Chapter 40

When attempting to resuscitate a patient in cardiac arrest, which of the following questions would you pose if you suspect that the patient is hyperkalemic? A) "Does this patient undergo dialysis?" B) "Is this patient a known diabetic?" C) "Does this patient take blood thinners?" D) "Has this patient had vomiting or diarrhea?"

A) "Does this patient undergo dialysis?"

Adequately perfused kidneys produce at least ___ to ___ mL of urine per hour. A) 30, 50 B) 50, 70 C) 70, 100 D) 100, 110

A) 30, 50

You have given an 800-mL normal saline bolus to a patient in shock. How much of this fluid will remain in the intravascular space after 20 minutes? A) 320 mL B) 380 mL C) 480 mL D) 600 mL

A) 320 mL

The blood pressure of an infant or child can be maintained with blood loss of up to: A) 35% to 40%. B) 40% to 45% C) 45% to 50% D) 50% to 55%

A) 35% to 40%.

Which of the following volume expanders has been shown to interfere with platelet function and cause clotting problems? A) Dextran B) Hespan C) Plasmanate D) Lactated Ringer's

A) Dextran

Parasympathetic nervous system stimulation results in: A) a negative dromotropic effect. B) increased myocardial contractility. C) a decreased inotropic effect. D) decreased gastrointestinal motility.

A) a negative dromotropic effect.

A trauma patient has lost an estimated 1.5 L of blood through external bleeding and is hypotensive. How much normal saline or lactated Ringer's solution should he receive? A) 1.5 L B) 3 to 4.5 L C) At least 5 L D) 250 to 500 mL

B) 3 to 4.5 L

The mean arterial pressure must be greater than or equal to ____ mm Hg to ensure that the brain, coronary arteries, and kidneys remained perfused. A) 50 B) 60 C) 70 D) 80

B) 60

If you can feel a pulse over the femoral artery of an adult, but are unable to feel a pulse over the radial artery, his or her systolic blood pressure is MOST likely between ___ and ___ mm Hg. A) 60, 70 B) 70, 80 C) 80, 90 D) 90, 100

B) 70, 80

Which of the following blood pressures is MOST consistent with a pericardial tamponade? A) 80/50 mm Hg B) 90/70 mm Hg C) 100/60 mm Hg D) 110/80 mm Hg

B) 90/70 mm Hg

By which of the following mechanisms do patients with septic shock become hypovolemic? A) Sustained systemic vascular dilation B) Fluid leakage out of the vascular space C) Spontaneous destruction of red blood cells D) Frequent and severe vomiting and diarrhea

B) Fluid leakage out of the vascular space

Which of the following components represent the perfusion triangle? A) Red blood cells and oxygen B) Heart, blood, blood vessels C) Oxygen, lungs, red blood cells D) Organs, oxygen, carbon dioxide

B) Heart, blood, blood vessels

Which of the following solutions is preferred for fluid resuscitation of a patient in shock in the prehospital setting? A) Dextran or Plasmanate B) Isotonic crystalloid C) Hypertonic saline D) Dextrose in water

B) Isotonic crystalloid

In addition to IV fluids, treatment for a patient in neurogenic shock may include: A) atropine. B) amiodarone. C) epinephrine 1:1,000. D) low-dose dopamine.

B) amiodarone.

A characteristic sign of neurogenic shock caused by a spinal injury is: A) pink, warm, dry skin above the level of the injury. B) an absence of sweating below the level of the injury. C) a reflex tachycardia secondary to vascular dilation. D) irregular breathing secondary to brainstem insult.

B) an absence of sweating below the level of the injury.

When an adult patient with hemorrhagic shock loses more than 40% of his or her blood volume: A) blood flow is diverted away from the skin to the liver, kidneys, and lungs. B) cardiovascular deterioration cannot be reversed by compensatory mechanisms. C) vital organ damage can be repaired if a blood transfusion is started promptly. D) immediate IV fluid replacement can rapidly restore adequate tissue perfusion.

B) cardiovascular deterioration cannot be reversed by compensatory mechanisms.

Tissue perfusion is primarily a function of the: A) endocrine system. B) cardiovascular system. C) respiratory system. D) peripheral nervous system.

B) cardiovascular system.

When communicating an intuitive decision and obtaining feedback to your team, you should FIRST advise your team: A) of what you think should be done next. B) of what you think the patient's problem is. C) of what led you to a particular diagnosis. D) to ask any questions or voice any concerns.

B) of what you think the patient's problem is.

Premorbid conditions are those that: A) are a direct cause of death. B) precede the onset of a disease. C) are caused by an acute illness. D) have no effect on patient outcome.

B) precede the onset of a disease.

Clinical indicators of sympathetic nervous system discharge include: A) diffuse wheezing. B) pupillary dilation. C) hypoventilation. D) increased salivation.

B) pupillary dilation.

The recommended approach for fluid resuscitation of a patient in shock is ___ mL/kg until ______. A) 20, normotension is achieved B) 10, mental status improves C) 20, radial pulses become stronger D) 10, the skin becomes pink and dry

C) 20, radial pulses become stronger

Which of the following scenarios would MOST likely cause a bias to decision making? A) 72-year-old female with fever, chills, and severe flank pain B) 19-year-old male with acute dyspnea and pleuritic chest pain C) 23-year-old male with crushing substernal chest pain and nausea D) 56-year-old female with acute onset confusion and slurred speech

C) 23-year-old male with crushing substernal chest pain and nausea

Which of the following is an element of the Fick principle? A) Adequate production of pyruvic acid B) A relatively constant end-tidal CO2 C) An adequate number of red blood cells D) Consistent white blood cell production

C) An adequate number of red blood cells

Which of the following vital signs values are MOST consistent with neurogenic shock? A) Blood pressure, 120/70; pulse, 70; respirations, 14 B) Blood pressure, 160/100; pulse, 40; respirations, 8 C) Blood pressure, 80/60; pulse, 50; respirations, 24 D) Blood pressure, 70/40; pulse, 120; respirations, 26

C) Blood pressure, 80/60; pulse, 50; respirations, 24

Which of the following lists, in the correct order, the smallest to largest units of life? A) Tissues, organs, cells, organism, organ systems B) Organs, organ systems, tissues, cells, organism C) Cells, tissues, organs, organ systems, organism D) Organism, organs, organ systems, tissues, cells

C) Cells, tissues, organs, organ systems, organism

You and your team are treating an unresponsive trauma patient. Which of the following questions would be the MOST relevant to ask your team when evaluating for the presence of a tension pneumothorax? A) What is the patient's systolic blood pressure? B) Are the patient's heart tones becoming muffled? C) Is the patient becoming difficult to ventilate? D) Does the patient's pulse weaken during inhalation?

C) Is the patient becoming difficult to ventilate?

Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock? A) They cause platelets to clump together. B) They do not expand the circulating volume. C) They do not have oxygen-carrying capacity. D) They increase the viscosity of the blood.

C) They do not have oxygen-carrying capacity.

The force or resistance against which the heart pumps is called: A) preload. B) blood pressure. C) afterload. D) systemic vascular resistance.

C) afterload.

Infection, hypertensive crisis, and medication noncompliance are differential diagnoses that should be considered when treating a patient who presents with: A) acute chest pain. B) unilateral weakness. C) altered mental status. D) vomiting and diarrhea.

C) altered mental status.

During multiple-organ dysfunction syndrome, the release of __________, a potent vasodilator, leads to tissue hypoperfusion and may contribute to hypotension. A) renin B) epinephrine C) bradykinin D) angiotensin

C) bradykinin

The MOST immediate treatment for the patient with a tension pneumothorax is to: A) establish a large-bore IV line. B) ventilate with a bag-mask device. C) evacuate air from the pleural space. D) apply high-flow supplemental oxygen.

C) evacuate air from the pleural space.

Systemic effects of epinephrine include: A) bronchoconstriction. B) decreased preload. C) increased afterload. D) diffuse vasodilation.

C) increased afterload.

Accumulating acids and other waste products in the blood: A) act as potent vasoconstrictors, which worsens ischemia. B) cause a left shift in the oxyhemoglobin dissociation curve. C) inhibit hemoglobin from binding with and carrying oxygen. D) cause a marked increase in the production of red blood cells.

C) inhibit hemoglobin from binding with and carrying oxygen.

Relative bradycardia during neurogenic shock occurs because: A) systemic venous pooling of the blood overstimulates the vagus nerve. B) the parasympathetic nervous system does not release acetylcholine. C) the sympathetic nervous system is not stimulated to release catecholamines. D) the brainstem does not receive messages to increase the heart rate.

C) the sympathetic nervous system is not stimulated to release catecholamines.

A patient with severe dehydration is found to be hypotensive during your assessment. The MOST important intervention in this case is: A) applying blankets to keep the patient warm. B) immediate fluid resuscitation at the scene. C) transport with fluid resuscitation en route. D) high-flow oxygen via nonrebreathing mask.

C) transport with fluid resuscitation en route.

Signs and symptoms of multiple-organ dysfunction syndrome may include: A) severe polyuria. B) marked hyperglycemia. C) uncontrollable bleeding. D) warm, flushed skin.

C) uncontrollable bleeding.

What is the mean arterial pressure of a person who has a blood pressure of 140/90 mm Hg? A) 82 mm Hg B) 97 mm Hg C) 101 mm Hg D) 107 mm Hg

D) 107 mm Hg

If the left ventricle fills with 85 mL of blood and ejects 60 mL during a contraction, the ejection fraction is approximately ___%. A) 55 B) 60 C) 65 D) 70

D) 70

What is formed when carbon monoxide binds to the hemoglobin molecule? A) Myoglobin B) Oxyhemoglobin C) Methemoglobin D) Carboxyhemoglobin

D) Carboxyhemoglobin

Which of the following clinical signs would differentiate septic shock from hypovolemic shock? A) Severe hypotension B) Altered mental status C) Weak, thready pulse D) Warm or hot skin

D) Warm or hot skin

Disseminated intravascular coagulation is defined as a(n): A) decrease in white blood cell count, which results in decreased resistance to infection. B) pathophysiologic reaction that occurs when cellular ischemia leads to anaerobic metabolism. C) abnormal process in which disease or injury causes hemostasis due to platelet aggregation. D) pathological condition in which the proteins that normally control blood clotting become active.

D) pathological condition in which the proteins that normally control blood clotting become active.

According to the Frank-Starling mechanism: A) systemic venous pooling of blood results in a decrease in preload. B) an increase in systolic blood pressure causes a reflex bradycardia. C) coronary artery perfusion is directly proportional to cardiac output. D) the length of myocardial fibers determines force of cardiac contraction.

D) the length of myocardial fibers determines force of cardiac contraction.

A 6-year-old male was struck in the abdomen. He is restless; his skin is cool, pale, and clammy; and his blood pressure is 94/60 mm Hg. After applying high-flow oxygen and keeping him warm, you should: A) defer vascular access unless his blood pressure begins to decrease. B) establish vascular access at the scene and then transport. C) position him on his side and transport without delay. D) transport promptly and establish vascular access en route.

D) transport promptly and establish vascular access en route.

In medicine, intuition would MOST likely be used to: A) rule out a particular diagnosis. B) justify not transporting a patient. C) downgrade the transport status. D) triage a patient to a higher category.

D) triage a patient to a higher category.

Carbonic acid is formed by the combination of: A) water and bicarbonate. B) water and hemoglobin. C) lactate and pyruvic acid. D) water and carbon dioxide.

D) water and carbon dioxide.

Which of the following is a normal response of the body to hypoperfusion? A) Antidiuretic hormone is released by the pituitary gland. B) Vasodilation causes increased blood flow to the kidneys. C) Sodium and water are excreted to maintain the blood's pH. D) Peripheral vasoconstriction preserves blood flow to the skin.

A) Antidiuretic hormone is released by the pituitary gland.

Which of the following is the MOST accurate definition of multiple-organ dysfunction syndrome? A) Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness B) Sequential failure of two or more organs or organ systems caused by an acute injury or illness affecting any part of the patient's central nervous system C) Acute and predictable failure of the kidneys, liver, lungs, and heart that resulted from any disorder or injury that directly affected these organs D) Progressive failure of two or more organs or organ systems that were directly affected by the acute disorder or injury that caused the patient's initial illness

A) Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness

Which of the following depicts a positive orthostatic tilt test? A) The patient becomes dizzy upon standing B) Systolic blood pressure drops 10 mm Hg upon standing C) Pulse increases from 80 to 90 upon standing D) The patient begins to vomit upon sitting up

A) The patient becomes dizzy upon standing

Which of the following is an example of a peri-arrest condition? A) Ventricular tachycardia and a systolic blood pressure of 60 mm Hg B) Sinus tachycardia secondary to fever and a mild infection C) Ventricular fibrillation that has persisted for 6 minutes D) Bradycardia in the absence of chest pain or other symptoms

A) Ventricular tachycardia and a systolic blood pressure of 60 mm Hg

Which of the following is the MOST accurate definition of distributive shock? A) Widespread dilation of the resistance and capacitance vessels B) Decreased perfusion due to sympathetic nervous system failure C) Sustained constriction of the small venules and small arterioles D) Shunting of blood from the periphery to the body's vital organs

A) Widespread dilation of the resistance and capacitance vessels

The negative target-organ effects of anaphylactic shock are reversed with: A) epinephrine. B) methylprednisolone. C) diphenhydramine. D) low-dose dopamine.

A) epinephrine.

Shock in the trauma patient should be considered _____________ until proved otherwise. A) hemorrhagic B) distributive C) obstructive D) neurogenic

A) hemorrhagic

When administering IV fluid boluses to an elderly patient in shock, it is especially important to monitor his or her: A) lung sounds. B) mental status. C) pulse rate. D) blood pressure.

A) lung sounds.

The MOST common cause of cardiogenic shock is: A) myocardial infarction. B) ventricular aneurysm. C) a sudden dysrhythmia. D) papillary muscle rupture.

A) myocardial infarction.

Paramedic intuition is BEST described as: A) pattern recognition and matching based on past experience. B) the quick formulation of a field diagnosis based on assessment. C) the field diagnosis arrived at based on the general impression. D) instinct or a "gut feeling" based on past reading or studying.

A) pattern recognition and matching based on past experience.

During anaerobic metabolism, the precapillary sphincters __________ in response to __________. A) relax, lactic acid buildup B) constrict, capillary engorgement C) relax, systemic vasoconstriction D) constrict, decreased carbon dioxide

A) relax, lactic acid buildup

Baroreceptors function by: A) sensing decreased blood flow and activating the vasomotor center. B) dilating the blood vessels when systemic vascular resistance is low. C) measuring subtle shifts in arterial oxygen and carbon dioxide levels. D) constricting the blood vessels when systemic vascular resistance is high.

A) sensing decreased blood flow and activating the vasomotor center.

Cardiac output is dependent upon: A) stroke volume and heart rate. B) blood pressure and heart rate. C) afterload and peripheral resistance. D) peripheral resistance and heart rate.

A) stroke volume and heart rate.

Your primary assessment of a multisystems trauma patient reveals that he is unresponsive and is not breathing. What should you do next? A) Transport at once. B) Assess for a pulse. C) Ventilate the patient. D) Intubate his trachea.

B) Assess for a pulse.

Which of the following will be of MOST help to the paramedic when formulating a field diagnosis? A) Receiving input from family members B) Considering or ruling out various conditions C) Identifying and treating immediate life threats D) Trending the vital signs over a period of time

B) Considering or ruling out various conditions

Which of the following occurs during compensated shock? A) Cerebral hypoperfusion causes pupillary constriction B) Increased rate of breathing causes respiratory alkalosis C) Urine output decreases to less than 20 mL/hour D) Vasomotor failure leads to a drop in systolic blood pressure

B) Increased rate of breathing causes respiratory alkalosis

Which of the following assessment findings should increase your index of suspicion for obstructive shock? A) Low blood pressure B) Jugular venous distention C) Increased lung compliance D) Generalized edema

B) Jugular venous distention

Which of the following hemodynamic parameters decreases, regardless of the etiology of the shock? A) Pulse rate B) Mean arterial pressure C) Central venous pressure D) Peripheral vascular resistance

B) Mean arterial pressure

Which of the following statements regarding gas exchange in the lungs is correct? A) There are more carbon dioxide molecules in the blood than in inhaled air. B) Oxygen molecules move from the alveoli into the blood by diffusion. C) There are more oxygen molecules in the blood than in the alveoli. D) Carbon dioxide molecules move from the alveoli into the blood by diffusion.

B) Oxygen molecules move from the alveoli into the blood by diffusion.

Afterload is increased following alpha-1 stimulation because of: A) decreased preload. B) arteriolar constriction. C) increased contractility. D) widespread vasodilation.

B) arteriolar constriction.

Intrinsic causes of cardiogenic shock include: A) pleural effusion. B) cardiomyopathy. C) pulmonary embolus. D) tension pneumothorax.

B) cardiomyopathy.

The Trendelenburg position is accomplished by: A) keeping the legs below the level of the heart. B) elevating the foot end of the backboard 6 to 12 inches. C) elevating the patient's torso to a 45-degree angle. D) placing the patient on his or her side and elevating the legs.

B) elevating the foot end of the backboard 6 to 12 inches.

The capillary "washout" phase occurs when: A) anaerobic metabolism causes the postcapillary sphincters to remain constricted, causing capillary fluid engorgement. B) postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells. C) cellular ischemia causes the postcapillary sphincters to remain constricted, causing the capillaries to become engorged with fluid. D) precapillary sphincters constrict in response to the buildup of lactic acid, vasomotor failure, and increased carbon dioxide.

B) postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells.

Incomplete glucose breakdown leads to an accumulation of: A) lactic acid. B) pyruvic acid. C) bicarbonate. D) carbonic acid.

B) pyruvic acid.

Hypotension during anaphylactic shock is caused primarily by: A) vascular damage. B) relative hypovolemia. C) cardiac muscle injury. D) capillary leakage.

B) relative hypovolemia.

Which of the following substances or elements reinforces red blood cells, creating the final step in the formation of a blood clot? A) Fibrin B) Plasminogen C) Fibrinogen D) Platelets

C) Fibrinogen

Which of the following would MOST likely allow you to reach the status of entry-level competence? A) Functioning for at least 2 years in the field B) Passing the state or national paramedic exam C) Interning with an experienced preceptor D) Studying didactic material at least 2 hours per week

C) Interning with an experienced preceptor

A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of _____________ shock A) neurogenic B) obstructive C) psychogenic D) hypovolemic

C) psychogenic

Which of the following injuries or conditions would cause obstructive shock? A) Severe burns B) Massive sepsis C) Pelvic fracture D) Cardiac tamponade

D) Cardiac tamponade

Which of the following premorbid conditions would MOST likely occur in an otherwise healthy adult? A) Renal failure B) Congestive heart failure C) Coronary artery disease D) Drug toxicity

D) Drug toxicity

What effect would the restoration of normotension have on a patient with internal bleeding and a blood pressure of 70/54 mm Hg? A) Increased hemostasis and improved cerebral perfusion B) Acute pulmonary edema secondary to volume overload C) Facilitation of the clotting mechanisms that stop bleeding D) Formed clot dislodgement and worsened internal bleeding

D) Formed clot dislodgement and worsened internal bleeding

Which of the following is the BEST indicator of tissue perfusion during compensated shock? A) Systolic blood pressure B) Pulse rate and quality C) Skin color and condition D) Level of responsiveness

D) Level of responsiveness

A 40-year-old man had a syncopal episode after receiving news of the death of a loved one. He complains of a headache and is unable to walk without becoming dizzy. You should be the MOST suspicious for: A) hypoglycemia. B) a dysrhythmia. C) hypovolemia. D) a head injury.

D) a head injury.

An adult patient presents with a blood pressure of 78/60 mm Hg, a pulse rate of 120 beats/min and irregular, and labored breathing. Further assessment reveals pale, cool, moist skin and diffuse crackles in all lung fields. You should suspect: A) septic shock. B) neurogenic shock. C) hypovolemic shock. D) cardiogenic shock.

D) cardiogenic shock.

A tendency to gather and rely on information that confirms your existing views and avoids or downplays information that does not confirm your preexisting hypothesis or field differential is called a(n) ___________ bias. A) personal B) anchoring C) differential D) confirmation

D) confirmation

Anaerobic metabolism is the process in which: A) the cells produce carbon dioxide and water. B) adequate amounts of oxygen reach the cell level. C) the adrenal glands fail to release catecholamines. D) inefficient cellular metabolism produces lactic acid.

D) inefficient cellular metabolism produces lactic acid.