Chapter 15

You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include:

oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the:

liver.

A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is:

epilepsy.

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:

has bleeding within the brain.

The spinal cord exits the cranium through the: A. vertebral foramen. B. foramen magnum. C. foramen lamina. D. cauda equina.

B. foramen magnum.

What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position?

8

The mental status of a patient who has experienced a typical seizure: A) Is likely to improve over a period of 5 to 30 minutes. B) Progressively worsens over a period of a few hours. C) Is easily differentiated from that of acute hypoglycemia. D) Typically does not improve, even after several minutes.

A) Is likely to improve over a period of 5 to 30 minutes.

A transient ischemic attack (TIA) occurs when: A) The normal body processes destroy a clot in a cerebral artery. B) Signs and symptoms resolve spontaneously within 48 hours. C) Medications are given to dissolve a cerebral blood clot. D) A small cerebral artery ruptures and causes minimal damage.

A) The normal body processes destroy a clot in a cerebral artery.

You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should:

suction her oropharynx and apply 100% oxygen.

The three major parts of the brain are the: A) Midbrain, cerebellum, and spinal cord. B) Cerebrum, cerebellum, and brain stem. C) Brain stem, midbrain, and spinal cord. D) Cerebellum, medulla, and occiput.

B) Cerebrum, cerebellum, and brain stem.

Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. severe hypovolemia C. acute hypoglycemia D. acute alcohol withdrawal

B. severe hypovolemia

Which of the following medications is NOT used to treat patients with a history of seizures? Select one: A. phenobarbital B. phenytoin (Dilantin) C. hydromorphone (Dilaudid) D. carbamazepine (Tegretol)

C. hydromorphone (Dilaudid)

The left cerebral hemisphere controls: A. heart rate and pupil reaction. B. the right side of the face. C. the right side of the body. D. breathing and blood pressure.

C. the right side of the body.

The three major parts of the brain are the:

cerebrum, cerebellum, and brain stem.

When assessing arm movement of a patient with a suspected stroke, you should: A. expect to see one arm slowly drift down to the patient's side. B. ask the patient to hold his or her arms up with the palms down. C. observe the patient for approximately 5 minutes. D. ask the patient to close his or her eyes during the assessment.

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

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

D. cerebral vasodilation.

Which of the following MOST accurately describes a simple partial seizure?

a seizure that begins in one extremity

When caring for a patient with documented hypoglycemia, you should be MOST alert for:

a seizure.

An area of swelling or enlargement in a weakened arterial wall is called:

an aneurysm.

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to:

ask his wife when she noticed the symptoms.

Which of the following MOST accurately describes the cause of an ischemic stroke?

blockage of a cerebral artery

Muscle control and body coordination are controlled by the:

cerebellum.

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min and adequate. In addition to high-flow oxygen, further treatment should include:

dimming the lights in the back of the ambulance and transporting without lights and siren.

A patient whose speech is slurred and difficult to understand is experiencing:

dysarthria.

During the primary assessment of a semiconscious 70-year-old female, you should:

ensure a patent airway and support ventilation as needed.

A patient with an altered mental status is:

not thinking clearly or is incapable of being aroused.

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should:

transport the child to the hospital and reassure the mother en route.

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:

usually have an altered mental status or decreased level of consciousness.

You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include: A) Oxygen via a nonrebreathing mask, left lateral recumbent position, and transport. B) An oral airway, assisted ventilation with a bag-mask device, Fowler's position, and transport. C) Assisted ventilation with a bag-mask device, right lateral recumbent position, and transport. D) Oxygen via a nonrebreathing mask, supine position with legs elevated 6² to 12², and transport.

A) Oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.

The anterior aspect of the cerebrum controls: A) Vision. B) Touch Correct Answer C) Emotion. D) Movement.

A) Vision.

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

A. a ruptured cerebral artery.

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: A. cerebrum. B. brain stem. C. cerebral cortex. D. cerebellum.

B. brain stem.

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

B. when the patient last appeared normal.

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: A) Has had a prior heart attack. B) Is older than 60 years of age. C) Has bleeding within the brain. D) Has a GCS score that is less than 8.

C) Has bleeding within the brain.

You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should: A) Wait for the seizure to stop, manually open her airway, insert an oropharyngeal airway, and assess her oxygen saturation with the pulse oximeter. B) Place a bite block in between her teeth, apply high-flow oxygen via a nonrebreathing mask, and consider inserting a nasopharyngeal airway. C) Maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen. D) Restrain her extremities to prevent her from injuring herself, suction her airway to remove the vomitus, and assist her ventilations with a bag-mask device.

C) Maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen.

You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should: A) Advise the mother to take her child to the doctor the following day. B) Cover the child with wet towels and give oxygen via nasal cannula. C) Transport the child to the hospital and reassure the mother en route. D) Call medical control and request permission to give the child aspirin.

C) Transport the child to the hospital and reassure the mother en route.

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

D) Repeat the arm drift test, but move the patient's arms into position yourself.

Which of the following medications is NOT used to treat patients with a history of seizures? A) phenytoin (Dilantin) B) carbamazepine (Tegretol) C) phenobarbital D) hydromorphone (Dilaudid)

D) hydromorphone (Dilaudid)

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

D. severe twitching of all the body's muscles.

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?

a 17-year-old male with depression and anxiety

Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should:

assist ventilations, perform a rapid exam, and prepare for immediate transport.

Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?

confusion and fatigue

Which of the following medications is NOT used to treat patients with a history of seizures?

hydromorphone (Dilaudid)

You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:

obtain a description of how the seizure developed.

A transient ischemic attack (TIA) occurs when:

the normal body processes destroy a clot in a cerebral artery.