Final Study

You are summoned to a grocery store for a female patient found having a "fit" by store employees. Upon arrival, you are escorted to the side of an alert but mildly confused 41-year-old woman who is diaphoretic and appears exhausted. After 2-3 more minutes, she becomes more alert and informs you that she has a history of seizures and just had a generalized seizure. Despite your urging, she refuses transport to the hospital. Your safest action would be to:

Advise medical direction of the situation

When administering oral glucose to a patient with diabetes, the EMT must take precautions to prevent which adverse effect?

Airway obstruction

The most common complaint of patients with diabetes for which EMS is summoned is:

Altered mental status

A 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he complained of a sore throat throughout the day, and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is very warm to the touch. Vital signs are pulse, 132; respirations, 28 breaths/min; and SpO2, 90% on room air. Which is your first action in caring for this child?

Apply supplemental oxygen

You are caring for an alert and oriented patient with chest pain. Emergency First Responders have initiated supplemental oxygen, and your EMT partner assisted in the administration of aspirin and two nitroglycerin tablets. Currently, the patient's vital signs are pulse, 76; respirations, 16 breaths/min; blood pressure, 110/56 mmHg; and SpO2, 95%. When transporting this patient on the stretcher, which position is best?

Position of comfort

A patient who was found face-down in a pond is unresponsive, apneic, and pulseless. Friends state that the patient was hot and wanted to take a swim in the pond. Which intervention should be included in your care of this patient?

Positive pressure ventilations at 10 ventilations per minute with supplemental oxygen

An alert and oriented 69-year-old male patient has slight right-arm weakness but exhibits no deficits to the right leg. The EMT should consider this patient to be a:

Priority for transport to a hospital with a stroke center

On room air, which of these patients requires supplemental oxygen?

47-year-old female; temperature 100.3°F; denies dyspnea; SpO2, 91%

For which of these patients is a "talk down" technique indicated?

A 26-year-old who took LSD and is panicked because spiders are after him

Regarding women and cardiac compromise, with which of these statements would you agree?

"The death rate for women suffering a heart attack is higher than that for men."

Which of these patients has a normal fasting glucose level?

A 37-year-old female who is weak and dizzy with a glucose level of 81 mg/dL

Which of these patients would be most eligible to receive a fibrinolytic medication for stroke if no other contraindications are found?

A 48-year-old male whose symptoms started while watching the 6 p.m. news, at which time he dialed 911

You are administering a medication through a metered-dose inhaler (MDI) using a spacer. Which of these actions would be most appropriate?

Administer the medication into the spacer and then have the patient inhale

You are treating a patient for mild chest pain but notice that his blood pressure is elevated. Which of these statements made by the patient would make you suspect he has acute hypertension?

"The doctor checks my blood pressure regularly and it's not normally that high."

Regarding the field triage of injured patients, which of these patients is NOT a member of a special patient population that would necessitate transport to a trauma center?

A female patient who is 12 weeks pregnant and who fell on the sidewalk, injuring her hip and wrist

Friends of a male patient who experienced a generalized seizure while at a picnic are worried because he cannot remember the seizure. You should inform them that this is:

A normal finding that is common among those who suffer this type of seizure

Which of these statements made by the EMT indicates a safe understanding of the administration of nitroglycerin in the prehospital setting?

"A total of three nitroglycerin tablets may be administered in the prehospital setting, and this includes what the patient recently took prior to EMS arrival."

You are caring for a postictal male patient with a known history of seizures. He is confused and cannot remember his 8-year-old son's name. His son tearfully asks you if his father will ever remember him. Your response would be:

"Although he is confused now, he should remember your name in a little bit."

The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states:

"An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."

A patient who is severely short of breath and covered with hives states that she is allergic to crab. Despite her allergy, she tried some crab dip 10 minutes ago, since it had been "years and years" since she had her last allergic reaction. Which question should the EMT ask first?

"Do you have an epinephrine auto-injector?"

Which of these questions would the EMT ask when performing the Los Angeles Prehospital Stroke Screen?

"Have you ever had a seizure?"

A male patient with a history of behavioral problems continually smacks his lips, sticks his tongue out, and turns his head to the left. His arm also jerks upward regularly. Which statement, made by a caregiver, would an EMT recognize as most important and relating to this presentation?

"He has been on psych medications for many years."

Which of these complaints would the EMT expect from a person who has just used crack cocaine for the first time?

"I have chest pain."

Which of these statements made by your new EMT partner demonstrates an understanding of assessment findings related to stroke?

"If one arm is weak, a stroke should be suspected."

You are approached by an EMR who informs you that last week, he was on a call in which a patient with chest pain and a known history of coronary artery disease was not given oxygen by the EMTs. You would reply:

"It has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful."

A patient informs you that he found out he is allergic to certain molds and was prescribed an epinephrine auto-injector. He asks you how the epinephrine will help him the next time he is exposed to mold. Your response would be:

"It will cause the blood vessels to constrict and your airway structures to relax so that they reopen."

You are on the scene of a patient who just experienced a seizure. The patient is still in the postictal phase and is not fully oriented. Family members state that he has a history of diverticulitis, gastric ulcers, and diabetes. Your partner asks you if you think he should obtain a blood glucose level. Your response should be:

"Yes, that is a good idea since he has a history of diabetes."

Medical direction has ordered the administration of activated charcoal to a 3-year-old boy. Which of these doses would be most appropriate?

1 gram/kg

A patient with diabetes presents as alert but irritable and confused. His airway is patent with an intact gag reflex and breathing is adequate. You do not have a glucometer available and are not sure if his blood sugar is high or low. In this situation, what would be your next best action?

Administer oral glucose

The wife of a 43-year-old male patient has called 911 because her husband was difficult to wake up and now is lethargic with garbled speech. She reports a history of diabetes, stroke, renal failure, and high blood pressure. The patient's airway is patent, respirations are tachypneic but adequate, and radial pulse is rapid. Your partner reports the following vital signs: pulse, 136; respirations, 22 breaths/min; blood pressure, 106/62 mmHg; SpO2, 92%; and blood glucose, 642 mg/dL. What would be the most appropriate action in the care of this patient?

Administer supplemental oxygen

On scene, you are treating a 62-year-old female patient with chest pain, diaphoresis, and nausea. She has a history of heart problems as well as diabetes, for which she takes medications. She is allergic to penicillin and iodine. She is alert, oriented, and calm, and there are no threats to the airway, breathing, or circulation. The patient took 81 mg of aspirin this morning, as she always does. Her vital signs are pulse, 100; respirations, 16 breaths/min; blood pressure, 118/90 mmHg; and SpO2, 97% on room air. In overseeing the care of this patient, which of these actions would demand immediate and corrective intervention?

Applying oxygen through a nasal cannula

A 67-year-old male patient with a history of coronary artery disease and COPD called 911 for chest discomfort and mild dyspnea. When you are at the patient's side, he states that the pain started when he was cleaning out his garage, but after a period of rest, the pain has resolved. His airway is patent, breathing adequate, radial pulse irregular, and skin warm and dry. He has a past medical history of atrial fibrillation (irregular heartbeat), coronary artery disease, and diabetes, for which he takes insulin. Vital signs are pulse, 68; respirations, 16 breaths/min; blood pressure, 148/88 mmHg; and SpO2, 97% on room air. The patient took 81 mg of aspirin as prescribed this morning on awakening. What should you do first?

Assess breath sounds

After a lengthy response time in a rural community, you arrive at the home of a 62-year-old female patient who is still seizing. Your immediate action would be to:

Assess the patient's airway and breathing

The EMT is properly using a small-volume nebulizer when she:

Attaches the nebulizer to oxygen at 8 to 10 lpm

A panicked and anxious patient tells you that he is allergic to peanuts and thinks he may have accidentally eaten some. He states that the last time he ate peanuts he almost died and needed to have a "tube put in his throat." When assessing this patient, which of these signs or symptoms would provide the best evidence that the patient is having an allergic, and possibly an early anaphylactic, reaction?

Hives on his chest

You have arrived at a home where the parents found their 13-year-old son in the garage inhaling propane from the family grill. Your assessment reveals the patient to be alert and oriented, with an open airway. His breathing is labored, and his pulse is rapid for his age. When conducting the secondary assessment, which of these findings or history would be of the greatest concern?

Bilateral wheezing

A patient has a low platelet count. Based on this finding, which complication is he most at risk for?

Bleeding

Your partner states that he wants to palpate the blood pressure. Which equipment would you hand him?

Blood pressure cuff

Within the body, the release of histamine causes dilation of the:

Blood vessels

When assessing an adult patient with difficulty breathing, which of these signs or symptoms would be of most immediate concern?

Blue coloration to the lips

A male patient suddenly found himself unable to talk and with profound weakness to his right arm and leg. Currently he is responsive to verbal stimuli and has the following vital signs: pulse, 88; respirations 14 breaths/min and adequate; and blood pressure, 210/80 mmHg. When transporting this patient to the hospital, in which position should you place him?

Left lateral recumbent

A patient complains of chest pain that radiates into his neck and arms. The primary assessment reveals a patent airway, adequate breathing, and a strong, regular radial pulse. The patient's skin is warm and dry, and reveals no signs of inadequate perfusion. What should you do next?

Check vital signs

A patient with a past medical history of angina is now complaining of chest discomfort. When assessing this patient, which sign or symptom should alert the EMT that the patient is probably experiencing an acute myocardial infarction and not an anginal attack?

Chest discomfort is not relieved by nitroglycerin

A patient denies difficulty breathing, but displays signs of respiratory distress. You state, "I know that you said you are breathing fine, but you cannot speak more than two to three words at a time without gasping for air." Your response is an example of:

Confrontation

After successfully rewarming a patient's frozen foot and frozen toes, the EMT should:

Cover the foot and toes with dry, sterile dressings

Which portion of the heart, when weakened by a heart attack, is responsible for causing fluid to back up into the alveoli?

Left ventricle

You are responding to a call for a 4-year-old child hit by a car. When assessing this child, which injury patterns would you recognize as typical based on the child's age and mechanism of injury?

Deformed femurs, bruises to the chest and abdomen, and head injury

You have arrived on the scene of an explosion in a warehouse used to store fertilizers. A paramedic, who has already triaged the nine patients involved, directs you to a young man sitting under a tree. The man states that he is having excruciating ear pain. The initial assessment and rapid trauma assessment reveal no obvious injuries. Given this presentation, the EMT would recognize the injury was likely sustained:

During the primary blast phase

You believe a patient for whom you are caring is starting to experience respiratory failure. Which of these findings is supportive of this suspicion?

ETCO2 of 56 mmHg

You have been dispatched to a pool party for a 19-year-old male with shoulder pain. He states that he dove off the diving board and hit the bottom of the pool with his right shoulder and back. Although there is alcohol at the party, he denies drinking. The patient is alert and oriented and has obvious redness and abrasions to his right shoulder, neck, and back. He complains of neck pain and tingling in his right arm, but denies any other discomfort to any other part of the body. Your next action would be to:

Establish manual spine motion restriction

What is the basic function of the respiratory system?

Exchange oxygen and carbon dioxide with the environment

What best illustrates the EMT's failure to meet the standard of care when treating a patient with chest pain?

Failing to give the patient oxygen

The tricuspid valve prevents blood from:

Flowing from the right ventricle into the right atrium

Your legal right to function as an EMT is contingent upon:

Following standing orders and protocols, as approved by medical direction

When you are obtaining information for the medical history, which of these findings would be significant for a patient with suspected cholecystitis?

Fried chicken and potato salad for dinner

Which of these is a high-velocity wound that carries the greatest risk for death when considering the concept of cavitation?

Gunshot wound to the spleen

A patient with severe head and neck pain states that he was properly wearing his seat belt when another car struck him from behind. As a knowledgeable EMT, you would realize that the complaint of:

Head and neck pain could occur even when the seat belt is properly worn

Assessment of a 63-year-old female patient reveals a patent airway, adequate breathing, and strong radial pulse. She has no difficulty speaking and no facial droop, but exhibits a slight left arm drift and has a headache. The EMT should interpret these specific findings as:

Highly suggestive that a stroke may be occurring

A patient is alert and oriented, with a blood pressure of 228/110 mmHg, a heart rate of 82 beats/min, respirations of 20 breaths/min and adequate, and a pulse oximeter reading of 96% on room air. The patient complains of a bad headache that started suddenly. The patient has equal grips and good lower leg function. The blood glucose is 68 mg/dL, and pupils are reactive, although the patient has trouble maintaining a horizontal gaze when asked to do so. He has a history of seizures, hypertension, and atrial fibrillation. Given these assessment findings, which one meets a criterion for the MEND stroke screening tool that suggests the patient may be experiencing a stroke?

Horizontal gaze abnormality

A patient has been involved in a very serious motor vehicle collision and is in shock. Assessment findings indicate that he sustained blunt trauma to the abdominal and pelvic areas. Which type of shock is the patient most likely suffering?

Hypovolemic

What is the primary reason to administer oral glucose to a patient?

Increase the amount of circulating glucose in the bloodstream

A 23-year-old diver has been brought to the surface by fellow divers after behaving erratically while in the water. Your assessment reveals him to be confused and uncoordinated, with an open airway and adequate breathing. He has a strong radial pulse and SpO2 of 98%. The patient has diabetes, and your partner reports that his blood sugar is 91 mg/dL. The remainder of your assessment is unremarkable. Based on this presentation and history, what would be the most likely cause of his condition?

Increased nitrogen levels in the blood

You have been called to a residence for a cognitively challenged 32-year-old female patient who drank from a bottle of floor cleaner. She is unconscious, exhibits snoring respirations, and is having a difficult time breathing due to swelling from burns in her mouth. Which of these steps should be included in the initial care for this patient?

Insert a nasal airway

What does the first "I" in the AEIOU-TIPPSS mnemonic stand for?

Insulin

You are assisting a paramedic in the transport of a patient from a community hospital emergency department to a large medical center. The patient was diagnosed with an acute myocardial infarction and received fibrinolytic therapy in the ED. Currently, you are transporting the patient with the fibrinolytic medication infusing through an IV. In regard to the fibrinolytic therapy, you know that during this transport, you will need to closely monitor the patient for which complication?

Internal bleeding

When treating a patient for an overdose, the highest priority of care is placed on:

Managing the airway and breathing

For a patient with a history of an unstable abdominal aortic aneurysm, the EMT should recognize and prepare for:

Massive internal bleeding

You suspect a patient of being infected with pertussis. While performing the primary assessment, you note a deep cough with clear breath sounds. Her vital signs are pulse, 108; respirations, 16 breaths/min; and SpO2, 96% on room air. Given this scenario, which action by the EMT would be most appropriate?

Monitor the patient and transport

Which of these scene size-up observations would make you suspicious that a patient who complains of shortness of breath has congestive heart failure?

Multiple pillows stacked at the head of the patient's bed

When an EMT performs the secondary assessment on a postictal patient with a known history of seizures, which of these assessment findings would be of most concern?

New contusion noted to the forehead

An elderly patient with diabetes who experiences a silent MI will most likely:

Not be awakened by a heart attack as he sleeps

A 56-year-old male patient has been exposed to fumes containing cyanide. Why should the EMT call for advanced life support assistance?

Paramedics may be able to administer a cyanide antidote

The EMT would recognize that the pain associated with a kidney stone is caused by:

Passage of the stone through the ureter

A 42-year-old female patient is lying in bed with anxiety after smoking some bath salts 30 minutes earlier. As you enter the bedroom, which finding poses the greatest danger to rescuers, given the nature of this medication?

Patient aggression or violence

A 26-year-old female patient complains of abdominal pain. The pain is generalized to her abdomen and worsens when walking. She also tells you that she is having a foul-smelling, yellow-colored vaginal discharge. The primary assessment reveals no threats to the airway, breathing, or circulation. Her vital signs are pulse, 104; respirations, 16 breaths/min; blood pressure, 108/60 mmHg; and oral temperature of 102.1°F. She finished her last menstrual period three days ago. Which condition do you suspect?

Pelvic inflammatory disease

You are called for an elderly woman who has slipped on the ice. On arrival, you find her supine on an icy sidewalk and responsive to painful stimuli with decorticate posturing (flexion). She has blood coming from a laceration on the back of her head and is breathing agonally at 4 times a minute. What should you do immediately?

Perform the manual jaw-thrust maneuver

A young male patient with a seizure history is postictal in his bed. His airway is patent, breathing labored, and radial pulse strong and fast. Vital signs are pulse, 140; respirations, 20 breaths/min; blood pressure, 158/92 mmHg; and SpO2, 96% on room air. At this time, which action would be most appropriate?

Place the patient in a lateral recumbent position

When performing a secondary assessment on an elderly male patient who is confused and combative, which of these assessment findings should be of most concern to the EMT?

Pulse of 164

An 18-year-old female patient has eaten a poisonous mushroom. Medical direction has ordered you to administer activated charcoal. Immediately following administration, the patient vomits the medication. She remains alert and oriented with no current life threats to the airway, breathing, or circulation. Your next action would be to:

Readminister the activated charcoal

You have been called to a railroad yard for an unknown emergency. When you arrive on scene, you are directed to a tanker car, where two men are lying on the ground next to the railcar. The men are mechanics for the railroad company and were performing some type of repair work on the valves for the tanker car. The only other person around is a security guard, who saw the men suddenly collapse on a surveillance video camera and called 911 immediately. He has an automated external defibrillator (AED) at his side. Your initial action would be to:

Remain at a safe distance and call for fire department assistance

Which of these statements about the AED and its use in the treatment of cardiac arrest is true?

Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator

You are en route for a possible heroin overdose. As an EMT, you would recognize heroin fits best into which drug category based on its effects?

Sedatives

A paramedic has asked you to place the patient on a nonrebreather mask at 15 liters per minute. To administer oxygen at this flow rate, you should:

Select "15" on the oxygen therapy regulator

A patient has been found unresponsive on her bedroom floor. When assessing her, the EMT would have the highest index of suspicion for a narcotic overdose when he notes:

Shallow and slow respirations

You are dispatched on a call to a "rave" for a possible ecstasy overdose. Law enforcement is already at the scene and has established scene safety so you can enter. Which kind of signs and symptoms would you expect to find with this type of overdose?

Signs and symptoms related to brain injury or damage

A young boy complains of pain to his fingers after spending several hours outside riding a sled in cold winter temperatures. After ensuring he has no life-threatening conditions, you turn your attention to his hands and note that the fingers are cold to the touch. You suspect that he is suffering from a superficial freezing cold injury. Which sign or symptom would help confirm this suspicion?

Skin on the fingers that is soft and numb

A 49-year-old male has been stabbed in the lower right chest. Police tell you that the patient got into an argument with an unidentified man, who then stabbed him before fleeing the scene. After assessing the patient, you are suspicious that the knife punctured the lung and is causing internal bleeding. In this situation, the mechanism of injury would be:

Stab wound to the right chest

You have been called for a 58-year-old male patient with an unknown medical emergency. On scene, you find the alert and oriented patient complains of headache as well as weakness and "tingling" to his right arm and leg. He has diabetes and high blood pressure, for which he takes the appropriate medications. When asked, he reports that he may have passed out earlier in the day, immediately after taking his morning dose of insulin. His pulse is 96, respirations 16 breaths/min, and blood pressure 180/106 mmHg. Based on this presentation, you should treat the patient for:

Stroke

A male patient has altered mental status secondary to a brain tumor. The EMT would classify the brain tumor as which type of cause?

Structural

You are completing the prehospital care report and are documenting the fact that you assisted a patient in taking his nitroglycerin pill. How will you document the route of administration?

Sublingual

You are preparing to transport a 46-year-old male patient who has had multiple seizures throughout the morning, according to the family. Currently, he is on your stretcher and is postictal. He has a history of seizures for which he takes anticonvulsant medications. He also has diabetes and kidney failure. Of the equipment listed here, which is the most essential to have ready during transport of this patient?

Suction device

Which of these assessment findings would indicate that the patient is experiencing an anaphylactic reaction after a bee sting and requires immediate intervention?

Swollen lips and oral mucosa, with a blood pressure of 84/50 mmHg

If a clot occludes the blood flow through the coronary artery, what will be the detrimental effect?

The flow of oxygen-rich blood to the muscle of the ventricle will be decreased

A car, driven by an unrestrained male, strikes a utility pole at 35 mph. Given this scenario, which would be true?

The internal organs struck the inside of the body at a speed of 35 mph

A 41-year-old female patient has called 911 for a headache. Which of these assessment findings should make the EMT suspicious that the patient has a migraine headache?

The pain was preceded by an aura

A patient has pulmonary hypertension, which has increased the resistance in the pulmonary blood vessels. In response, what will most likely occur over a long period of time?

The right side of the heart will weaken

Which of these is the best explanation of why a patient who experiences a syncopal episode often regains consciousness after falling?

The supine position allows better perfusion to the brain

A patient with a history of frequent urinary tract infections (UTI) complains of lower abdominal pain and feels as though she has a UTI again. Which assessment findings would cause you to question that the problem is a UTI?

Vaginal bleeding

Failure to promptly treat ventricular tachycardia can result in myocardial cell hypoxia and ischemia, which then contributes to the rhythm deteriorating to:

Ventricular fibrillation