Chapter 17

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

a 17-year-old male with depression and anxiety

78.You are examining a patient whose signs include lip smacking, jerking of the left arm, and agitation. Based on these signs, what type of seizure is this patient experiencing?

complex partial seizure.

91.You are transporting a semiconscious patient to the hospital. En route, you note that the patient's mental status is not improving, despite 100% supplemental oxygen. You should suspect that this patient

is hypoglycemic.

41.The mental status of a patient who has experienced a generalized seizure a. progressively worsens over a period of a few hours. b. typically does not improve, even after several minutes. c. is easily differentiated from that of acute hypoglycemia. d. is likely to improve over a period of 5 to 30 minutes.

is likely to improve over a period of 5 to 30 minutes.

89.You receive a call to a residence, where a neighbor has found the resident, a 40-year-old female, semiconscious on her living room floor. During your assessment, you discover a bottle of Dilantin on a nearby table. You should be MOST suspicious that this patient

is postictal following a seizure.

4.Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the a. pancreas. b. kidneys. c. liver. d. brain.

liver.

29.You are caring for a 68-year-old man with sudden onset of left-sided paralysis and slurred speech. His airway is patent, his respirations are 14 breaths/min with adequate depth, and his oxygen saturation is 98%. Treatment for this patient should include A. recovery position and transport. B. ventilatory assistance and transport. C. high-flow oxygen and transport. D. oral glucose gel and transport.

recovery position and transport.

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

foramen magnum.

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

has bleeding within the brain

33.Patients with a subarachnoid hemorrhage typically complain of a sudden severe A. bout of dizziness B. headache C. altered mental status D. thirst

headache

82.Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache?

history of migraines

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

hydromorphone (Dilaudid)

7.The MOST significant risk factor for a hemorrhagic stroke is A. hypertension. B. severe stress. C. diabetes mellitus. D. heavy exertion.

hypertension.

31.Headache, vomiting, altered mental status, and seizures are all considered early signs of

increased intracranial pressure

17.You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should a. assess the patient for a facial droop and hemiparesis. b. initiate CPR and attach an AED as soon as possible. c. perform CPR for 5 minutes before applying the AED. d. obtain a blood glucose sample to rule out hypoglycemia.

initiate CPR and attach an AED as soon as possible.

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

8

30.Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of

8 or 9??

77.What is the difference between a stroke and a transient ischemic attack?

A TIA resolves completely within 24 hours of onset.

27.Which of the following MOST accurately describes a simple partial seizure? A. A seizure that causes the patient to stare blankly B. A seizure that begins in one extremity C. A generalized seizure without incontinence D. A seizure that is not preceded by an aura

A seizure that begins in one extremity

39.At each vertebra in the neck and back, two nerves, called ______ nerves, branch out from the spinal cord and carry signals to and from the body.

spinal

32.Hypoglycemia can mimic conditions such as A. cystic fibrosis B. myocardial infarction C. high fevers D. stroke

stroke

16.You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should A. assist her ventilations with a bag-valve mask. B. administer one tube of oral glucose and transport. C. insert an oral airway, apply oxygen, and transport. D. suction her oropharynx and transport immediately.

suction her oropharynx and transport immediately.

81.Which of the following clinical signs is MOST suggestive of a ruptured aneurysm? A. Unilateral hemiparesis B. Confusion and weakness C. Nasal discharge of blood D. Sudden, severe headache

sudden severe headache

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

the right side of the body.

44.Successful treatment of a stroke depends on whether

thrombolytic therapy is given within 3 hours after symptoms began.

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

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

87.Which of the following MOST accurately describes the postictal state that follows a seizure? A. Confusion and fatigue B. Hyperventilation and hypersalivation C. A rapidly improving level of consciousness D. A gradually decreasing level of consciousness

A. Confusion and fatigue Dazed, confused, or combative appearance

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n): A. hemorrhagic stroke. B. acute ischemic stroke. C. severe migraine headache. D. transient ischemic attack.

A. hemorrhagic stroke

79.You are dispatched to a home where you find a 70-year-old man. He is exhibiting facial drooping and, when you ask him to tell you what day it is, he says "January." Which part of the brain is most likely to have been affected?

Aphasia is the inability to produce or understand speech. This occurs when the left hemisphere of the cerebrum is impacted by a stroke.

The MOST important reason for promptly transporting a stroke patient to the hospital is because: A. a transient ischemic attack can be ruled out. B. medications may be given to reverse the stroke. C. the clot in the coronary artery may be dissolved. D. he or she needs close blood pressure monitoring.

B. medications may be given to reverse the stroke

Which of the following are components of the Cincinnati Prehospital Stroke Scale? A. Arm drift, blood pressure, speech B. Speech, pupil response, arm drift C. Facial symmetry, speech, arm drift D. Pupil response, facial droop, speech

C. Facial symmetry, speech, arm drift

15.Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure? A. A rapidly improving level of consciousness B. Hyperventilation and hypersalivation C. A gradually decreasing level of consciousness D. Confusion and fatigue

Confusion and fatigue

67.Function of the Cerebellum

Controls muscle and body coordination , responsible for coordinating complex tasks that involve many muscles

66.Function of the brain stem

Controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction.

An acute ischemic stroke is caused by: A. a ruptured cerebral artery. B. increased intracranial pressure. C. an acute rise in a person's blood pressure. D. a blocked cerebral artery.

D. a blocked cerebral artery

A type of seizure that is characterized by severe twitching of all the body's muscles and lasts for several minutes or longer is called a(n): A. partial seizure. B. absence seizure. C. tonic-clonic seizure. D. generalized seizure.

D. generalized seizure

86.Successful treatment of a stroke depends on whether or not A.surgical intervention is performed to remove obstructive clots. B.medications are given to restore the function of infarcted cells. C.the stroke occurs within the left or right hemisphere of the brain. D.thrombolytic therapy is given within 3 hours after symptoms began.

D.thrombolytic therapy is given within 3 hours after symptoms began.

71.When you are assessing for a stroke, which of the following neurologic tests should be included in the assessment as a minimum?

Facial movement, arm movement, and speech

1.A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport? A. He has experienced seizures since he was 20 B. His wife states that this was his "usual" seizure C. His Glasgow Coma Scale (GCS) score was 15 D. He is currently not prescribed any medications

He is currently not prescribed any medications

76.Which of the following mimics a stroke and also causes a seizure? - Meningitis - Postictal state - Hypoglycemia - Migraine headache

Hypoglycemia

90.Which of the following conditions would MOST likely mimic the signs and symptoms of a stroke?

Hypoglycemia

12.Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke? A. Intracranial bleeding B. A postictal state C. Hypovolemia D. Hypoglycemia

Hypovolemia

37.____ is a loss of bowel and bladder control and can be due to a generalized seizure.

Incontinence

74.What happens when blood flow to a particular part of the brain is cut off by a blockage, resulting in tissue damage? - Ischemic stroke - Hemorrhagic stroke - Seizure - Status epilepticus

Ischemic stroke

36.You are called to a home and find a 56-year-old woman supine in her bed. She appears alert, but has slurred speech. Her family tells you she has a history of TIAs and hypertension. You ask the patient, "What day is it today?" Her reply is, "Butterfly." Which area of the brain is likely affected?

Left hemisphere

83.Which of the following medications would indicate that a patient has a history of seizures?

Levetiracetam (Keppra)

70.________ affect(s) the entire brain, often causing anxiety, restlessness, and confusion. - Poor blood supply to one side of the brain - Low oxygen levels in the bloodstream - Very low blood glucose levels - Aneurysms

Low oxygen levels in the bloodstream will

73.What is the name of the condition when the patient forgets about the injured side after a stroke? - Hemiparesis - Neglect - Aphasia - Ataxia

Neglect

14.Which of the following is a metabolic cause of a seizure? a. Poisoning b. Brain tumor c. Massive stroke d. Head trauma

Poisoning

13.Which of the following conditions would MOST likely affect the entire brain? A. Ruptured cerebral artery in the occipital lobe B. Reduced blood supply to the left hemisphere C. Blocked cerebral artery in the frontal lobe D. Respiratory failure or cardiopulmonary arrest

Respiratory failure or cardiopulmonary arrest

69.Most common types of headaches are

Tension headache, migraines, and sinus headaches

72.You are treating a patient who is exhibiting slurred speech, facial droop, and an inability to move his left arm. Which neurologic examination emphasizes these possible stroke signs? - Chicago Prehospital Stroke Scale- 3 -Item Stroke Severity Scale - Cincinnati Prehospital Stroke Scale - Glasgow Coma Scale

The Cincinnati Prehospital Stroke Scale looks at facial droop, arm lift, and speech.

65.The brain is divided in three major parts

The brain stem, The Cerebellum, The cerebrum

28.Which of the following symptoms would lead the EMT to believe that a patient's headache is caused by sinus congestion? A. There is numbness in the extremities B. There is associated neck stiffness C. The headache began suddenly D. The pain is worse when bending over

The pain is worse when bending over

38.________may reverse stroke symptoms and even stop the stroke if given within 3 to 6 hours of onset of symptoms.

Thrombolytic therapy

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

a ruptured cerebral artery.

11.When caring for a patient with documented hypoglycemia, you should be MOST alert for? A. a seizure. B. a febrile convulsion. C. respiratory distress. D. an acute stroke.

a seizure.

10.A transient ischemic attack (TIA) occurs when a. medications are given to dissolve a cerebral blood clot. b. a small cerebral artery ruptures and causes minimal damage. c. a small clot in a cerebral artery causes temporary symptoms. d. signs and symptoms resolve spontaneously within 48 hours.

a small clot in a cerebral artery causes temporary symptoms.

85. A patient who is experiencing receptive aphasia is

able to speak clearly but has difficulty understanding.

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

an aneurysm.

35.When blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel, the result is A. a hemorrhagic stoke B. atherosclerosis C. an ischemic stroke D. a cerebral embolism

an ischemic stroke

3.Febrile seizures a. occur when a child's fever rises slowly. b. often result in permanent brain damage. c. are usually benign but should be evaluated. d. are also referred to as absence seizures.

are usually benign but should be evaluated.

84.Components of the Cincinnati Prehospital Stroke Scale include

arm drift, speech, and facial droop.

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

ask his wife when she noticed the symptoms.

25.When assessing for arm drift of a patient with a suspected stroke, you should A. ask the patient to close his or her eyes during the assessment. B. observe movement of the arms for approximately 2 minutes. C. ask the patient to hold his or her arms up with the palms down. D. expect to see one arm slowly drift down to the patient's side.

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

45.Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should A. place a bite block in her mouth in case she has a seizure and transport at once B. apply oxygen via a nonbreathing mask, place her on her left side, and transport C. apply oxygen via nonbreathing mask and trasport her for a blood-alcohol test D. assist ventilations, perform a rapid scan exam, and prepare for immediate transport

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

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

blockage of a cerebral artery

40.The ____ controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction

brain stem

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

brain stem.

60.Muscle control and body coordination are controlled by the

cerebellum.

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

cerebral vasodilation.

24.The three major parts of the brain are the A. cerebrum, cerebellum, and brain stem. B. midbrain, cerebellum, and spinal cord. C. cerebellum, medulla, and occiput. D. brain stem, midbrain, and spinal cord.

cerebrum, cerebellum, and brain stem

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

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

8.A patient whose speech is slurred and difficult to understand is experiencing A. dysphagia B. dysarthria C. paraplegia D. aphasia

dysarthria.

51.The anterior aspect of the cerebrum controls

emotion

2.During the primary assessment of a semiconscious 70-year-old female, you should A. immediately determine the patient's blood glucose level. B. ask family members if the patient has a history of stroke. C. insert a nasopharyngeal airway and assist ventilations. D. ensure a patent airway and support ventilation as needed.

ensure a patent airway and support ventilation as needed.

80.A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is A. epilepsy. B. a brain tumor. C. a serious infection. D. intracranial bleeding.

epilepsy

88.A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is A. a brain tumor. B. intracranial bleeding. C. epilepsy. D. a serious infection.

epilepsy.

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

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

63.Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale? A. arm drift B. speech C. memory D. facial droop

memory

34.The principal difference between a patient who has had a stroke and a patient with hypoglycemia almost always has to do with the A. papillary response B. mental status C. blood pressure D. capillary refill time

mental status

18.You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes valproate (Depakote) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to administering oxygen, you should a. place her in the recovery position and transport her with lights and siren. b. monitor her airway and breathing status and assess her blood glucose level. c. administer one tube of oral glucose and prepare for immediate transport. d. give her small cups of water to drink and observe for further seizure activity.

monitor her airway and breathing status and assess her blood glucose level.

23.A patient with an altered mental status is A. not thinking clearly or is incapable of being aroused B. typically alert but is confused as to preceding events C. completely unresponsive to all forms of stimuli D. usually able to be aroused with painful stimulus

not thinking clearly or is incapable of being aroused.

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

obtain a description of how the seizure developed.

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

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

68.The brain is most sensitive to changes in ________, _________, and ________levels

oxygen; glucose; temperature

64.An absence seizure is also referred to as a

petit mal seizure.

59.Status epilepticus is characterized by

prolonged seizures without a return of consciousness.

42.When transporting a stable stroke patient with a paralyzed extremity, place the patient in a a. recumbent position with the paralyzed side up. b. sitting position with the head at a 45° to 90° angle. c. supine position with the legs elevated 6 feet to 12 feet. d. recumbent position with the paralyzed side down.

recumbent position with the paralyzed side down

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

repeat the arm drift test, but move the patient's arms into position yourself.

75.What criteria must be met for a patient to have status epilepticus? - A seizure lasting more than 30 minutes - A seizure that was preceded by an aura - The presence of incontinence during the seizure - Multiple seizures with normal consciousness between each event

seizures that recur every few minutes or last longer than 30 minutes.

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

severe hypovolemia

50.A generalized seizure is characterized by

severe twitching of all the body's muscles.

54.A patient who is experiencing aphasia is

unable to produce or understand speech.

48.The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia A.always take oral medications to maintain normal blood glucose levels. B.do not present with slurred speech or weakness to one side of the body. C.are typically alert and attempt to communicate with health care providers D.usually have an altered mental status or decreased level of consciousness.

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

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

when the patient last appeared normal.