EMS CHAPTER 21-24
It is most important to determine a patient's weight when asking questions pertaining to a toxic ingestion because: A. you might need additional lifting and moving assistance. B. this will allow you to determine if the exposure is lethal. C. naloxone is contraindicated if the patient is very obese. D. activated charcoal is given based on a patient's weight.
D. activated charcoal is given based on a patient's weight.
Which of the following drugs is not a sedative-hypnotic? A. flunitrazepam (Rohypnol) B. oxycodone (Percocet) C. secobarbital (Seconal) D. diazepam (Valium)
B. oxycodone (Percocet)
A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is: A. dependence. B. addiction. C. tolerance. D. withdrawal.
C. tolerance.
The adult epinephrine auto-injector delivers ____ mg of epinephrine, and the infant-child auto-injector delivers ____ mg. A. 0.1; 0.01 B. 0.3; 0.15 C. 0.01; 0.1 D. 0.03; 0.3
B. 0.3; 0.15
Which of the following patients would MOST likely have a delayed onset of an allergic reaction? A. A 50-year-old male who was exposed to latex. B. A 45-year-old male who ingested penicillin. C. A 30-year-old male who was stung by a bee. D. A 21-year-old female who inhaled pollen.
B. A 45-year-old male who ingested penicillin.
When administering epinephrine via auto-injector, you should hold the injector in place for: A. 3 seconds. B. 8 seconds. C. 15 seconds. D. 10 seconds.
A. 3 seconds.
A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called: A. a wheal. B. a pustule. C. purpura. D. urticaria.
A. a wheal.
You are assessing a 45-year-old female who is severely depressed. She states that it seems as though her entire world is crashing down around her. She further states that she has had frequent thoughts of suicide, but is not sure if she can actually go through with it. How should you manage this situation? A. Ask the patient if she has developed a suicidal plan. B. Leave the scene and have a neighbor check in on her. C. Encourage the patient to remain quiet during transport. .D. Have law enforcement place her in protective custody.
A. Ask the patient if she has developed a suicidal plan.
You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient's potential for violence? A. His large body size B. His shouting of obscenities C. The broken window D. His clenched fists
A. His large body size
Which of the following statements regarding gonorrhea is correct? A. Painful urination is a common symptom of gonorrhea in men and women. B. Most men who are infected with gonorrhea do not experience symptoms. C. Mild infections with gonorrhea cause abdominal pain, vomiting, and fever. D. Symptoms of gonorrhea usually appear within 3 months after being infected.
A. Painful urination is a common symptom of gonorrhea in men and women.
Which of the following statements regarding the Salmonella bacterium is correct? A. The Salmonella bacterium itself causes food poisoning. B. Symptoms of salmonellosis appear within 12 hours. C. Refrigeration of food will prevent salmonellosis. D. The Salmonella bacterium produces toxins that cause food poisoning.
A. The Salmonella bacterium itself causes food poisoning.
Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction? A. The environment in which the patient is found. B. The time of year in which the exposure occurred. C. The patient's general physical appearance D. The patient's family history
A. The environment in which the patient is found.
Which of the following statements regarding pelvic inflammatory disease (PID) is correct? A. Untreated PID can lead to an ectopic pregnancy or an abscess. B. PID is an infection of the lower female reproductive organs. C. The majority of women with PID never develop symptoms. D. PID is a life-threatening condition that is associated with shock.
A. Untreated PID can lead to an ectopic pregnancy or an abscess.
Which of the following physiologic actions does epinephrine produce when given for an allergic reaction? A. Vasoconstriction and bronchodilation B. Bronchoconstriction and vasoconstriction C. Blocking of further histamine release D. Bronchodilation and vasodilation
A. Vasoconstriction and bronchodilation
Organic brain syndrome is defined as: A. a dysfunction of the brain caused by abnormal physical or physiological function. B. bizarre behavior secondary to a chemical imbalance or disturbance in the brain. C. a change in behavior or mental status secondary to decreased cerebral blood flow. D. a disorder that cannot be traced to the abnormal structure or function of an organ.
A. a dysfunction of the brain caused by abnormal physical or physiological function.
A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: A. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. B. assist her ventilations with a bag-valve mask, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport. C. administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. D. administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly.
A. administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.
A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory distress. you Should: A. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration. B. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg. C. ask him if he has epinephrine and request approval from medical control to administer it to the patient. D. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.
A. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration.
Delirium tremens (DTs) is a syndrome associated with withdrawal from: A. alcohol. B. opioids. C. cocaine. D. sedatives.
A. alcohol.
The most frequently used date rape drug is: A. alcohol. B. Ecstasy. C. Xanax. D. ketamine.
A. alcohol.
After ensuring his or her own safety, the EMT's next priority when caring for a patient with a behavioral emergency is to: A. assess the patient's response to his or her environment. B. determine the underlying cause of the problem and offer advice. C. transport the patient directly to a specialized psychiatric facility. D. diagnose the patient's problem and provide definitive treatment.
A. assess the patient's response to his or her environment.
You respond to a college campus for a young male who is acting strangely. After law enforcement has secured the scene, you enter the patient's dorm room and find him sitting on the edge of the bed; he appears agitated. As you approach him, you note that he has dried blood around both nostrils. He is breathing adequately, his pulse is rapid and irregular, and his blood pressure is 200/110 mm Hg. Treatment for this patient includes: A. attempting to calm him and giving him oxygen if tolerated. B. requesting a paramedic to administer naloxone (Narcan). C. assisting his ventilations with a bag-mask device. D. asking law enforcement to place handcuffs on the patient.
A. attempting to calm him and giving him oxygen if tolerated.
In contrast to a behavioral crisis, a behavioral health emergency occurs when a person: A. becomes agitated or violent and is a threat to him- or herself or others. B. experiences a sudden attack of panic secondary to a stressful situation. C. exhibits impaired functioning due to a chemical or genetic disturbance. D. experiences feelings of sadness and despair for longer than a month.
A. becomes agitated or violent and is a threat to him- or herself or others.
The onset of menstruation usually occurs in females who are: A. between 11 and 16 years of age. B. between 25 and 28 years of age. C. between 18 and 23 years of age. D. between 8 and 10 years of age.
A. between 11 and 16 years of age.
A 3-year-old female ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your primary assessment of the child, you should: A. contact the regional poison control center. B. immediately transport the child to the hospital. C. induce vomiting with syrup of ipecac. D. administer 25 g of activated charcoal.
A. contact the regional poison control center.
Common side effects of epinephrine include all of the following, EXCEPT: A. drowsiness. B. tachycardia. C. headache. D. dizziness.
A. drowsiness.
It is common for young females who experience their first menstrual period to: A. experience abdominal cramping, which may be misinterpreted. B. have a false positive home pregnancy test result. C. lose up to 500 mL of blood within the first 24 hours. D. become so emotionally distraught that they contemplate suicide.
A. experience abdominal cramping, which may be misinterpreted.
Each ovary produces an ovum in alternating months and releases it into the: A. fallopian tube. B. cervical os. C. uterus. D. vagina.
A. fallopian tube.
A physiologic disorder that impairs bodily function when the body seems to be structurally normal is called a: A. functional disorder B. seizure C. traumatic brain injury D. drug and alcohol abuse
A. functional disorder
The most common presenting sign of pelvic inflammatory disease (PID) is: A. generalized lower abdominal pain. B. nausea. C. foul-smelling vaginal discharge D. vomiting.
A. generalized lower abdominal pain.
Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include: A. histamines and leukotrienes. B. leukocytes and epinephrine. C. adrenaline and histamines. D. the bee venom itself.
A. histamines and leukotrienes.
Urticaria is the medical term for: A. hives. B. swelling. C. burning. D. a wheal.
A. hives.
Most poisonings occur via the ____ route. A. ingestion B. inhalation C. injection D. absorption
A. ingestion
When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that: A. internal bleeding might be profuse because prolonged alcohol use might impair the blood's ability to clot. B. long-bone fractures are likely because chronic alcohol consumption weakens the structure of the bones. C. delirium tremens (DTs) are commonly induced by physical trauma and can lead to life-threatening seizures. D. signs and symptoms of shock might be masked by the stimulant effects produced by alcohol.
A. internal bleeding might be profuse because prolonged alcohol use might impair the blood's ability to clot.
The poison control center will provide you with the most information regarding the appropriate treatment for a patient with a drug overdose if the center: A. is aware of the substance that is involved. B. is aware of the patient's age and gender. C. knows the location of the closest hospital. D. knows why the patient overdosed on the drug.
A. is aware of the substance that is involved
Pregnant women with bacterial vaginosis might have: A. low birth weight babies. B. secondary cervical cancer. C. hypertension later in life. D. babies that deliver after 42 weeks.
A. low birth weight babies.
Substance abuse is most accurately defined as: A. misusing a substance to produce a desired effect. B. willfully using a therapeutic drug to treat a medical illness. C. unwillingly and unknowingly consuming drugs or alcohol. D. knowingly selling illicit drugs to buy more drugs.
A. misusing a substance to produce a desired effect.
Before giving activated charcoal, you should: A. obtain approval from medical control. B. mix the suspension by stirring the bottle. C. have the patient drink a glass of milk. D. mix it with an equal amount of water.
A. obtain approval from medical control.
A 22-year-old male with a history of clinical depression called 9-1-1 and stated that he has attempted to kill himself. Your unit and law enforcement officers arrive at the scene simultaneously. You find the patient lying supine on the living room floor. He is unresponsive and cyanotic. An empty bottle of hydromorphone (Dilaudid) is found on an adjacent table. You should: A. open the patient's airway and assess his respirations. B. provide care after determining what Dilaudid is used for. C. ask the police to handcuff the patient for safety purposes. D. wait for the police to examine him before providing care.
A. open the patient's airway and assess his respirations.
Heroin is an example of a(n): A. opioid. B. cholinergic. C. sympathomimetic. D. hypnotic.
A. opioid.
Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of: A. oxycodone (Percocet). B. crack cocaine. C. ecstasy. D. amphetamine sulfate (Benzedrine).
A. oxycodone (Percocet).
When caring for a female patient who has been sexually assaulted, you should: A. place any bloodstained clothing or other articles in separate paper bags. B. allow law enforcement to take her statement before you begin treatment. C. advise her that she will not be allowed to shower or change her clothes. D. ask the patient for a concise, detailed report of what happened to her.
A. place any bloodstained clothing or other articles in separate paper bags.
Immediately after giving an epinephrine injection, you should: A. properly dispose of the syringe. B. record the time and dose given. C. reassess the patient's vital signs. D. notify medical control of your action.
A. properly dispose of the syringe.
The stinger from a honeybee should be: A. scraped away from the skin. B. squeezed with tweezers and removed. C. left in place and covered. D. irrigated with copious amounts of water.
A. scraped away from the skin.
In an apparent suicide attempt, a 19-year-old female ingested a full bottle of amitriptyline (Elavil). At present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier. Her blood pressure is 90/50 mm Hg, her pulse is 140 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. When transporting this patient, you should be most alert for: A. seizures and cardiac dysrhythmias. B. a sudden outburst of violence. C. an increase in her blood pressure. D. acute respiratory depression.
A. seizures and cardiac dysrhythmias.
Two of the MOST common signs of anaphylaxis are: A. urticaria and angioedema. B. hypertension and swollen hands. C. expiratory stridor and tachycardia. D. watery eyes and localized itching.
A. urticaria and angioedema.
You may not be able to determine whether a person has a mental illness, but you can predict the person's likelihood of becoming: A. violent. B. suicidal. C. psychotic. D. diabetic.
A. violent.
You respond to a local motel for a young female who was sexually assaulted. The patient is conscious but confused. She tells you that the last thing she remembers was drinking beer at a club with her friends the night before. When she awoke, she was in the bed of the motel room. You should suspect that this patient: A. was given flunitrazepam (Rohypnol). B. has a hangover from the night before. C. is a frequent and heavy heroin user. D. is addicted to a benzodiazepine drug.
A. was given flunitrazepam (Rohypnol).
Epinephrine is indicated for patients with an allergic reaction when: A. wheezing and hypotension are present. B. the patient is anxious and tachycardic. C. a paramedic is present at the scene. D. the reaction produces severe urticaria.
A. wheezing and hypotension are present.
You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for pelvic inflammatory disease? A. A history of ectopic pregnancy B. A shuffling gait when walking C. Vaginal passage of blood clots D. Bright red blood in the urine
B. A shuffling gait when walking
Which of the following MOST accurately defines an allergic reaction? A. direct negative effect on the body by an external substance B. An exaggerated immune system response to any substance C. Destruction of the immune system by an external substance D. A release of erythrocytes in response to a foreign substance
B. An exaggerated immune system response to any substance
Which of the following conditions would MOST likely lead to pelvic inflammatory disease if left untreated? A. Ectopic pregnancy B. Chlamydia C. Genital herpes D. Ovarian cysts
B. Chlamydia
During your assessment of a 30-year-old woman with abdominal pain, she tells you that she has been experiencing vaginal bleeding. Her vital signs are stable, and there are no signs of shock. What should you do? A. Carefully pack her vagina with a sterile multi-trauma dressing. B. Defer the vaginal examination until she is at the hospital. C. Position her supine, elevate her legs, and keep her warm. D. Visualize her vaginal area to assess the degree of bleeding.
B. Defer the vaginal examination until she is at the hospital.
Common names for activated charcoal include all of the following, except: A. LiquiChar. B. Fructose. C. InstaChar. D. Actidose.
B. Fructose.
During your assessment of a 50-year-old male who was found unresponsive in an alley, you note that he has slow, shallow respirations; bradycardia; facial cyanosis; and pinpoint pupils. As your partner begins assisting the patient's ventilations, he directs your attention to the patient's arms, which have multiple needle tracks on them. Which of the following would most likely explain the patient's presentation? A. Delirium tremens B. Heroin overdose C. Alcohol intoxication D. Closed-head injury.
B. Heroin overdose
Which of the following findings should make the MT especially suspicious that a woman was sexually assaulted? A. The odor of alcohol on her breath B. Inability to remember the event. C. Signs of shock on assessment D. A prescription for alprazolam (Xanax)
B. Inability to remember the event.
Which of the following clinical presentations is MOST consistent with pelvic inflammatory disease (PID)? A. Pain around the umbilicus, low-grade fever, and generalized weakness B. Lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge C. Upper abdominal cramping, severe headache, and heavy vaginal bleeding D. Left lower quadrant pain, referred pain to the left shoulder, and fever
B. Lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge
Which of the following statements regarding inhaled poisons is correct? A. Chlorine is a colorless and odorless gas that causes hypoxia and pulmonary edema. B. Lung damage might progress after the patient is removed from the environment. C. Burns around the eyes are the most common indication of an inhalation poisoning. D. Carbon monoxide is very irritating to the upper airway and might cause swelling.
B. Lung damage might progress after the patient is removed from the environment.
A 24-year-old woman complains of an ache in her abdomen that gets worse when she walks. She has a fever and chills and tells you that it burns when she urinates. Which of the following should you suspect? A. Gonorrhea B. Pelvic inflammatory disease C. Chlamydia D. Ectopic pregnancy
B. Pelvic inflammatory disease
Which of the following statements regarding rape is correct? A. Only a licensed physician can make a diagnosis of rape. B. Rape is a legal term, not a medical diagnosis. C. The EMT should try to determine if rape occurred. D. Rape causes more physical than emotional harm.
B. Rape is a legal term, not a medical diagnosis.
A patient with a history of schizophrenia called EMS because he was experiencing abdominal pain. When law enforcement arrived, the patient became violent, necessitating the placement of handcuffs. When you assess the patient, he tells you that killing someone will make his abdominal pain go away. His vital signs are stable. How should you manage this situation? A. Refuse to transport the patient because of his homicidal threat. B. Request a police officer to accompany you in the ambulance. C. Transport the patient in a prone position on the stretcher. D. Request that a police officer transport him to the hospital.
B. Request a police officer to accompany you in the ambulance.
Which of the following is an example of a functional behavioral disorder? A. Head trauma B. Schizophrenia C. Drug addiction D. Alzheimer's disease
B. Schizophrenia
You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a wheal surrounded by an area of redness. He states that he had a "bad reaction" the last time he was stung by a scorpion, and carries his own epinephrine auto-injector. You should: A. apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once. B. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital. C. apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and transport. D. assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains stable.
B. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.
In general, injected poisons are impossible to dilute or remove because they: A. are usually fatal within 30 minutes of exposure. B. are usually absorbed quickly into the body. C. react with the blood, which increases their toxicity. D. absorb slowly into the body, despite their potency.
B. are usually absorbed quickly into the body.
You respond to the residence of a 55-year-old woman with a possible allergic reaction to peanuts that she ate approximately 30 minutes ago. The patient is conscious and alert but has diffuse urticaria and the feeling that she has a lump in her throat. As your partner applies oxygen to the patient, you should: A. obtain a complete set of baseline vital signs. B. ask her if she has prescribed epinephrine. C. ascertain if she has a family history of allergies. D. ask her when her last allergic reaction occurred.B
B. ask her if she has prescribed epinephrine.
As you enter the residence of a patient who has possibly overdosed, you should: A. look for drug paraphernalia. B. be alert for personal hazards. C. quickly gain access to the patient. D. observe the scene for drug bottles.
B. be alert for personal hazards.
After administering activated charcoal to a patient, it is most important to: A. monitor the patient's blood pressure. B. be alert for vomiting. C. document the intervention. D. call medical control.
B. be alert for vomiting.
When assessing a patient with a behavioral crisis, you should: A. frisk the patient for the presence of weapons. B. be direct and clearly state your intentions. C. ask the police to handcuff the patient for safety. D. spend as little time with the patient as possible.
B. be direct and clearly state your intentions.
In anticipation of receiving a fertilized ovum, the lining of the uterine wall: A. diverts blood flow to the vagina. B. becomes engorged with blood. C. thins and begins to separate. D. sheds and is expelled externally.
B. becomes engorged with blood.
General guidelines for managing a patient with a behavioral emergency include: A. firmly identifying yourself as an EMS provider. B. being prepared to spend extra time with the patient. C. allowing the patient to be alone if he or she wishes. D. placing the patient between yourself and an exit.
B. being prepared to spend extra time with the patient.
Activated charcoal is given to patients who have ingested certain substances because it: A. decreases absorption of poisons into the lungs. B. binds to the substance and prevents absorption. C. is a direct antidote for many toxic substances. D. induces vomiting and empties the stomach.
B. binds to the substance and prevents absorption.
The major side effect associated with administration of activated charcoal is: A. abdominal pain. B. black stools. C. headache. D. ringing in the ears.
B. black stools.
A construction worker complains of intense pain after a bag of dry powder was spilled on his arm. The EMT should: A. brush the chemical from his arm and cover it with a sterile dressing. B. brush the chemical from his arm and then flush the skin with water. C. immediately flush the skin with clean water for 15 to 20 minutes. D. cover the exposed area with a sterile dressing and elevate his arm.
B. brush the chemical from his arm and then flush the skin with water.
When assessing a patient who is displaying bizarre behavior, the EMT should: A. avoid asking questions about suicide because this may give the patient ideas. B. consider that an acute medical illness may be causing the patient's behavior. C. carefully document his or her perception of what is causing the patient's behavior. D. check his or her blood glucose level only if he or she has a history of diabetes.
B. consider that an acute medical illness may be causing the patient's behavior.
The single most significant factor that contributes to suicide is: A. drug abuse. B. depression. C. advanced age. D. a chronic illness.
B. depression.
Common signs and symptoms of an allergic reaction include all of the following, EXCEPT: A. abdominal cramps. B. drying of the eyes. C. persistent dry cough. D. flushing of the skin.
B. drying of the eyes.
The first step in assessing a patient with a behavioral emergency is to: A. restrain the patient. B. ensure your safety. C. obtain proper consent. D. take vital signs.
B. ensure your safety.
Naloxone (Narcan) would reverse the effects of: A. diazepam (Valium). B. hydromorphone (Dilaudid). C. phenobarbital (Luminal). D. temazepam (Restoril).
B. hydromorphone (Dilaudid).
A hypnotic drug is one that: A. prevents amnesia. B. induces sleep. C. increases the senses. D. increases the pulse.
B. induces sleep.
A 78-year-old female presents with an acute change in her behavior. The patient's son tells you that his mother has type 2 diabetes and was diagnosed with Alzheimer's disease 6 months ago. The patient's speech is slurred, and she is not alert to her surroundings. You should: A. conclude that the patient's blood sugar is high. B. inquire about the possibility of head trauma. C. transport the patient to a psychiatric facility. D. allow the patient to refuse transport if she wishes.
B. inquire about the possibility of head trauma.
A 25-year-old man overdosed on heroin and is unresponsive. His breathing is slow and shallow and he is bradycardic. He has track marks on both arms. The EMT should: A. position the patient on his side and transport without delay. B. insert a nasal airway and ventilate with a bag-mask device. C. administer naloxone via the intramuscular route. D. administer naloxone via the intranasal route.
B. insert a nasal airway and ventilate with a bag-mask device.
Law enforcement personnel request your assistance for a 30-year-old man who was pulled over for erratic driving. The patient became acutely violent while he was being questioned, which required one of the officers to subdue him with a Taser. When you arrive and assess the patient, you find that he is very agitated and is experiencing apparent hallucinations. His skin is flushed and diaphoretic. You should: A. recognize that he is experiencing a complex psychiatric crisis, quickly load him into the ambulance, and transport without delay. B. limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you. C. quickly rule out any life-threatening conditions and then perform a detailed secondary assessment as he is being restrained. D. suspect that he is acutely hypoglycemic, consider giving him one tube of oral glucose, and transport with lights and siren.
B. limit physical contact with the patient as much as possible and avoid interrupting him if he is attempting to communicate with you.
The physical examination of a sexual assault victim should be: A. performed in the presence of at least two police officers. B. limited to a brief survey for life-threatening injuries. C. deferred until the patient can be evaluated by a physician. D. as detailed as possible so all injuries can be documented.
B. limited to a brief survey for life-threatening injuries.
While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates: A. enlargement of the bronchioles in the lungs B. narrowing of the bronchioles in the lungs. C. rapid swelling of the upper airway tissues. D. a significant amount of fluid in the alveoli.
B. narrowing of the bronchioles in the lungs.
Bacterial vaginosis is a condition that occurs when: A. numerous bacteria enter the uterus through the cervix and cause severe tissue damage. B. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. C. harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes. D. abnormal bacteria enter the vagina and cause damage without causing any symptoms.
B. normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.
Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assault. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, al and crying. When you ask her what happened, she tells you that she does not want to be treated or transported the hospital. She further tells you that all she wants to do is clean up. You should: A. ask her if there is anyone you can contact, such as a friend or relative. B. provide emotional support and visually assess her for obvious trauma. C. advise her that she cannot clean herself up because this will destroy evidence. D. defer any physical assessment so that you do not destroy potential evidence.
B. provide emotional support and visually assess her for obvious trauma
A man with a prolonged history of alcohol abuse fell from a second-story balcony. His blood pressure is 80/60 mm Hg, his heart rate is 120 beats/min, and his skin is cool and pale. When caring for this patient, the EMT should recall that: A. patients with alcoholism are prone to hyperglycemia. B. reduced blood clotting worsens internal bleeding. C. patients with alcoholism are prone to hyperthermia. D. alcohol is a stimulant, which likely caused his fall.
B. reduced blood clotting worsens internal bleeding.
A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to: A. try to gain the patient's trust by telling him that you see the vampires too. B. restrain the patient with appropriate force in order to treat his injuries. C. approach the patient and calm him by placing your hand on his shoulder. D. request that the police officers arrest him and take him to the hospital.
B. restrain the patient with appropriate force in order to treat his injuries
Injury to the labia would most likely occur following: A. strenuous exercise. B. sexual abuse. C. a significant fall. D. a motor-vehicle crash.
B. sexual abuse.
When caring for a patient experiencing excited delirium, the MT should remember that: A. most patients will have low blood pressure and hyperglycemia. B. sudden death can occur if the patient's violence is not controlled. C. excited delirium is worsened by nervous system depressant drugs. D. lights and siren are effective in redirecting the patient's behavior.
B. sudden death can occur if the patient's violence is not controlled.
Signs and symptoms of a sympathomimetic drug overdose include: A. hypothermia. B. tachycardia. C. hypotension. D. slurred speech.
B. tachycardia.
EMTs receive a call for a possible sexual assault. The patient is a young female who is conscious and alert and has no apparent injuries. She states, I can't remember anything, but I know I was raped." The EMTs should suspect that: A. the patient knew her attacker, but is afraid to say. B. the patient was given a drug prior to the incident. C. an underlying head injury is causing her amnesia. D. the traumatic experience has created a mental block.
B. the patient was given a drug prior to the incident.
The outermost cavity of a woman's reproductive system, which forms the lowest part of the birth canal, is called A. cervix. B. vagina. C. perineum. D. uterus.
B. vagina.
The effects of epinephrine are typically observed within ______ following administration. A. 30 seconds B. 1 hour C. 1 minute D. 30 minutes
C. 1 minute
Most patients who die of anaphylaxis do so within the first ____ minutes following exposure. A. 60 B. 90 C. 30 D. 5
C. 30
EMTs are dispatched for a teenage male who is "not acting right." When they arrive, they are informed that the patient was huffing. Several cans of Freon are found near the patient. Which of the following is a unique consideration for this patient? A. Encouraging walking will help eliminate Freon from the body. B. The pulse oximeter will yield a falsely elevated reading C. A sudden adrenaline release can cause a fatal dysrhythmia. D. Oxygen will not increase the patient's oxygen saturation.
C. A sudden adrenaline release can cause a fatal dysrhythmia.
Which of the following conditions or situations would MOST likely make excited delirium worse? A. Limited physical contact B. Dimly lit environment C. Alcohol withdrawal D. Elevated blood glucose
C. Alcohol withdrawal
What type of poisoning will cause burns around the mouth in children? A. Inhaled poison. B. Injected poison. C. Alkaline poison. D. Plant poisoning.
C. Alkaline poison.
Which of the following statements regarding the physical examination of a patient with a behavioral problem is correct? A. It is only appropriate to perform a physical examination on a patient with a behavioral problem if he or she is unconscious or is being physically restrained. B. Performing a physical examination on a patient with a behavioral problem will likely cause him or her to become violent and should be avoided in the field. C. Although the physical exam can be difficult, the patient's emotional state may be determined by noting facial expressions, pulse rate, and respirations. D. The physical examination of a patient with a behavioral problem often yields crucial information and should always be performed, even if the patient is violent.
C. Although the physical exam can be difficult, the patient's emotional state may be determined by noting facial expressions, pulse rate, and respirations.
Common causes of acute psychotic behavior include all of the following, EXCEPT: A. schizophrenia. B. mind-altering substance use. C. Alzheimer's disease. D. intense stress.
C. Alzheimer's disease.
Which of the following statements regarding fire ants is correct? A. Fire ant bites typically occur on the face. B. Fire ant bites rarely cause anaphylaxis. C. Fire ants often bite a person repeatedly. D. Most people are allergic to fire ant toxin.
C. Fire ants often bite a person repeatedly.
Which of the following statements regarding pelvic inflammatory disease (PID) is correct? A. The most common presenting symptom of PID is generalized upper abdominal pain. B. The most severe cases of PID occur in women who are not sexually active. C. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy. D. PID most commonly affects women who have had an ectopic pregnancy in the past.
C. PID can scar the fallopian tubes, which increases the risk of an ectopic pregnancy.
You are assessing a conscious 55-year-old male with a sudden change in behavior. Which of the following clinical findings would be MOST suggestive of dysfunction of this patient's central nervous system? A. Excessive tearing or crying B. An irregular pulse C. Rapid eye movement D. Consistent eye contact
C. Rapid eye movement
In which position should you restrain a physically uncooperative patient? A. With arms and legs bound together. B. Prone C. Supine D. With hands tied behind the back
C. Supine
Which of the following questions would be least pertinent during the initial questioning of a patient who ingested a substance? A. What type of substance was taken? B. How much of the substance was taken? C. Why was the substance ingested? D. How long ago was the substance taken?
C. Why was the substance ingested?
The foreign substance responsible for causing an allergic reaction is called a(n): A. histamine. B. leukotriene. C. allergen. D. antibody.
C. allergen.
A patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and hyperthermia should be suspected of ingesting a significant quantity of: A. ibuprofen. B. acetaminophen. C. aspirin. D. cocaine.
C. aspirin.
During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should: A. perform a rapid secondary assessment. B. assess her blood pressure and elevate her legs. C. assist her ventilations with a bag-mask device. D. perform a visual assessment of her vaginal area.
C. assist her ventilations with a bag-mask device.
Your priority in caring for a patient with a surface contact poisoning is to: A. decontaminate the patient's skin. B. obtain and maintain a patent airway. C. avoid contaminating yourself. D. move the patient to a safe area.
C. avoid contaminating yourself.
It is MOST important for the EMT to remember that suicidal patients may: A. have a definitive plan. B. be self-destructive. C. be homicidal as well. D. inject illicit drugs.
C. be homicidal as well.
A 40-year-old male intentionally cut his wrist out of anger after losing his job. Law enforcement has secured the scene prior to your arrival. As you enter the residence and visualize the patient, you can see that he has a towel around his wrist and a moderate amount of blood has soaked through it. You should: A. quickly tend to the bleeding wound. B. approach the patient with caution. C. calmly identify yourself to the patient. D. tell the patient that you want to help.
C. calmly identify yourself to the patient.
General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: A. supplemental oxygen and keeping the patient supine. B. treating external lacerations with sterile compresses. C. carefully removing any foreign bodies from the vagina. D. refraining from placing any dressings into the vagina.
C. carefully removing any foreign bodies from the vagina.
As a woman approaches menopause: A. her risk of developing pelvic inflammatory disease lowers significantly. B. she usually experiences abdominal cramping without vaginal bleeding. C. her menstrual periods may become irregular and vary in severity. D. she cannot become pregnant because of fluctuating hormone levels.
C. her menstrual periods may become irregular and vary in severity.
When documenting a call in which a female was sexually assaulted, you should: A. record your opinion only if you have reasonable proof to justify the statement. B. only use quotation marks when recording any statements made by witnesses. C. keep the report concise and record only what the patient stated in her own words. D. translate the patient's words or statements using proper medical terminology.
C. keep the report concise and record only what the patient stated in her own words.
When an auto-injector is used to give epinephrine, the primary injection site is the: A. medial portion of the thigh. B. medial part of the buttocks. C. lateral portion of the thigh. D. lateral portion of the arm.
C. lateral portion of the thigh.
When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: A. keep assessment and treatment to a minimum. B. ask questions related to her gynecologic history. C. maintain her ABCs and transport without delay. D. determine the underlying cause of her problem.
C. maintain her ABCs and transport without delay.
People at risk for suicide include all of the following, EXCEPT: A. those with a recent diagnosis of a serious illness. B. substance abusers. C. married males older than 30 years. D. children with parents addicted to alcohol.
C. married males older than 30 years.
In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps orcancer: A. is typically not as severe. B. can be controlled in the field. C. may be relatively painless. D. often presents with acute pain.
C. may be relatively painless.
Your unit is dispatched to the county jail for an intoxicated inmate. Upon arrival, you find the patient, a 33-year-old male, lying supine in a jail cell. He is responsive to painful stimuli only and has slow, shallow respirations. You should be most concerned that this patient: A. might become violent. B. might experience a seizure. C. might vomit and aspirate. D. is severely hypoglycemic.
C. might vomit and aspirate.
Airborne substances should be diluted with: A. activated charcoal. B. syrup of ipecac. C. oxygen. D. an alkaline antidote.
C. oxygen.
Immediately after physically restraining a violent patient, the EMT should: A. inform medical control of the situation. B. document the time the restraints were applied. C. reassess the patient's airway and breathing. D. advise the patient why restraint was needed.
C. reassess the patient's airway and breathing.
An EMT's primary responsibility to the patient who has been poisoned is to: A. administer 25 g of activated charcoal. B. contact poison control immediately. C. recognize that a poisoning occurred. D. administer the appropriate antidote.
C. recognize that a poisoning occurred.
A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving, and his blood pressure is stable. Your next action should be to: A. notify medical control of the patient's response to your treatment. B. reassess his breathing and blood pressure in 15 minutes. C. record the time and dose of the injection and transport promptly, D. visualize his airway to assess for oropharyngeal swelling.
C. record the time and dose of the injection and transport promptly,
Injuries to the vagina and external genitalia are serious because: A. external injury is always associated with internal injury. B. most injuries to these areas are unnoticed by the patient. C. these areas are rich with blood vessels and nerves. D. severe infection occurs in nearly all cases of external injury.
C. these areas are rich with blood vessels and nerves.
You are dispatched to a local nursery for a 39-year-old female who is sick. When you arrive, you find the patient lying on the floor. She is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. You quickly feel her pulse and note that it is very slow. Immediate management for this patient should include: A. requesting a paramedic to give her atropine. B. assisted ventilation with a bag-mask device. C. thoroughly suctioning her oropharynx. D. performing a rapid secondary assessment.
C. thoroughly suctioning her oropharynx.
If you are uncertain how to treat a patient who has been poisoned or exposed to a specific substance, you should: A. administer naloxone via the intranasal route. B. keep the patient supine and elevate his legs. C. try to find the container the substance was in. D. encourage the patient to drink milk or water.
C. try to find the container the substance was in.
Pelvic inflammatory disease (PID) typically does NOT affect the: A. uterus. B. ovaries. C. urinary bladder. D. fallopian tubes.
C. urinary bladder.
You receive a call to a residence where a man found his wife unresponsive on the couch. The patient's respiratory rate is 8 breaths/min, her breathing is shallow, her heart rate is 40 beats/min, and her pulse is weak. The husband hands you an empty bottle of hydrocodone (Vicodin), which was refilled the day before. You should: A. contact the poison control center. B. perform a rapid head-to-toe exam. C. ventilate her with a bag-mask device. D. apply oxygen via a nonrebreathing mask.
C. ventilate her with a bag-mask device.
After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old female with an allergic reaction, you note improvement in her breathing and resolution of her hives. However, she is still anxious and tachycardic. You should: A. transport her rapidly, because it is obvious that she is having a severe reaction to the epinephrine. B. consider administering 0. 15 mg of epinephrine to completely resolve her allergic reaction. C. contact medical control and obtain authorization to administer another 0.3 mg of epinephrine. D, monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
D, monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector, and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment of this patient? A. Remain at the scene with the patient and request a paramedic ambulance. B. Ask the patient if he has any diphenhydramine tablets that you can administer. C. Quickly determine if there are any bystanders who may carry epinephrine D. Administer oxygen, transport at once, and request a paramedic intercept.
D. Administer oxygen, transport at once, and request a paramedic intercept.
Which of the following sets of vital signs would the MT most likely encounter in a patient with acute cocaine overdose? A. BP, 190/90 mm Hg: pulse, 40 beats/min B. BP, 60/40 mm Hg: pulse, 140 beats/min C. BP, 180/100 mm Hg; pulse, 50 beats/min D. BP, 200/100 mm Hg: pulse, 150 beats/min
D. BP, 200/100 mm Hg: pulse, 150 beats/min
______ is what you can see of a person's response to the environment. A. Neurosis B. Affect C. Psychosis D. Behavior
D. Behavior
Which of the following medications blocks the release of histamines? A. Epinephrine (Adrenalin) B. Albuterol (Ventolin) C. Acetaminophen (Tylenol) D. Diphenhydramine (Benadryl)
D. Diphenhydramine (Benadryl)
Your paramedic partner administers atropine to a 49-year-old male with bradycardia. Which of the following side effects would you expect the patient to experience? A. Excessive lacrimation B. Pupillary constriction C. A fall in blood pressure D. Dry mucous membranes
D. Dry mucous membranes
Which of the following drugs is commonly referred to as "roofies"? A. GHB B. Ketamine C. MDMA D. Rohypnol
D. Rohypnol
Which of the following sounds indicates swelling of the upper airway? A. Rales B. Wheezing C. Rhonchi D. Stridor
D. Stridor
Which of the following statements regarding epinephrine administration via the intramuscular (IM) route is correct? A. The maximum single adult dose is 0.15 mg. B. The IM route should not be used in children. C. The preferred injection site is the upper arm D. The 1:1000 concentration should be used.
D. The 1:1000 concentration should be used.
Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated immediately? A. Diffuse urticaria B. Systemic vasodilation C. Severe hypotension D. Upper airway swelling
D. Upper airway swelling
A 4-year-old, 15-kg male ingested an unknown quantity of acetaminophen (Tylenol). The child's mother states that she does not know when the ingestion occurred. The child is conscious and alert and in no apparent distress. The EMT should: A. administer high-flow supplemental oxygen. B. give the child milk to absorb the Tylenol. C. contact medical control for guidance. D. administer 15 g of activated charcoal.
D. administer 15 g of activated charcoal.
A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should: A. position her legs well above the level of her heart. B. advise her to see her physician as soon as possible. C. request a paramedic unit to administer epinephrine. D. administer oxygen and transport her to the hospital.
D. administer oxygen and transport her to the hospital.
A 66-year-old male presents with bizarre behavior. His daughter states that he did not seem to recognize her and was very rude to her. The patient is conscious and has a patent airway and adequate breathing. You should: A. conclude that the patient has Alzheimer's disease. B. advise the patient that his behavior is unacceptable. C. carefully restrain the patient and transport at once. D. ask the daughter how her father normally behaves.
D. ask the daughter how her father normally behaves.
Activated charcoal may be indicated for a patient who ingested: A. methanol. B. ethanol. C. iron. D. aspirin.
D. aspirin.
A 38-year-old woman was bitten by fire ants while at the park. Your primary assessment reveals that she is semiconscious; has labored breathing; and has a rapid, thready pulse. She has a red rash on her entire body, and her face is swollen. You should: A. perform a rapid secondary assessment. B. locate the area where the fire ants bit her. C. place her supine with her legs elevated. D. assist her ventilations with 100% oxygen.
D. assist her ventilations with 100% oxygen.
You and your paramedic partner are caring for a patient who ingested codeine, acetaminophen (Tylenol), and hydrocodone (Vicodin). The patient is unresponsive, his breathing is slow and shallow, and his pulse is slow and weak. Treatment for this patient should include: A. assisted ventilation and flumazenil (Romazicon). B. oxygen via a nasal cannula and atropine sulfate. C. high-flow oxygen via a nonrebreathing mask. D. assisted ventilation and naloxone (Narcan)
D. assisted ventilation and naloxone (Narcan)
A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and that he might have had a seizure shortly before your arrival. This patient is most likely experiencing: A. alcohol intoxication. B. acute schizophrenia. C. acute hypovolemia. D. delirium tremens.
D. delirium tremens.
Signs of excited delirium include: A. pallor, hypotension, and constricted pupils. B. subdued behavior, crying, and suicidal thoughts. C. slurred speech, bradycardia, and a high fever. D. diaphoresis, tachycardia, and hallucinations.
D. diaphoresis, tachycardia, and hallucinations.
Posttraumatic stress disorder can happen after: A. extended periods of hyperthermia or hypothermia. B. alcohol withdrawal. C. a bout with depression. D. exposure to or injury from a traumatic occurrence.
D. exposure to or injury from a traumatic occurrence.
Anaphylaxis is MOST accurately defined as a(n): A. allergic reaction that causes bronchodilation and vasoconstriction. B. severe allergic reaction that typically resolves without treatment. C. moderate allergic reaction that primarily affects the vasculature. D. extreme allergic reaction that may affect multiple body systems.
D. extreme allergic reaction that may affect multiple body systems.
Whenever possible, a female sexual assault victim should be: A. thoroughly assessed, even if no signs of injury exist. B. encouraged to take a shower and change her clothes. C. asked to provide a brief description of the perpetrator. D. given the option of being treated by a female EMT.
D. given the option of being treated by a female EMT.
When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she: A. has obtained a complete set of vital signs. B. ascertains if the patient was ever pregnant. C. has formed a general impression of the patient. D. has gathered patient history information.
D. has gathered patient history information.
If a woman with vaginal bleeding reports syncope, the EMT should assume that she: A. is pregnant. B. has an ectopic pregnancy. C. has an infection. D. is in shock.
D. is in shock.
Because the stinger of a honeybee remains in the wound following a sting: A. the body's immune system deactivates the bee's venom. B. the stinger should quickly be removed with tweezers. C. the toxicity of the venom decreases within 10 minutes. D. it can continue to inject venom for up to 20 minutes.
D. it can continue to inject venom for up to 20 minutes.
An overdose of acetaminophen, the active ingredient in Tylenol, will most likely cause: A. acute kidney failure. B. central nervous system depression. C. bleeding gastric ulcers. D. liver damage and failure.
D. liver damage and failure.
A 48-year-old male is found unconscious in the garden by his wife. When you arrive at the scene and assess the man, you find that he is unresponsive, has labored breathing, and has hives over his entire trunk. You should A. administer oxygen and position him on his side. B. perform a detailed secondary assessment. C. ask his wife if he has any known allergies. D. maintain his airway and assist his ventilations.
D. maintain his airway and assist his ventilations.
Atropine sulfate and pralidoxime chloride are antidotes for: A. lysergic acid diethylamide (LSD). B. diphenhydramine (Benadryl). C. anticholinergic drugs. D. nerve gas agents.
D. nerve gas agents.
Potentially life-threatening consequences of pelvic inflammatory disease (PID) include: A. bacterial vaginosis and chlamydia. B. uterine rupture with severe bleeding. C. ovarian cysts and gonorrhea. D. ovarian abscess and ectopic pregnancy.
D. ovarian abscess and ectopic pregnancy.
A technique used to gain insight into a patient's thinking, which involves repeating in question form what the patient has said, is called: A. intuitive listening. B. passive listening. C. active listening. D. reflective listening.
D. reflective listening.
You respond to a call for an unknown emergency. When you arrive at the scene, the patient's husband meets you at the door and states that his wife has been depressed and has locked herself in an upstairs bedroom. He further tells you that he keeps his handgun in the bedroom. You should: A. get in your ambulance and leave the scene immediately. B. go upstairs with caution and attempt to talk to the patient. C. ask the husband to attempt to reason with his wife. D. remain in a safe place and request law enforcement.
D. remain in a safe place and request law enforcement.
You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should: A. administer a nebulized bronchodilator to improve the status of her breathing. B. crush up an antihistamine tablet and place it in between her cheek and gum. C. monitor her en route to the hospital and call medical control if she worsens. D. request permission from medical control to give another dose of epinephrine.
D. request permission from medical control to give another dose of epinephrine.
Signs of absorbed poison exposure include all of the following, except: A. redness of skin in light-skinned people. B. liquid or powder on a patient's skin. C. burns, itching, or irritation to the skin. D. severe nausea, vomiting, and diarrhea.
D. severe nausea, vomiting, and diarrhea.
When a female has reached menarche: A. menstrual periods become less frequent. B. she can no longer produce an ovum. C. she usually requires hormone therapy .D. she is capable of becoming pregnant.
D. she is capable of becoming pregnant.
The term "behavioral crisis" is MOST accurately defined as: A. a sudden, violent outburst of an otherwise mentally stable person toward a family member. B. a medical illness with psychological symptoms that may lead to limited motor functioning. C. a period of severe depression that lasts longer than 2 weeks and cannot be controlled with medications. D. situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior.
D. situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior.