. Liter c. Meter d. Yard

c. Meter

The unit of measurement most commonly used in the medical community is the: a. Apothecary system b. Common household system c. Metric system d. Statistical system

c. Metric system

After correctly positioning the laryngoscope blade in the patient's mouth, you should:

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

In contrast to a curved (MAC) laryngoscope blade, a straight (MILLER) laryngoscope blade is designed to:

extend beneath the epiglottis and lift it up.

Vestibular folds are also called:

false vocal cords.

A patient with orthopnea:

has dyspnea while lying flat.

It would be appropriate to insert a nasopharyngeal airway in patients who:

have an altered mental status with an intact gag reflex.

You place a Combitube on a 27-year-old male patient in cardiac arrest. After ventilating through the number 1 port, you hear breath sounds. What should you do? a. Pull the tube back approximately 1 to 2 cm. b. Remove the tube and ventilate the patient. c. Secure the tube and ventilate through the number 1 port. d. Secure the tube and ventilate through the number 2 port.

c. Secure the tube and ventilate through the number 1 port.

While inserting a nasal airway, the beveled tip should be directed toward the: a. Floor of the nose b. Lateral cartilage of the nose c. Septum of the nose d. Top of the nose

c. Septum of the nose

Which of the following is a possible indication of airway compromise? a. Breathing b. Crying c. Snoring d. Speaking

c. Snoring

The use of equipment and fields that are free of all forms and types of life is called: a. Body substance isolation Standard precautions b. Medical asepsis c. Sterile technique d. Universal precautions

c. Sterile technique

The F.A.S.T. IO system is designed to be inserted in the patient's: a. Clavicle b. Humeral head c. Sternum d. Tibia

c. Sternum

Which of the following statements is correct regarding the endotracheal tube used in pediatric patients under the age of 8 years? a. The endotracheal tube cuff should be inflated fully with 10 mL of air. b. The cuff of the tube should be inflated with 5 mL of air. c. The endotracheal tube should not need an inflatable cuff. d. Use a small, cuffed tube, but do not inflate the cuff.

c. The endotracheal tube should not need an inflatable cuff.

Which of the following is an anatomic difference in a child's airway as compared to that of an adult? a. A child's tongue is small in relationship to the size of the mouth. b. The distance from the vocal cords to the carina gets smaller with age. c. The epiglottis is U-shaped in a child. d. The vocal cords slope from front to back in infants.

c. The epiglottis is U-shaped in a child.

You are caring for a 58-year-old male patient who has been on a ventilator at home. One of the ventilator settings shows FiO2 = 0.40. What does this indicate? a. The minimum peak expiratory flow rate is 4 liters per minute. b. The percentage of carbon dioxide arterial blood is 40. c. The inspired oxygen is set at 40%. d. The rate of breathing is set at 40 times per minute.

c. The inspired oxygen is set at 40%.

Placing an infant or young child in a supine position may cause flexion and occlusion of the airway. Which of the following may be the cause for this occlusion? a. The anterior location of the larynx and pharynx b. The extreme flexibility of the infant's airway c. The larger size of the child's head relative to his body d. The larger size of the child's tongue relative to his body

c. The larger size of the child's head relative to his body

Diffusion is: a. A gaseous substance dissolving in a liquid substance b. The active transport of gas with energy expended c. The movement of a gas from a higher pressure to a lower pressure across a semipermeable membrane d. The movement of a gas from a lower pressure to a higher pressure across a semipermeable membrane

c. The movement of a gas from a higher pressure to a lower pressure across a semipermeable membrane

A catheter that is flexible and designed to suction smaller portions of the airway or through an endotracheal tube is known as a _____ catheter. a. Pharyngeal b. Tonsil-tip c. Whistle-tip d. Yankauer

c. Whistle-tip

Capnography can serve as an indicator of:

chest compression effectiveness.

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:

continue to ventilate and use additional confirmation techniques.

The King LT-D airway features a:

curved tube with ventilation ports located between two inflatable cuffs.

1 gram is equal to _____ micrograms. a. 10 b. 100 c. 1,000 d. 1,000,000

d. 1,000,000

To form secondary units from the basic unit of the metric system, one can divide or multiply by: a. 5, 10, 20 parts b. 5, 15, 30 parts c. 5, 10, 100 parts d. 10, 100, or 1000 parts

d. 10, 100, or 1000 parts

A patient has significant respiratory distress. Upon auscultation, you note increased rales and wheezes. The patient begins to have decreased mental status and respiratory failure. After intubating the patient, what FiO2 setting should be used? a. 40% b. 50% c. 75% d. 100%

d. 100%

How many milligrams equal 1 gram? a. 1 b. 10 c. 100 d. 1000

d. 1000

How many milliliters equal 1 liter? a. 1 b. 10 c. 100 d. 1000

d. 1000

You are treating a 200-lb patient. The physician orders 8 mcg/kg/min of dopamine. You have a microdrip set, a 250-mL bag of D5W, and 400 mg of dopamine. How many drops will you administer? a. 16 b. 20 c. 24 d. 27

d. 27

You are ordered to administer amiodarone (300 mg) to your cardiac arrest patient. Packaging is 150 mg in 3 mL. How many milliliters will you administer? a. 0.6 b. 3 c. 5 d. 6

d. 6

A microdrip administration set delivers: a. 10 drops/mL b. 15 drops/mL c. 20 drops/mL d. 60 drops/mL

d. 60 drops/mL

You are ordered to administer 4 mg per minute of lidocaine to a patient with a ventricular dysrhythmia. The lidocaine is mixed 4 mg/mL, and you are using a 60 drops/mL administration set. The flow rate will be: a. 15 drops/minute b. 30 drops/minute c. 45 drops/minute d. 60 drops/minute

d. 60 drops/minute

A bag-mask device with a reservoir and an adequate oxygen source (at least 15 L/min) delivers an oxygen concentration of: a. 21% b. 40% to 60% c. 80% d. 90% to 100%

d. 90% to 100%

When using a bag-mask device on room air, the paramedic will provide the patient with an oxygen concentration of approximately 21%. By adding a reservoir and supplemental oxygen to the bag-mask device at a flow rate of 15 L/min, the paramedic can deliver an oxygen concentration of: a. 60% to 80% b. 75% to 100% c. 80% to 90% d. 90% to 100%

d. 90% to 100%

The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because:

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

The condition in which the body's tissues and cells do not receive enough oxygen is called:

hypoxia

Signs of clinical improvement during CPAP therapy include:

increased ease of speaking.

After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then:

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

Examination of the posterior chest wall should include what type of assessment of lung sounds? a. Assessment in all 10 locations b. Assessment midaxillary only c. Assessment one time over each lung d. Assessment over all lobes

d. Assessment over all lobes

A patient with a suppressed cough mechanism:

is at serious risk for aspiration.

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.

is unconscious but breathing.

In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device:

it must be equipped with a 15/22-mm proximal adaptor.

Decreased ventilation compliance following intubation is LEAST suggestive of:

left bronchus intubation.

The vocal cords are formed by two pairs of:

ligaments.

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

lower third of the thyroid cartilage.

A patient is tachycardic and hypotensive. He is complaining of chest pain and shortness of breath. Which of the following interventions would most likely identify the cause of this patient's hypoperfusion? a. Blood analysis b. Core body temperature c. Diphenhydramine administration d. ECG

d. ECG

Clean techniques used in the field: a. Eliminate the chance of infection b. Employ sterile techniques and surgical asepsis c. Ensure the field is free of all forms of life d. Focus on destroying pathogens

d. Focus on destroying pathogens

The nasopharyngeal airway should be measured: a. From the corner of the mouth to the earlobe b. From the tip of the nose to the chin c. From the tip of the nose to the corner of the mouth d. From the tip of the nose to the tragus of the ear

d. From the tip of the nose to the tragus of the ear

Automatic transport ventilators are typically contraindicated in patients who: a. Are breathing spontaneously b. Are under 12 years of age c. Are unresponsive d. Have an airway obstruction

d. Have an airway obstruction

Which of the following is an accurate statement regarding multiple organ dysfunction system? a. It has a mortality rate of 5% to 50% b. It involves four or more organ systems c. It is an uncommon cause of death in the ICU setting d. It is often caused by sepsis

d. It is often caused by sepsis

Pulmonary surfactant: a. Increases airway pressures within the lungs b. Increases the attractive forces between the water molecules in the lungs c. Lowers the recoil in the elastic fibers in the alveolar walls d. Lowers the surface tension, preventing alveolar collapse

d. Lowers the surface tension, preventing alveolar collapse

The King LT airway can be used to:

maintain a patent airway in spontaneously breathing patients.

Aspiration is the technique of: a. Injecting a medication slowly into a muscle b. Injecting two medications into the same muscle c. Inserting-injecting-withdrawing-reinserting the needle into a muscle d. Pulling back on the plunger to ensure that the needle has not been placed in a blood vessel

d. Pulling back on the plunger to ensure that the needle has not been placed in a blood vessel

Which of the following is a systemic complication associated with peripheral intravenous therapy? a. Cellulitis b. Hematoma c. Pneumothorax d. Pulmonary embolism

d. Pulmonary embolism

Which of the following "rights" refers to the appropriate readministration of a medication? a. Right documentation b. Right dose c. Right patient d. Right time

d. Right time

You are ordered to start an IV in the patient's lower extremity. The site of choice is the: a. Antecubital b. Dorsal venous arch c. External jugular d. Saphenous

d. Saphenous

Once the endotracheal tube position has been confirmed, which of the following is the next most appropriate step? a. Assess capnography and arterial blood gases every 5 minutes. b. Insert the tube further into the airway as a precaution. c. Manually hold the tube in place during ventilation. d. Secure the tube with tape or a commercial tube holder.

d. Secure the tube with tape or a commercial tube holder.

Which of the following types of shock occurs as a result of infection? a. Cardiogenic b. Hypovolemic c. Neurogenic d. Septic

d. Septic

Which of the following is a function of the larynx? a. Passage of air into the esophagus b. Passage of food into the lungs c. Protection of the nasopharynx d. Speech production

d. Speech production

Removal or destruction of disease-causing organisms or infected material is known as: a. Debridement b. Medical asepsis c. Medical cleansing d. Sterilization

d. Sterilization

The process that makes an object free from all forms of life by using extreme heat or certain chemicals is called? a. Antisepsis b. Cleaning c. Disinfection d. Sterilization

d. Sterilization

You are on scene with an 18-year-old male who has suffered major burns to his lower extremities and arms. You are about to attempt intraosseous access. Which of the following would be an appropriate site? a. Anterior superior iliac spine b. Anterior tibial surface c. Distal femur d. Sternum

d. Sternum

Which of the following is a site used for central venous cannulation? a. Antecubital fossa b. External jugular vein c. Saphenous vein d. Subclavian vein

d. Subclavian vein

A chemical substance inside the alveoli that acts to lubricate the alveoli, decrease surface tension inside the alveoli, and facilitate expansion of the alveoli is known as: a. Atelectasis enzyme b. Hilum expansion chemical c. Surface enzyme d. Surfactant

d. Surfactant

Which of the following is considered an abnormal finding when assessing a patient's mouth and pharynx? a. Pink color noted in mucous membranes b. No foreign objects noted c. Normal dentition d. Swollen tongue

d. Swollen tongue

You have a patient that requires intubation. The epiglottis is soft and floppy. Which of the following would be the most appropriate airway maneuver? a. Dual lumen airway b. The Macintosh blade in the vallecula c. The Macintosh blade over the epiglottis d. The miller blade to lift the epiglottis

d. The miller blade to lift the epiglottis

A 5-year-old patient is in respiratory failure from RSV. Which of the following best describes the choice of blade for this patient? a. A curved blade can better retract the epiglottis b. The laryngoscope should not be used in children c. The optimum blade size should be at least a 3 d. The optimum blade to use is the straight blade

d. The optimum blade to use is the straight blade

If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO2 detector should:

turn yellow during exhalation.

Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is_______ and _______.

unconscious, apneic

The process of moving air in and out of lungs is called:

ventilation.

According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is:

waveform capnography.

A size 3 or 4 LMA:

will accommodate the passage of a 6.0-mm ET tube.

Approximately how far should you insert a 5.0mm ET tube in a 4-year-old child?

15 cm (diameter x 3)

What is the normal percentage of expired oxygen?

16%

Irreversible Shock - Symptons

-Blood Volume Loss - 45% -Mental Status - Extremely Lethargic/Unresponsive - Muscle Tone - Limp - Respiratory Rate - Severe Tachypnea/Agonal Breathing - Skin Color - Pale, Mottled, Central/Peripheral Cyanosis - Skin Tugor - Tenting - Skin Temp - Cold - Cap Refill - Prolonged (>5 sec) - HR - Marked Tachycardia to Bradycardia - BP - Severe Hypotension - Pulse Pressure - Decreased

What are the 3 stages of shock?

1) Early (Compensated) Shock 2) Late (Decompensated) Shock 3) Irreversible Shock

What are five categories of shock?

1) Hypovolemic 2) Cardiogenic 3) Distributive 4) Obstructive/Mechanical 5) Dissociative

To prevent muscular fasciculations associated with the use of succinylcholine, you should administer:

10% of the usual dose of a nondepolarizing paralytic.

Red Blood Cells (RBCs)

90% of all formed elements 40-45% of circulating blood volume Hemoglobin + Oxygen - Bright Red Blood

Unless proven otherwise, any unexplained signs of shock are assumed to be _____ in nature. A) Hypovolemic B) Cardiogenic C) Neurogenic D) Septic

A) Hypovolemic

You are on scene with a patient who is having significant bleeding from the rectum. You obtain a history. Which of the following findings would indicate a rationale for the severe bleeding? A) Warfarin (Coumadin) use B) Obesity C) A history of surgery 5 years ago D) A sedentary lifestyle

A) Warfarin (Coumadin) use

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.

You are treating a 42-year-old woman who was the unrestrained driver of a car that crashed head-on into a tree at approximately 45 miles per hour. Both femurs are obviously fractured, and she has an unstable pelvis. She is unresponsive, tachycardic, tachypneic, and severely hypotensive. Based on her vital signs, you suspect the woman to be in what stage of shock? A) Irreversible B) Early C) Cardiogenic D) Late

A) Irreversible

You are on scene with a patient who has severed his leg in a farming accident. There is considerable blood loss. Which of the following is an appropriate fluid therapy for this patient? A) Isotonic crystalloid solution B) Ringer's lactate, 100 mL/hr C) D5 1/2NS, 500-mL bolus D) NS fluid bolus titrate to wet lung sounds

A) Isotonic crystalloid solution

The patient is presenting with signs/symptoms of hypovolemic shock. Proper treatment for this patient should include: A) Maintaining a supine position for the patient B) Supplying oxygen at 2 to3 liters per minute C) Providing fluids via oral and IV routes D) Raising the patient's body temperature by using blankets and heat packs

A) Maintaining a supine position for the patient

Irreversible shock is noted by: A) Multiple organ failure B) Hypotension at 70 to 80 mm Hg systolic pressure C) Hyperactive hepatic perfusion D) Refractory capillary occlusions

A) Multiple organ failure

You are on scene with a patient who recently suffered a heart attack. He has been told that his cardiac output has decreased since this heart attack. Which of the following is the direct cause of this decreased cardiac output? A) Stroke volume B) Afterload C) Preload D) Atrial kick

A) Stroke volume

Hypovolemic shock resulting from any cause is first treated with: A) Crystalloid fluid volume replacement B) Colloid plasma expander agents C) Vasopressor agents to aid in peripheral vascular resistance D) Vasodilatory agents to aid preload

A) Crystalloid fluid volume replacement

You are on scene with a 16-year-old runner who was stung by a bee. She is having no difficulty in breathing, but there is significant swelling at the site. Her heart rate is 102 beats/min, her respiratory rate is 22 breaths/min, and her blood pressure is 110/88 mm Hg. Which of the following would be an appropriate initial treatment for this patient? A) Diphenhydramine B) Solu-Medrol C) Dopamine D) Epinephrine

A) Diphenhydramine

Initial management for most patients in hypovolemic shock is: A) Fluid boluses B) Chest compressions C) Antibiotics D) Vasopressors

A) Fluid boluses

Which of the following directly affects perfusion as it relates to shock? A) Fluid volume B) Baseline muscle mass C) Heart size D) Body weight

A) Fluid volume

Which of the following patients may benefit from CPAP?

Alert patient with respiratory distress following submersion in water

Common feature of all types of shock?

All have a critical reduction in the supply of oxygenated blood to the bodies tissue.

Multiple Organ Dysfunction Syndrome (MODS)

Altered organ function Homeostasis cannot be maintained without intervention. Body systems fail Cascade effect

Hemorrhagic Anemia

Anemia caused by blood loss.

Hemolytic Anemia

Anemia caused by the destruction and underproduction of RBC's.

Blood Vessels Flow pg.1258 Vol1

Arteries Arterioles Precapillary Sphincters Capillaries Postcapillary Sphincters Venules Viens

What happens as shock progresses from early to late? A) The precapillary sphincters relax, and the postcapillary sphincters remain open. B) The precapillary sphincters relax, and the postcapillary sphincters remain closed. C) The precapillary sphincters close, and the postcapillary sphincters remain open. D) The precapillary sphincters close, and the postcapillary sphincters remain closed.

B) The precapillary sphincters relax, and the postcapillary sphincters remain closed.

You are ordered to administer 1 mg of atropine IV push. Your vial contains 10 mL at 0.1 mg/mL. How many milliliters will you administer? a. 0.1 b. 1 c. 10 d. 10.1

c. 10

You are on scene to treat a 29-year-old female who was thrown from a vehicle during an accident. You notice multiple deformities in her extremities, and she has a rigid abdomen. Initial vital signs indicate a blood pressure 110/80 mm Hg and a heart rate of 114 beats/min. Which of the following is an accurate statement regarding her condition? A) Death B) Early (compensated) shock C) Irreversible shock D) Late (decompensated) shock

B) Early (compensated) shock

The blood loss of 15% to 30% is associated with the ________ stage of shock and is classified as class _____. A) Early/1 B) Early/2 C) Late/3 D) Irreversible/4

B) Early/2

Water and sodium leaking into cells, potassium leaking out of cells, and cellular swelling typically occur in which phase of shock? A) Chemical B) Irreversible C) Early D) Late

B) Irreversible

Which of the following is a cause of external bleeding? A) Splenic rupture B) Lower gastrointestinal bleeding C) Intracranial bleeding D) Bowel perforation

B) Lower gastrointestinal bleeding

The management and treatment of a patient in any stage of shock must be directed to: A) Maintaining mental status B) Managing oxygenation and perfusion of organs C) Maintaining a pulse pressure of at least 30 mm Hg D) Increasing systolic blood pressure

B) Managing oxygenation and perfusion of organs

You are managing a 34-year-old male patient who was the unrestrained driver of a pickup truck that rolled over at approximately 55 mph. During your trauma assessment, you find him awake but confused and anxious. He is speaking two to three words at a time. There is no obvious head trauma, moderate JVD, crepitus on the left lateral chest wall, and decreased breath sounds on the left side. There is tenderness in the upper right abdominal quadrant, and the rest of his exam reveals only superficial lacerations. His blood pressure is 86/40 mm Hg, his heart rate is 112 beats/min, and his respiratory rate is 30 breaths/min. Immediate care for this patient includes: A) Pericardiocentesis for cardiac tamponade B) Needle chest decompression for a tension pneumothorax C) IV fluids, blood ideally, for hypovolemia D) Use of a PASG and rapid sequence intubation

B) Needle chest decompression for a tension pneumothorax

Washout Phase

Postcapillary sphincters open, allowing fluid in the capillary beds to be pushed into circulation Follows stagnate phase. Cells released endotoxins Excess K+ and acid causing more harm

You are on scene with a 32-year-old male who sustained a gunshot wound to the abdomen. Vital signs indicate a heart rate of 142 beats/min, a blood pressure of 70 mm Hg systolic, and a respiratory rate of 26 breaths/min. You attempt to gain intravenous access multiple times. Which of the following is the next appropriate initial treatment? A) Provide oral hydration. B) Attempt IO access. C) Consider using a PASG. D) Hold IV fluids.

B) Attempt IO access.

You are on scene with a 77-year-old female in a nursing home. She feels warm to the touch. She has a blood pressure of 68 mm Hg by palpation and a heart rate of 110 beats/min. Which of the following is the cause of the patient's hypotension? A) Virus B) Bacteria C) Heart failure D) Spinal cord injury

B) Bacteria

The stagnant phase of shock is also known as: A) Compensated shock B) Decompensated shock C) Dissociative shock D) Irreversible shock

B) Decompensated shock

The best definition of shock is: A) Dilation of blood vessels or inadequate blood volume B) Dilation of blood vessels, pump failure, or inadequate blood volume C) Pelvis fracture D) Pump failure

B) Dilation of blood vessels, pump failure, or inadequate blood volume

You are treating a patient who presents with signs of shock. No trauma is noted, and the only pertinent history is a leg fracture 6 days earlier. What type of shock do you suspect? A) Hypovolemic shock B) Obstructive shock C) Dissociative shock D) Neurogenic shock

B) Obstructive shock

Cardiac Output

Blood pumped into the aorta each minute Heart Rate x Stroke Volume.

Stroke Volume

Blood pushed out of the ventricle with each contraction Cardiac Output / Hear Rate Normal stroke volume: male 70ml x kg; female 65ml x kg

Preload

Blood that passively flows into ventricles Initial 70%

Heart Blood Flow

Vena Cava Right Atria Tricuspid Valve Right Ventricle Pulmonary Valve Pulmonary Artery Pulmonary Vein Left Atria Mitral/Bicuspid Valve Left Ventricle Aortic Valve Aorta

The transfer of oxygen and carbon dioxide between the capillary red blood cells and the tissue cells is called: a. External respiration b. Internal respiration c. Internal ventilation d. Pulmonary ventilation

b. Internal respiration

After inserting an 18 gauge over-the-needle catheter into the hand vein of a 30 y/o 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 occured and immediately discontinue the IV D. discontinue the IV and circumferentially wrap a dressing around the extremity

C. recognize that infiltration has occured and immediately discontinue the IV

The process of moving air into and out of the lungs is called A. respiration B. inhalation C. ventilation D. exhalation

C. ventilation

Which of the following structures extends from the epiglottis to the glottis? a. Alveoli b. Laryngopharynx c. Oropharynx d. Trachea

b. Laryngopharynx

Clinical signs of irreversible shock include: A) Decreased muscle tone B) Confusion C) Hypoxemia D) Hot, dry skin

C) Hypoxemia

Shock might best be defined as: A) Internal or external blood loss B) Hypoxemia C) Inadequate tissue perfusion D) Low blood pressure

C) Inadequate tissue perfusion

You are on scene with a patient who fell off of a construction beam. He has multiple fractures and bleeding. You are monitoring vital signs. Blood pressure is 50 mm Hg by palpation. Heart rate is 60 beats/min. Which of the following best describes this patient's condition? A) Washout phase B) Early (compensated) shock C) Irreversible shock D) Late (compensated) shock

C) Irreversible shock

Which of the following is a cause of dissociative shock? A) Anemia B) Excessive vomiting C) Pulmonary embolism D) Pericarditis

C) Pulmonary embolism

Use of the PASG would be indicated for: A) Congestive heart failure B) Penetrating thoracic injury C) Suspected intraperitoneal hemorrhage with hypotension D) Traumatic cardiopulmonary arrest

C) Suspected intraperitoneal hemorrhage with hypotension

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.

Medical control orders and infusion of 1 liter of normal saline over 4 hours during a long distance transport. You have a 1,000 mL bag or 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

When handling a patient who is in shock, what is the concern if they are taking an ACE inhibitor? A. ACE inhibitors block channels in the heart, limiting performance. B. ACE inhibitors inhibit ADH from being released from the pituitary gland. C. ACE inhibitors inhibit the conversion of angiotension I to angiotension II. D. ACE inhibitors prevent blood clotting, thus causing excess hemorrhage.

C. ACE inhibitors inhibit the conversion of angiotension I to angiotension II.

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 repsirations

C. Kussmaul respirations

What type of distributive shock results in a loss of sympathetic vascular tone? A. Anaphylactic B. Cardiogenic C. Neurogenic D. Septic

C. Neurogenic

During compensated shock, what happens to ventilations? A. They decrease in rate and increase in depth. B. They increase in rate and decrease in depth. C. They increase in rate and depth. D. They stay the same.

C. They increase in rate and depth.

Confirmation that you are in the medullary space is achieved by: A. feeling the bone "pop." B. pushing the needle 2 to 4 mm. C. aspirating bone marrow and blood. D. feeling resistance to the twisting of insertion. E. none of the above

C. aspirating bone marrow and blood.

After starting an IV in an arm vein of a patient with chest pain and properly securing the catheter in place, you not 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

Indications for CPAP include:

COPD CHF Pneumonia Asthma pulmonary edema.

An ET tube that is too large for a patient:

Can be difficult to insert and may cause trauma.

What does adequate perfusion depend on?

Cardiac Output (CO) Systemic Vascular Resistance (SVR) Transport of O2.

Blood

Carries O2 and nutrients from lungs to tissues.

Cardiogenic Shock

Condition in which the function of the heart muscle is severely impaired, leading to decreased cardiac output and inadequate tissue perfusion.

White Blood Cells (WBC)

Consume infectious organisms and produce antibodies.

During inhalation, the diaphragm does what?

Contract, which takes energy

What is a late sign of Decompensated Shock in children?

Hypotension

What is the main difference in Compensated and Decompensated Shock?

Hypotension

A severe allergic reaction caused by histamine release from exposure to an antigen is called: A) Psychogenic shock B) Antihistamine shock C) Septic shock D) Anaphylactic shock

D) Anaphylactic shock

You are treating a patient in decompensated shock. On physical exam, you note that the patient has hypotension, tachycardia, tachypnea, and crackles. What type of shock do you suspect? A) Septic B) Anaphylactic C) Hypovolemic D) Cardiogenic

D) Cardiogenic

A patient with noted hypotension, bradycardia, and jugular venous distention would lead you to suspect what type of shock? A) Hypovolemic shock B) Neurogenic shock C) Septic shock D) Cardiogenic shock

D) Cardiogenic shock

You are dispatched to treat a 22-year-old male patient who has reportedly been struck with a ball bat at the midshaft right femur. The area is contused, swollen, and angulated. The patient is conscious, alert, and normotensive, but tachycardic. He is in what stage of shock? A) Irreversible shock B) Decompensated shock C) Postcapillary shock D) Compensated shock

D) Compensated shock

You are on scene with a 92-year-old female who lives alone. The heat index is above 100° F. She denies trauma but smells of incontinence of watery stool. You arrive on scene and measure a heart rate of 120 beats/min and a blood pressure of 72 mm Hg systolic by palpation. You notice no injury. Which of the following is the probable cause of her hypovolemic shock? A) Internal bleeding B) External bleeding C) Congestive heart failure D) Dehydration

D) Dehydration

The death rate for patients with cardiogenic shock is: A) Typically low with adequate fluid replacement B) Lower than 20% with antibiotic therapy C) High unless bronchodilators are administered immediately D) High

D) High

You are on scene with a patient who had open-heart surgery 2 weeks ago. He is complaining of chest pain, shortness of breath, and weakness. On physical examination, you notice jugular venous distention, clear lung sounds, and muffled heart tones. Which of the following types of shock is this patient demonstrating? A) Dissociative B) Cardiogenic C) Hypovolemic D) Obstructive

D) Obstructive

You are evaluating a 24-year-old female patient who was the driver of a sedan involved in a head-on highway-speed motor vehicle crash. After she has been extricated from being pinned against the steering wheel, you begin your evaluation. She is awake but very anxious and confused. You do not note any head trauma, JVD is present, her chest wall appears intact, but her lung sounds are decreased bilaterally, though clear. Her heart tones sound distant. There is a large abrasion from the seatbelt developing across her chest and bruising in the shape of the steering wheel. Her abdomen is tender in the upper quadrants with bruising developing in the right upper quadrant. Her vital signs are heart rate, 128 beats/min; blood pressure, 88/74 mm Hg; and respiratory rate, 26 breaths/min and shallow. Immediate care for this patient includes: A) IV fluids, blood ideally, for hypovolemia B) Needle chest decompression for a tension pneumothorax C) PASG and rapid sequence intubation D) Pericardiocentesis for cardiac tamponade

D) Pericardiocentesis for cardiac tamponade

Neurogenic shock resulting from head injury creates: A) Hyperventilation syndrome B) Decreased cardiac output C) Peripheral vascular constriction D) Peripheral vascular dilation

D) Peripheral vascular dilation

Peritonitis and cellulitis might produce what type of shock? A) Hemorrhagic shock B) Hypovolemic shock C) Cardiogenic shock D) Septic shock

D) Septic shock

Which of the following is a cause of distributive shock? A) Laceration B) Broken femur C) Heart attack D) Spinal cord injury

D) Spinal cord injury

During irreversible shock, arterial hypotension and opening of AV shunts cause: A) Increased blood flow through the arterioles B) Systemic hypertension C) Decreased blood flow in the capillaries D) Stagnation of blood flow in the capillaries

D) Stagnation of blood flow in the capillaries

Your patient has a blood pressure of 60/40 mm Hg and a heart rate of 110 beats/min, and you suspect internal bleeding. Which of the following is an appropriate initial treatment for this patient? A) Contact medical control. B) Consider cardioversion. C) Start dopamine. D) Start two large peripheral IV lines.

D) Start two large peripheral IV lines.

Which of the following causes obstructive shock? A) Stenosis B) Deep vein thrombosis C) Peripheral vascular constriction D) Tension pneumothorax

D) Tension pneumothorax

Early shock is compensated by: A) Cellular/vascular shunting B) Capillary leakage C) Increased preload pressure D) Vasoconstriction

D) Vasoconstriction

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.

From an airway management perspective, the MOST important anatomical consideration regarding an adults tongue is A. the fact 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.

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.

Leaving the constricting band on for too long is likely to cause: A. collapse of the vein. B. damage to the distal blood vessels. C. damage to the vessels under the band. D. changes in the distal venous blood. E. all of the above

D. changes in the distal venous blood.

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 semi-conscious D. does not remove the need for proper head positioning

D. does not remove the need for proper head positioning

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 in the blood

D. exchange oxygen and carbon dioxide in the blood

You respond to a report of a 14-year-old female patient who is reported having difficulty breathing. Upon arrival you find that she is having difficulty breathing, and her mother tells you that the girl has asthma. You consider which events occur with an asthma attack in order to develop a plan of treatment. Which would you NOT expect with an asthma attack?

Decreased secretion of mucous

Pulse Pressure

Difference between the systolic and diastolic blood pressure. - Less then 30mm Hg suggests major vasoconstriction, maybe an indicator of hypovolemic shock.

Hypovolemic Shock

Inadequate tissue perfusion caused by inadequate vascular volume.

Sterilization is recommended for: a. Environmental surfaces that have become soiled b. Instruments or devices that penetrate the skin c. Reusable instruments that come in contact with mucous membranes d. Surfaces that come into contact with intact skin

b. Instruments or devices that penetrate the skin

Types of Hypovolemic Shock?

Hemorrhagic Shock (Internal or External) Dehydration (Vomiting, Diarrhea, Sweating) Third Spacing (Shift of interstitial fluids "third spacing" due to thermal injuries (plasma loss) or diabetes.)

Which position should the endotracheal tube be in for digital intubation? a. Curved in a more exaggerated J shape b. In a straight position to facilitate insertion c. Larger than the tube ordinarily used d. Well lubricated with a numbing solution

a. Curved in a more exaggerated J shape

Hemoglobin

Iron containing protein Allows RBC's to carry O2

How does the Release of Anitdiuretic Hormone (ADH) compensate in shock?

Kidneys reabsorb more H2O Increase BP

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia?

Kussmaul respirations

A neonatal patient is said to weigh 1.2 kg. This is equivalent to which of the following? a. 120 g b. 240 g c. 1,200 g d. 12,000 g

c. 1,200 g

How does Intracellular Fluid Shift compensate in shock?

Moves fluid from cells and tissue into the blood vessels Increasing BP

What is the most common cause of cardiogenic shock?

Myocardial Infarction (MI)

What are the formed elements of plasma?

Nutrients, Electrolytes, Gases, Wastes, Proteins (albumin, clotting factors, antibodies and hormones) also carries small amounts of O2.

Distributive Shock

Occurs when blood vessels dilate, increasing the size of the vascular space and the blood must fill a greater space resulting in an altered distribution of the blood volume. No blood is lost.

Shock can result from what 4 conditions?

Pump Failure. (Heart Failure) Failure of the pipes. (Blood Vessel Failure) Inadequate Fluid in the pipes. (Blood Volume) Inability of RBC's to deliver O2 to tissues.

Blood Formed Elements

Red blood cells White blood cells Plateles

Afterload

Resistance which the ventricles must pump against to eject blood from the heart. Dependent on vasodilation/vasoconstriction

Acute Respiratory Distress Syndrome (ARDS)

Respiratory failure and acute noncardiac pulmonary edema caused by a direct or indirect pulmonary insult. Symptom of MODS.

Septic Shock

Sepis with hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include lactic acidosis, decreased urine output, or sudden change in mental status.

What are the 3 types of Distributive Shock?

Septic Shock Anaphylactic Shock Neurogenic Shock *Certain overdoses such as sedatives and narcotics.

Beck's Triad

Signs of cardiac tamponade JVD,Hypotension, and muffled heart sounds

Fick Principle

Supply and Demand principle of adequate O2 perfusion

The dispatcher informs you that you have call for respiratory distress. While responding, you receive a radio report from a first responder on the scene giving you patient information. The report includes that the patient is a smoker with a history of COPD. Based on the pathophysiology of this disease, which other piece of information is MOST likely to be included in the first responder's radio report?

Symptoms increased gradually over days

Irreversible Shock

Terminal Shock Body completely shifted from aerobic metabolism to anaerobic metabolism Metabolic acidosis. Cell damage due to endotoxins in vascular space

Sepsis

The systemic response to an infection.

How does the Renin-Angiotensin-Aldosterone Mechanism compensate in shock?

Vasoconstricting agent. Increases preload and afterload Kidneys reabsorb more water.

How does the Autonomic Nervous System (ANS) compensate in shock?

Vasocontriction Bronchodilation Increased Cardiac Output (Inotropy, Chronotropy, Dromotropy)

Cuffed ET tubes are generally not used in the field until the child is 8 to 10 years old because:

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

Which of the following is the equivalent of 200 g? a. 0.2 kg b. 0.2 lb c. 0.2 mcg d. 0.2 m

a. 0.2 kg

A patient weighing 220 lb weighs: a. 100 kg b. 110 kg c. 440 kg d. 484 kg

a. 100 kg

The kilogram is equal to: a. 2.2 lb b. 4.4 lb c. 8.2 lb d. 8.4 lb

a. 2.2 lb

You have just delivered a newborn male and need to suction secretions from the airway. Which of the following best describes the amount of time that suctioning should be done on a newborn? a. 3 to 5 seconds b. 10 seconds or less c. Under 15 seconds d. 30 seconds or less

a. 3 to 5 seconds

Your patient is to receive a dosage of 5 mcg/kg. The patient weighs 150 lb. Which of the following is the correct dosage of medication for this patient? a. 340 mcg b. 540 g c. 750 mcg d. 1000 mcg

a. 340 mcg

The distal cuff of the ET tube should hold _____ mL of air. a. 6 to 10 b. 10 to 20 c. 15 to 25 d. 20 to 30

a. 6 to 10

The normal partial pressure of oxygen in arterial blood is: a. 80 to 100 Torr b. 150 to 160 Torr c. 180 to 200 Torr d. 210 to 220 Torr

a. 80 to 100 Torr

During a digital intubation attempt, which of the following needs to be done before digit insertion? a. A bite block should be placed to avoid injury to the rescuer b. Intravenous access should be established c. Nasotracheal intubation d. Placement of an endotracheal tube

a. A bite block should be placed to avoid injury to the rescuer

Which of the following is the best definition of standard precautions? a. Actions required by personnel every time they are in contact to a patient b. Actions required by personnel when they encounter a dirty patient c. Actions required by personnel when they encounter a patient with a known disease d. Actions required by personnel when they encounter an elderly patient

a. Actions required by personnel every time they are in contact to a patient

Systemic complications of a peripheral IV might include: a. Air embolus/catheter shear b. Diverticulitis c. Hemothorax d. Pneumothorax

a. Air embolus/catheter shear

Complications of intraosseous cannulation include all of the following EXCEPT: A. pulmonary embolism. B. fracture. C. growth plate damage. D. aspiration of bone marrow. E. complete insertion.

a. Alveoli

Which of the following respiratory structures is the location of oxygen and carbon dioxide exchange? a. Alveoli b. Carina c. Hilum d. Vallecula

a. Alveoli

Which of the following has been directly linked to perfusion? a. Amount of hemoglobin b. Blood pressure c. Carbon dioxide level d. Systemic vascular resistance

a. Amount of hemoglobin

You have started a central IV line on a critical patient and are en route to the hospital. Just as you notice the IV tubing has accidentally disconnected from the catheter, your patient becomes cyanotic, weak, and dyspneic; has a rapid pulse; and begins to lose consciousness. You suspect the patient is experiencing: a. An air embolism b. Fluid overload c. Hypovolemia d. Infiltration

a. An air embolism

Shock that results from severe allergic reactions is called: a. Anaphylactic shock b. Cardiogenic shock c. Neurogenic shock d. Septic shock

a. Anaphylactic shock

Which of the following is a cause of dissociative shock? a. Anemia b. Excessive vomiting c. Pulmonary embolism d. Pericarditis

a. Anemia

Which of the following terms best describes the use of alcohol or iodine to clean the skin before a needle puncture? a. Antisepsis b. Cleaning c. Disinfection d. Sterilization

a. Antisepsis

When activated, the central nervous system ischemic response causes an increase in: a. Arterial pressure b. Contractility c. Heart rate d. Respiratory rate

a. Arterial pressure

For which of the following conditions is peak expiratory flow decreased? a. Asthma b. Emphysema c. Profound hypovolemia d. Pulmonary embolism

a. Asthma

Your patient was choking on a piece of meat. He attempted to cough the meat out, then became silent and turned blue. You and your partner attempted the Heimlich maneuver without any success. The patient is now unresponsive. Which of the following would be an appropriate next action? a. Attempt to remove the meat with Magill forceps. b. Begin CPR. c. Place an oropharyngeal airway. d. Provide supplemental oxygen.

a. Attempt to remove the meat with Magill forceps.

The technique of giving a medication in less than 1 to 3 minutes through an IV line is called an IV: a. Bolus b. Hickman c. Infusion d. Intermittent infusion

a. Bolus

Which of the following best defines the purpose of humidified oxygen? a. Bubble oxygen to add moisture to the gas b. Dry moist oxygen to prevent airway irritation c. Inject moisture into the oxygen cylinder d. Moisten oxygen the inside the face mask

a. Bubble oxygen to add moisture to the gas

Which of the following is an enteral route of medication administration? a. Buccal b. Intramuscular c. Intravenous d. Subcutaneous

a. Buccal

A potential hazard associated with parenteral medication administration is: a. Cellulitis or abscess formation b. Hypovolemia c. Injection of needle splinters d. Slow medication absorption

a. Cellulitis or abscess formation

Which of the following is a vein found in the antecubital fossa? a. Cephalic b. Cutaneous c. Femoral d. Popliteal

a. Cephalic

The patient is a 62-year-old woman involved in a motor vehicle crash. You note that the woman is in obvious respiratory distress. In assessing the patient, you also note that the patient has a stoma because of a laryngectomy several years earlier. What should you do to assist the woman's breathing? a. Insert an endotracheal tube into the stoma and ventilate. b. Perform nasotracheal intubation and ventilate thought the tube. c. Use an adult bag-mask device over the patient's mouth and nose. d. Use an adult-sized mask and ventilate through the stoma.

a. Insert an endotracheal tube into the stoma and ventilate.

The laryngeal mask airway: a. Is easier to insert than an endotracheal tube b. Is ideal for conscious patients c. Is well tolerated by a patient with an intact gag reflex d. Provides absolute protection against aspiration

a. Is easier to insert than an endotracheal tube

An advantage of a Venturi mask is that: a. It can be used to deliver a precise concentration of oxygen b. High concentrations of oxygen can be delivered c. It is color coded for easy recognition in dimly lit environments d. It uses less oxygen but delivers a higher concentration

a. It can be used to deliver a precise concentration of oxygen

The purpose of the oropharyngeal airway is to: a. Keep the tongue from blocking the airway. b. Lift the palate to further open the airway. c. Open the nasopharynx to allow airflow. d. Push the epiglottis away from the larynx.

a. Keep the tongue from blocking the airway.

You have a patient who has significant peripheral vascular disease. He has been in a motor vehicle crash and appears to have a fractured right humerus. His right arm is swollen and edematous. He is currently being intubated. Which of the following would be the most appropriate site for venous cannulation? a. Left cephalic vein b. Left external jugular c. Right cephalic vein d. Right hand

a. Left cephalic vein

You are about to suction a patient's airway because of copious secretions. Which of the following should be completed before suctioning? a. Provide supplemental oxygen before suctioning. b. Provide supplemental oxygen with a bag-mask device before suctioning. c. Remove secretions with gauze before suctioning. d. Suction with hard catheter first.

a. Provide supplemental oxygen before suctioning.

Which of the following statements is most accurate when assessing the ventilations of a 2-year-old child? a. Respirations are primarily diaphragmatic in the under-7 age group. b. Respirations are primarily diaphragmatic in the under-13 age group. c. Respirations are primarily intercostal in the under-7 age group. d. Respirations are primarily intercostal in the under-13 age group.

a. Respirations are primarily diaphragmatic in the under-7 age group.

Before you administer lidocaine 2% to a patient, you confirm your partner has drawn up the 2% concentration, not the 20% concentration. This is an example of which of the "six rights"? a. Right dose b. Right drug c. Right route d. Right time

a. Right dose

When documenting parenteral medications, you must document medication, dosage, time, route, and the: a. Site of injection b. Size of the medication container c. Size of the syringe d. Type of dressing

a. Site of injection

A patient has a tracheostomy tube. The patient continually coughs, and there appears to be an obstruction of the tracheostomy tube. Which of the following rationales best explains why this occurs? a. The air bypasses the nose and mouth. b. The air has a shorter transport to the lungs. c. The material of the tracheostomy tube absorbs the humidity. d. There is too much humidified air in the trachea.

a. The air bypasses the nose and mouth.

You are using an esophageal detection device to verify endotracheal tube placement. After squeezing the bulb, attaching it to the endotracheal tube, and releasing the bulb, you note that the bulb does not reinflate. Which of the following should you assume? a. The endotracheal tube is in the esophagus. b. The endotracheal tube is in the mainstem bronchus. c. The endotracheal tube is in the trachea. d. The endotracheal tube is positioned in the carina.

a. The endotracheal tube is in the esophagus.

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:

abort the attempt and ventilate with a bag-mask device and 100% oxygen.

If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should:

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

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

adequately preoxygenate with 100% oxygen.

The endotracheal tube size refers to the _____ in millimeters. a. External diameter b. Internal diameter c. Length d. Length of tube that will pass beyond the vocal cords

b. Internal diameter

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:

administer oxygen via nonrebreathing mask and continue your assessment.

Each respiratory bronchiole divides to form:

alveolar ducts.

The LMA is:

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

breathing characterized by a prolonged inspiration unrelieved by expiration attempts, seen in patients with damage to the upper part of the pons

apneustic respiration

Most of the complications caused by intubation-induced hypoxia:

are subtle and occur gradually.

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:

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

A 28-year-old female patient is unresponsive from an unknown medical cause. Verbal and physical stimulation have failed to awaken her. You notice that the patient's airway is partially obstructed by her tongue. After properly positioning the woman's head and chin, you decide to insert an oropharyngeal airway. To determine the proper size airway, you measure from the: a. Center of the mouth to the larynx b. Corner of the mouth to the ear lobe c. Middle of the ear to the larynx d. Tip of the nose to the ear lobe

b. Corner of the mouth to the ear lobe

The "sixth patient right" of medication administration is: a. Asking the patient about allergies to medication b. Correct and thorough documentation of the medication administered c. Double calculation of a medication dosage d. Having a co-worker check your calculations

b. Correct and thorough documentation of the medication administered

You are on scene with a patient who requires multiple intravenous catheters. You dropped a needle following a needle stick. Which of the following is the most appropriate action? a. Call medical control. b. Count your sharps to see if one is missing. c. Do not worry. You can check at the end of your shift. d. Refuse to transport until sharp is located.

b. Count your sharps to see if one is missing.

You are on scene with a patient who has lost a considerable amount.of blood because of multiple injuries. Which of the following is consistent with hypovolemic shock? a. Increased venous return b. Decreased preload c. Decrease anaerobic metabolism d. Increased intravascular volume

b. Decreased preload

After intubation you determine a right mainstem intubation. The next appropriate action to take is to: a. Continue to ventilate the patient b. Deflate the cuff and withdraw the tube 1 to 2 cm c. Inflate the cuff with an additional 3 to 5 mL of air d. Remove the tube

b. Deflate the cuff and withdraw the tube 1 to 2 cm

When using a straight blade to intubate an adult patient, the tip of the blade should be placed: a. Above the epiglottis b. Directly on the epiglottis c. In the vallecula d. Past the epiglottis at the vocal cords

b. Directly on the epiglottis

It is 0700 hours, and you arrive at the station as usual. Upon inspecting your vehicle, you notice that the sharps container is 75% full. What should you do? a. Attempt to empty "nonsharps" from the container. b. Dispose of the container according to protocol. c. Do nothing. d. Throw it in the regular garbage and replace it with a new container.

b. Dispose of the container according to protocol.

You have just finished administering a patient with a 50-mg IM injection of diphenhydramine. What is your next intervention? a. Check the airway. b. Dispose of the needle and syringe in a sharps container. c. Increase the oxygen being delivered. d. Recheck vital signs.

b. Dispose of the needle and syringe in a sharps container.

When choosing a location for venipuncture, choose the most suitable: a. Central vein b. Distal vein c. Leg vein d. Proximal vein

b. Distal vein

Which of the following is an appropriate action to avoid getting stuck with a sharp? a. Always put sharps in the trash. b. Do not overfill sharps containers. c. Recap needles. d. Stick needles into a mattress for safe keeping.

b. Do not overfill sharps containers.

A 48-year-old female patient presents in respiratory failure following an exposure to toxic fumes. She is breathing four times per minute and she appears to be gasping for each breath. Which of the following devices should be used? a. Bag-mask device ventilation b. Endotracheal intubation c. Inserting the LMA d. Using the Combitube

b. Endotracheal intubation

During the transfer of an intubated patient, you notice that coarse breath sounds are developing. You attempt to suction the trachea for secretions. The suction catheter becomes obstructed. Which of the following best describes the next appropriate action? a. Change the catheter tip. b. Flush the catheter with sterile saline to clear obstruction. c. Perform a finger sweep. d. Stop suctioning, and continue to ventilate.

b. Flush the catheter with sterile saline to clear obstruction.

A patient has a tracheostomy tube in place. You are transporting this patient from an extended care facility to the emergency department. It appears that the tracheostomy may be partially obstructed. Which of the following devices or techniques would be the best to remove an obstruction from the tracheostomy tube? a. Finger sweep b. French catheter attached to suction c. Remove the tracheostomy tube and flush with fluid d Yankauer suction tip

b. French catheter attached to suction

The narrowest part of the adult upper airway is known as the: a. Epiglottis b. Glottic opening c. Nasopharynx d. Vallecula

b. Glottic opening

Inadequate circulation of blood and nutrients to the tissue is known as: a. Autolysis b. Hypoperfusion c. Necrosis d. Phagocytosis

b. Hypoperfusion

You have just administered an IV medication to your patient that was prepared for you by your paramedic partner. After administering the medication, you realize your partner prepared the wrong medication. Which of the following is your best course of action? a. Document the drug you intended to give. b. Immediately advise medical direction and carefully monitor the patient for effects of the medication. c. Immediately call the state Pharmacy Board and inform them of the error. d. Place the blame on your partner and have him or her write the report.

b. Immediately advise medical direction and carefully monitor the patient for effects of the medication.

Which of the following is the process by which fluid enters the surrounding tissue? a. Hematoma b. Infiltration c. Pneumothorax d. Thrombus

b. Infiltration

Tidal volume is the amount of air: a. Always present in the alveoli b. Inhaled or exhaled during a normal breath c. Left in the lungs after a forceful exhalation d. That oOne can inhale after a maximal inhalation

b. Inhaled or exhaled during a normal breath

A 44-year-old female patient is in respiratory distress after being struck in the face with a baseball bat. The patient has an oxygen saturation of 72%. Which of the following airway maneuvers is the most appropriate? b a. Insert a dual lumen airway. b. Insert an endotracheal tube. c. Insert an oropharyneal airway. d. Use a nasopharyngeal airway.

b. Insert an endotracheal tube.

The patient is a 38-year-old woman who fell and broke her left femur. The woman is complaining of severe pain. Her vital signs are blood pressure, 116/70 mm Hg; pulse, 90 beats/min; and respirations, 18 breaths/min. After caring for the woman's injury, you and your team place the woman on the stretcher and in the ambulance. You decide to monitor the patient's pulse oximetry. Although the woman's vital signs remain nearly unchanged, her SpO2 drops from 98 to 92 and her skin becomes slightly pale. Which of the following is the most likely cause for the drop in SpO2? a. Development of shock lung b. Loss of blood because of the fracture c. Malfunctioning pulse oximeter d. Severe pain interrupting breathing

b. Loss of blood because of the fracture

A disadvantage of the laryngeal mask airway is that: a. It can be used on any sized mouth b. Not all patients can be adequately ventilated with an LMA c. The LMA must be removed before intubation d. The spine must be manipulated for insertion of an LMA

b. Not all patients can be adequately ventilated with an LMA

Direct laryngoscopy is associated with complications including: a. Main stem bronchus intubation b. Oral trauma and breaking of teeth c. Perforation of the maxillary sinus d. Rupture of the tonsillar membrane

b. Oral trauma and breaking of teeth

Oropharyngeal airways are designed to: a. Allow for better visualization during endotracheal intubation b. Prevent the tongue from obstructing the airway c. Provide a guide for suction catheters d. Push the tongue into the oropharynx

b. Prevent the tongue from obstructing the airway

Which of the following actions is the most appropriate care for a patient with gurgling respirations? a. Insert an oropharyngeal airway b. Provide immediate suctioning c. Re-tip the patient's head d. Take no action

b. Provide immediate suctioning

A 10-year-old in respiratory failure from asthma has been intubated with the tube placed at a depth of 30 cm. What is the next most appropriate action? a. Begin ventilating the patient; this is the appropriate depth. b. Pull the tube back to 17 cm and begin ventilating. c. Push the tube in 2 cm farther. d. Remove tube and reintubate.

b. Pull the tube back to 17 cm and begin ventilating.

You are on scene with a 6-year-old who is having a seizure. You are unable to obtain IV access. The medication that is approved by your medical control is diazepam (Valium). Which of the following is an appropriate route for administration of this medication? a. Oral b. Rectal c. Subcutaneous d. Sublingual

b. Rectal

Antiseptics and disinfectants are chemical agents used to kill: a. Resistant bacterial strains b. Specific groups of microorganisms c. Spores of bacteria d. Spores of fungi

b. Specific groups of microorganisms

You are preparing to intubate a 4-year-old male patient. Upon removing the endotracheal tube from its package, you notice there is no inflatable cuff on the tube. Which of the following explains why this tube does not have a cuff? a. The pediatric airway collapses and is too small for a cuff. b. The pediatric airway creates a natural seal around the tube. c. The pediatric airway is fragile and a cuff may rupture it. d. The pediatric airway is too rigid to accommodate a cuff.

b. The pediatric airway creates a natural seal around the tube.

You are caring for a patient in the early stages of shock for which the body is compensating adequately. Which of the following comments regarding pulse oximetry readings is appropriate? a. The reading is completely accurate and reflects oxygen saturation. b. The reading is inaccurate because of the poor perfusion to the periphery. c. The reading is low and calls for aggressive airway management. d. The reading suggests adequate breathing and oxygenation.

b. The reading is inaccurate because of the poor perfusion to the periphery.

Which of the following is the best way to determine which of the three vessels is the vein in an attempt to catheterize the umbilical site in a newborn a. The arteries are dilated. b. The vein is a thin-walled vessel. c. There is only one artery. d. There are two veins.

b. The vein is a thin-walled vessel.

Intubation of the trauma patient is MOST effectively performed:

by two paramedics.

A disadvantage of ET intubation is that it:

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

A vial of Valium is supplied with 10 mg in 2 mL. The dosage for this patient is to receive 2 mg. How much solution should be drawn up for this patient? a. 0.2 mL b. 0.3 mL c. 0.4 mL d. 0.5 mL

c. 0.4 mL

You are on scene with a patient who was in a motor vehicle crash and hit the steering column. He is awake and complaining of chest pain and difficulty breathing. You do not see any sighs of deformities of the extremities, but his trachea is deviated to the right side. You hear finished breath sounds I'm the left. His respiratory rate is 28 and shallow. His heart rate is 125 beats a minute, and his blood pressure is 110mm By systolic. Which of the following is the most effective treatment for this patient? a. Cardiac monitor b. IV access c. Needle decompression of the chest d. Assisted ventilation with a bag-mask device

c. Needle decompression of the chest

A patient has fallen off of a ladder. He is complaining of neck pain and weakness in his arms and legs. He has a blood pressure of 80/68 mm Hg and a heart rate of 78 beats/min. Which of the following types of shock would be most likely in this scenario? a. Anaphylactic b. Hypovolemic c. Neurogenic d. Septic

c. Neurogenic

Your paramedic partner has just finished discussing a medication order with the medical director of your base hospital. Your paramedic partner draws up the medication and hands you the syringe to administer to the patient. What must you do next? a. Give the medication immediately. b. Make sure your paramedic partner tells you what medication is in the syringe before you administer the medication . c. Never administer an unlabeled medication prepared by another person. d. Talk to the medical direction staff yourself before you can give the medication prepared by your partner.

c. Never administer an unlabeled medication prepared by another person.

The most commonly used route of medication administration is: a. IM b. IV c. Oral d. Sub-Q

c. Oral

The most common type of IV catheter used in the prehospital setting is the: a. Needle over guidewire b. Needle over the catheter c. Over-the-needle catheter d. Steel shank catheter

c. Over-the-needle catheter

The type of intravenous catheter most commonly used in the prehospital setting is the: a. Butterfly catheter b. Hollow catheter c. Over-the-needle catheter d. Through-the-needle catheter

c. Over-the-needle catheter

Medication administration by the intramuscular, intravenous, or intraosseous route is called: a. Enteral administration b. Integumentary administration c. Parenteral administration d. Periosteal administration

c. Parenteral administration

Which of the following is an advantage of endotracheal intubation as compared to other airway devices? a. Avoids delivering high-flow oxygen to the patient b. Avoids problems with air filtration in the upper airway c. Permits deep tracheal suctioning to remove secretions d. Permits gastric lavage through the endotracheal tube

c. Permits deep tracheal suctioning to remove secretions

Which of the following is an advantage of endotracheal intubation as compared to other airway devices? a. Avoids delivering high-flow oxygen to the patient b. Avoids problems with air filtration in the upper airway c. Permits deep tracheal suctioning to remove secretions d. Permits gastric lavage through the endotracheal tube

c. Permits deep tracheal suctioning to remove secretions

Which of the following is considered a normal finding when assessing a patient's mouth and pharynx? a. Broken teeth b. Foreign objects noted c. Pink color noted in mucous membranes d. Swollen tongue

c. Pink color noted in mucous membranes

What is the role of the pleural fluid? a. Increases heat production during respiration b. Increases risk of infection c. Reduces friction d. Reduces respiratory rate

c. Reduces friction

Which of the following is an accurate statement regarding medical asepsis? a. Eliminates transmission of organisms b. Free of microorganisms c. Reduces risk of organism transmission d. Sterile

c. Reduces risk of organism transmission

If an endotracheal tube has been correctly placed, an esophageal detector device will: a. Change color b. Give a normal CO2 readout c. Reinflate easily d. Remain collapsed

c. Reinflate easily

You are ventilating the lungs of an adult patient, and your partner is applying cricoid pressure. The patient makes a retching sound as though he might vomit. Which of the following should be done to avoid injury? a. Increase the downward pressure to prevent aspiration of gastric contents. b. Move the cartilage laterally in the neck to reduce the tendency to vomit. c. Release the pressure on the cricoid cartilage to prevent gastric rupture. d. Suction the airway while maintaining pressure on the cricoid cartilage.

c. Release the pressure on the cricoid cartilage to prevent gastric rupture.

You are considering using the LMA to manage the patient's airway. After inserting the airway, the patient begins to gag. What should you do next? a. Continue ventilating the patient, as the LMA is a secure airway. b. Provide suction through the LMA. c. Remove the LMA, and ventilate the patient with a bag-mask device. d. Reposition the LMA.

c. Remove the LMA, and ventilate the patient with a bag-mask device.

You are inserting a nasopharyngeal airway and are meeting resistance during the insertion. Which of the following should be your next step? a. Increase the insertion pressure until the airway is seated. b. Remove the airway, and use an oropharyngeal airway. c. Remove the airway, relubricate it, and insert the airway in the other nostril. d. Tape the airway in place, and insert a second airway into the other nostril.

c. Remove the airway, relubricate it, and insert the airway in the other nostril.

What does accessory muscle use suggest? a. Normal respirations b. Respiratory arrest c. Respiratory distress d. Respiratory failure

c. Respiratory distress

Lung sounds are heard after intubation only over the right lung of an adult patient. The 7.0id ET tube is at 27 cm at the teeth. The most likely explanation for the findings in the intubation scenario is: a. Left-sided pneumothorax b. Occlusion of the endotracheal tube c. Right mainstem intubation d. Right-sided hypertympany

c. Right mainstem intubation

You are on scene with a patient who is having a seizure. You are unable to establish IV access. In determining which medications can be given by an alternative route, which of the following "right" applies? a. Right dose b. Right patient c. Right route d. Right time

c. Right route

The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because:

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

During ventilation with the LMA, the paramedic should:

observe the patient for signs of inadequate ventilation.

Which of the following statements regarding orotracheal intubation is correct?

orotracheal intubation is the most common method of performing ET intubation.

The MOST obvious risk associated with extubation is:

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

When preoxygenating an uninjured child prior to ET intubation, you should:

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.

When intubating a 3-year-old child, you would MOST likely use a:

size 2 straight blade.

The MOST significant complication associated with the use of an oropharyngeal airway is:

soft-tissue trauma with oral bleeding.

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:

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