Paramedic Comprehensive Final Exam Practice

The Pediatric Assessment Triangle will help answer all of the following questions, EXCEPT:

"Will the child cooperate during my exam?"

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding.

1,000 mL

Cardiac symptoms of myocarditis usually appear ______ days after the onset of initial symptoms.

10 to 14

Your patient has a blood pressure of 80/60 mm Hg. What is his mean arterial pressure?

66 mm Hg

The door-to-balloon time for a patient with an ST elevation myocardial infarction is ___ minutes or less.

90

A 30-year-old woman presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. What should you suspect?

Abruptio placenta

A 59-year-old female presents with severe substernal chest pain. She is anxious and diaphoretic. What should you do?

Administer aspirin.

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading?

Carboxyhemoglobin

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

Difference in blood pressure between the two arms

Which of the following is typically the first complaint in a patient who is developing compartment syndrome?

Disproportionate pain

A right-sided ECG is indicated for patients who present with:

ECG evidence of an inferior infarction.

A 60-year-old woman presents with fever, chills, and shortness of breath. She has a history of mitral valve prolapse. Assessment reveals flat, painless red lesions on the palms of her hands. What should you suspect?

Endocarditis

A 39-year-old woman's car broke down, stranding her out in the country for approximately 18 hours. The outside temperature is 23°F. When you arrive and assess the woman, you determine that she is pulseless and apneic; her core body temperature is estimated to be below 86°F. CPR is immediately initiated and the woman is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient?

Give a single shock, immediately resume CPR, place advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport.

You are dispatched to an apartment complex for a 20-year-old woman who is sick. When you arrive at the scene and begin assessing the patient, she tells you that she has been experiencing a purulent vaginal discharge, but denies vaginal bleeding or a fever. Her blood pressure is 104/64 mm Hg, pulse rate is 88 beats/min and strong, and respirations are 14 breaths/min and regular. What should you suspect?

Gonorrhea

Which of the following statements regarding Grey Turner sign is correct?

Grey Turner sign is characterized by flank bruising and indicates internal bleeding.

Which of the following clinical findings would MOST likely differentiate a massive hemothorax from a tension pneumothorax?

Hemoptysis

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class:

III.

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

Kyperkalemia

A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V1 through V4. What should you suspect?

Left anterior descending artery occlusion

Which of the following organs is LEAST susceptible to pressure changes caused by an explosion?

Liver

A 33-year-old male presents with chest pain that is alleviated when he sits forward. The 12-lead ECG shows ST elevation of 2 to 3 mm in multiple leads. What should you suspect?

Pericarditis

A 70-year-old male presents with pain in his legs while walking. Within a few minutes of sitting down, however, his symptoms resolve. What should you suspect?

Peripheral arterial disease

A patient presents with fever, a headache, and a unilaterally sore throat. What should you suspect?

Peritonsilar abscess

Which of the following is the MOST important consideration during a pandemic?

Personal protective equipment

A 40-year-old man presents with difficulty urinating, fever, and tremors. Which of the following should you suspect?

Prostatitis

A 69-year-old female presents with a sudden onset of shortness of breath that woke her from her sleep. She is conscious, but anxious, and is coughing up pink sputum. She can only speak in two-word sentences and has cyanosis to her face. Her BP is 170/90 mm Hg, pulse rate is 130 beats/min, and respirations are 28 breaths/min. What should you do?

Provide noninvasive positive-pressure ventilation.

You are evaluating a 60-year-old woman's 12-lead ECG and note that the R wave height in lead V1 exceeds the S wave depth. What condition would MOST likely cause this?

Pulmonary hypertension

You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for:

QRS widening.

What 12-lead ECG finding should make you suspect a posterior STEMI?

ST depression in leads V1 and V2

In which of the following situations is oxygen indicated for a patient who complains of chest pain, pressure, or discomfort?

Signs of heart failure are present.

A 22-year-old male with sickle cell disease presents with severe abdominal pain. On assessment, his abdomen appears bloated and is rigid to the touch. What should you suspect?

Splenic sequestration syndrome

You have intubated a 70-year-old woman with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and her ETCO2 is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient?

Tracheobronchial suctioning

Which of the following clinical findings is the MOST consistent with hypertrophic cardiomyopathy?

Unexplained syncope

An obese 30-year-old female had two children within an 18-month time span. She presents with a feeling of "heaviness" in her pelvis and lower back pain. She states that the symptoms resolve slightly when she lies down. What should you suspect?

Uterine prolapse

You and your partner respond to a call for a domestic disturbance. You are both wearing high-level body armor. There are no indications of any weapons on the premises. What should you do?

Wait for law enforcement personnel to arrive and secure the scene.

Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT:

a secondary assessment.

In contrast to a patient in shock, you would expect a patient with increased intracranial pressure to present with:

a widened pulse pressure.

You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being "drunk." Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient's ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should:

administer a second dose of dextrose and prepare for immediate transport.

An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should:

administer a sedative medication.

A 9-year-old, 55-pound girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can MOST rapidly improve this child's condition by:

administering epinephrine IM.

You receive a call for a "sick child." When you arrive at the scene, the child's mother tells you that her 5-year-old son has had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his heart rate is 150 beats/min. The MOST appropriate treatment for this child involves:

administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route.

You receive a call to a residence for a patient who is "sick." Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should:

advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

Following decontamination, a patient is presented to you by rescue personnel for transport. The patient is conscious and alert, and is in no obvious respiratory distress. The patient is emitting a pungent odor and has an orange chemical on her clothing. You should:

advise the rescuers that the patient has not been adequately decontaminated.

When a child experiences a low cardiac output state, he or she relies MOST on:

an increase in heart rate.

You are dispatched to a residence for a 50-year-old woman with respiratory distress. While you are assessing the patient, she tells you that she began experiencing flulike symptoms 4 days ago, shortly after delivering mail on the rural mail route for which she is responsible. Her blood pressure is 90/50 mm Hg, pulse rate is 120 beats/min, and respirations are 26 breaths/min and labored. Auscultation of her breath sounds reveals the presence of coarse crackles. This patient has MOST likely been exposed to:

anthrax.

A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 97% on room air. He denies any other injuries. Initial management for this patient involves:

applying cool, wet dressings to the burn and elevating his arm.

When attempting resuscitation of a child with pulseless electrical activity, you should:

attempt to identify an underlying cause of the arrest.

When ventilating a patient with facial injuries, it is MOST important to:

be alert for changes in ventilation compliance.

A 22-year-old woman experienced an acid chemical burn to her left forearm. She complains of intense pain and tingling in her fingers. She is conscious and alert, and denies any other symptoms. You should:

begin immediate irrigation with water.

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should suspect a/an:

brown recluse spider bite.

A 40-year-old man fell 20 feet 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:

carefully open his airway with the head tilt-chin lift maneuver.

A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves:

continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform:

defibrillation.

A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The MOST likely cause of her syncopal episode is:

dehydration.

When ventilating an apneic adult with a pulse with a bag-mask device, you should:

deliver each breath over 1 second at a rate of 10 to 12 breaths/min.

The FIRST step in the START triage system involves:

directing all the walking wounded to an easily identifiable landmark.

The killing of pathogenic agents by directly applying a chemical made for that purpose is called:

disinfection.

Takotsubo cardiomyopathy is MOST often associated with:

emotional stress.

A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should:

encourage her to cough and closely monitor her condition.

You are transferring a 60-year-old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of a prior stroke, and hypertension. The patient tells you that he feels a fluttering sensation in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190 beats/min. The patient's blood pressure is 116/70 mm Hg and he remains conscious and alert. You should:

ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.

A 51-year-old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to:

ensure that she is sitting up and leaning forward.

Complications of aspiration include all of the following, EXCEPT:

excess surfactant production.

Two MOST important underlying principles of National Incident Management System are:

flexibility and standardization.

A patient would MOST likely become trapped between the driver's seat and steering wheel following a:

frontal crash.

Paralytic medications exert their effect by:

functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine.

Mild effects of cyanide exposure:

generally resolve by simply removing the victim from the environment and administering oxygen.

The pain associated with pericarditis:

improves when the patient leans forward.

Triage and emergency medical treatment should be performed:

in the cold zone.

Physiologic effects of histamine include all of the following, EXCEPT:

increased cardiac contractility

The middle ear consists of the:

inner portion of the tympanic membrane and the ossicles.

A patient with a suppressed cough mechanism:

is at serious risk for aspiration.

Epiglottitis in children:

is uncommon because children are vaccinated against Haemophilus influenza type b.

If an EMS agency is providing relief to a neighboring community during a disaster, it is important to ensure that:

it has enough coverage in its home area of responsibility.

You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to:

manually open his airway.

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:

manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

A 48-year-old man with a history of hypertension presents with a severe headache, tinnitus, and blurred vision. He is conscious and alert and denies any other symptoms. His BP is 204/120 mm Hg, his pulse rate is 100 beats/min, and his oxygen saturation is 96%. The closest appropriate facility is 20 minutes away. You should:

monitor his cardiac rhythm and transport.

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.

A 36-year-old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing no chest rise. The quickest way to secure a patent airway in this patient is to:

perform a needle cricothyrotomy.

Following blunt trauma to the anterior chest, a 44-year-old woman presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of her chest. You should:

perform an immediate needle thoracentesis to the right side of the chest.

If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should:

perform laryngoscopy and use Magill forceps.

The major complication associated with hollow organ injury is:

peritonitis caused by rupture and spillage of toxins.

The size of the rescue area is dependent MOSTLY upon the:

potential hazards that exist.

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.

A 10-year-old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary survey, you should:

provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport.

A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient's vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should:

remain with the patient, contact medical control, and request law enforcement intervention.

You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 80%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should:

remove the bag-mask device and suction his tracheostomy tube.

Cor pulmonale is a term used to describe:

right ventricular failure caused by pulmonary disease.

A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on:

searching for reversible causes.

With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once:

secondary sexual characteristics have developed.

You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves:

sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea.

A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to:

seriously consider ceasing resuscitative efforts.

A 38-year-old man presents with an acute onset of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 22 breaths/min and regular. You should:

start an IV with normal saline and set it to keep the vein open, place him in a position of comfort, and administer morphine and promethazine.

A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves:

suctioning her airway until it is clear of blood and other secretions, administering a sedative and paralytic, and performing endotracheal intubation.

A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will MOST likely find that the patient is:

tachypneic

A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should suspect:

tetanus.

The general area of a child's body that sustains initial trauma after being struck by an automobile depends MAINLY on:

the child's height and the height of the bumper upon impact.

While interviewing a severely depressed woman, the patient suddenly lunges at you with her hands. It is not known if the patient has any weapons. Your MOST appropriate action should be to:

throw your patient care form directly at the patient's nose and egress rapidly.

You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and a patent IV line is in place. During transport, you reassess her and note that she has become diaphoretic, tachycardic, and tachypneic. You should:

tilt the backboard to the left side.

A young female with experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should:

transport immediately.

Nitroglycerin is contraindicated for patients:

with suspected right ventricular infarction.