Chapter 19 TEST
A patient who demonstrates any one of the three symptoms from the Cincinnati Prehospital Stroke Scale has a(n) ________% chance of having an acute stroke. A. 70 B. 60 C. 50 D. 80
A. 70
Your patient is a 19-year-old female who is 7 months pregnant. She just experienced a seizure. She has no previous history of seizures or any other medical condition. Which of the following is the MOST likely cause of the seizure? A. Eclampsia B. Congenital brain defects C. Hypoglycemia D. Trauma
A. Eclampsia
A patient with a history of seizures experiences a seizure for no apparent reason. What is the likely cause? A. Failure to take prescribed medication B. Fever C. Withdrawal from alcohol D. Head trauma
A. Failure to take prescribed medication
What statement BEST distinguishes type 1 from type 2 diabetes? A. In type 1 diabetes, the pancreas does not secrete insulin normally, but in type 2 diabetes, the body's cells fail to use insulin properly. B. Type 1 is typically far less severe than type 2. C. In type 1 diabetes, too much insulin is the problem, and in type 2 diabetes, too little insulin is the problem. D. Type 1 diabetes is known as non-insulin-dependent diabetes, and type 2 diabetes is known as insulin-dependent diabetes.
A. In type 1 diabetes, the pancreas does not secrete insulin normally, but in type 2 diabetes, the body's cells fail to use insulin properly.
For the reticular activating system (RAS) to work correctly, what three substances are needed? A. Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and water to keep the brain hydrated B. Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and sodium to keep the brain hydrated C. Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and water to keep the brain hydrated D. Oxygen to perfuse brain tissue, insulin to nourish brain tissue, and sodium to keep the brain hydrated
A. Oxygen to perfuse brain tissue, glucose to nourish brain tissue, and water to keep the brain hydrated
Your patient is an unresponsive 30-year-old male wearing a Medic-Alert bracelet indicating that he is a diabetic. The patient's coworkers came by his house to check on him when he did not show up for work and did not call in sick. Your assessment does not clearly indicate to you whether the patient may be hypoglycemic or hyperglycemic. Which of the following should you do next? A. Protect the patient's airway, administer oxygen, and consider assessing the patient's blood glucose per local protocol. B. Use your glucometer to check his blood sugar before taking any further action. C. Use the patient's glucometer to check his blood sugar level. D. Administer oral glucose, as it will not cause additional harm in hyperglycemia, but may prevent brain damage if the patient is hypoglycemic.
A. Protect the patient's airway, administer oxygen, and consider assessing the patient's blood glucose per local protocol.
Most of the diabetic emergencies that you will be called to deal with will be related to hypoglycemia. However, occasionally you will experience an instance of hyperglycemia. In the list below, which item is NOT likely to be a sign or symptom of hyperglycemia? A. Reduced rate of breathing B. Excessive urination C. Chronic thirst D. Nausea
A. Reduced rate of breathing
Which of the items below is NOT part of the Cincinnati Prehospital Stroke Scale? A. Test for equal grip strength. B. Ask the patient to smile. C. Test the patient for arm droop or lack of movement. D. Have the patient repeat a simple sentence.
A. Test for equal grip strength.
Which of the following BEST describes status epilepticus? A. Two or more seizures with tonic-clonic activity without an intervening period of consciousness B. A seizure involving convulsions on only one side of the body C. A period of drowsiness following tonic-clonic seizures D. A seizure that occurs without a known cause
A. Two or more seizures with tonic-clonic activity without an intervening period of consciousness
Which of the following may result in hypoglycemia in the diabetic patient? A. Vomiting after eating a meal B. Lack of exercise C. Failure to take insulin or oral diabetes medications D. Overeating
A. Vomiting after eating a meal
The condition in which there is an insufficient amount of sugar in the blood is called: A. hypoglycemia. B. hyperglycemia. C. diabetic ketoacidosis. D. diabetic coma.
A. hypoglycemia.
A dose of oral glucose gel in a toothpaste-type tube is: A. one tube. B. a quarter of a tube. C. half a tube. D. dependent on the patient's glucose level.
A. one tube.
The medical term for fainting is: A. syncope. B. dehydration. C. altered RAS status. D. vertigo.
A. syncope.
The insulin-glucose relationship has been described as a "lock and key" mechanism because: A. without the insulin "key," glucose cannot enter the locked cells. B. insulin is the "key" to unlocking cells storing glucose. C. without the glucose "key," insulin cannot enter the locked cells. D. glucose is the "key" to unlocking cells storing insulin.
A. without the insulin "key," glucose cannot enter the locked cells.
Which of the following blood glucose levels is considered normal for an adult? A. 180 mg/dL B. 80 mg/dL C. 40 mg/dL D. 150 mg/dL
B. 80 mg/dL
What is epilepsy? A. A condition in which a person has an aura followed by a seizure and that is usually controlled by medication. B. A condition in which a person has multiple seizures and that is usually controlled by medication. C. A condition in which a person has general seizures that start in childhood. D. A condition caused by congenital brain abnormalities that causes seizures only once or twice a year.
B. A condition in which a person has multiple seizures and that is usually controlled by medication.
Which of the following refers to difficulty in speaking or understanding speech as a result of a stroke? A. Ischemia B. Aphasia C. Hemiparesis D. Ataxia
B. Aphasia
When assessing a patient for a possible stroke, which of the following three functions should be tested by the EMT? A. Memory, ability to speak, and ability to track movement with the eyes B. Control of facial muscles, ability to speak, and ability to hold both arms in an extended position for 10 seconds C. Ability to walk, ability to hold both arms in an extended position for 10 seconds, and ability to name common objects D. Ability to walk, control of facial muscles, and balance
B. Control of facial muscles, ability to speak, and ability to hold both arms in an extended position for 10 seconds
During your primary assessment, you find your patient has an altered mental status. This could indicate which of the following? A. The need for suctioning of the airway B. Failing respiratory system C. Problems with the RAS due to hypertension D. The need for rapid transport
B. Failing respiratory system
Compared to hypoglycemia, which of the following is true of hyperglycemia? A. Its onset is more sudden. B. Its onset is more gradual. C. It is more easily treated in the prehospital environment than hypoglycemia. D. Its onset is preceded by an aura, such as hallucinations or detecting unusual odors.
B. Its onset is more gradual.
The typical steps of managing a diabetic emergency are: A. Assist the patient in accepting glucose, prepare to administer oral glucose, primary assessment, secondary assessment, and reassessment. B. Primary assessment, secondary assessment, prepare to administer oral glucose, assist the patient in accepting glucose, and reassessment. C. Prepare to administer oral glucose, assist the patient in accepting glucose, primary assessment, secondary assessment, and reassessment. D. Primary assessment, prepare to administer oral glucose, assist the patient in accepting glucose, secondary assessment, and reassessment.
B. Primary assessment, secondary assessment, prepare to administer oral glucose, assist the patient in accepting glucose, and reassessment.
The death of brain tissue due to deprivation of oxygen because of a blocked or ruptured artery in the brain is known as which of the following? A. Aphasia B. Stroke C. Transient ischemic attack D. Seizure
B. Stroke
You have arrived on the scene of a call for a possible stroke. On your arrival, the patient denies signs and symptoms, is alert and oriented, and moves all extremities well. Her husband states that before you arrived, the patient could not move her right arm and the left side of her face seemed to be "slack." Which of the following has most likely occurred? A. The patient has had a subarachnoid hemorrhage. B. The patient suffered a transient ischemic attack. C. The patient suffered a stroke. D. The patient is suffering from aphasia.
B. The patient suffered a transient ischemic attack.
Which of the following is one of the most common characteristics of a stroke? A. Sudden, severe headache B. Weakness on one side of the body C. Sudden onset of bizarre behavior D. Projectile vomiting
B. Weakness on one side of the body
Your patient is waking up from a seizure; it was the patient's first seizure ever. When you ask what happened, the patient tells you she had the smell of fresh mown grass just before she seized. This sensation is known as: A. the clonic phase. B. an aura. C. the postictal phase. D. the tonic phase.
B. an aura.
There are two types of seizures; if your patient is having a seizure that affects only one area of her body and does not cause her to lose consciousness, it is called a: A. generalized seizure. B. partial seizure. C. postictal seizure. D. tonic-clonic seizure.
B. partial seizure.
You respond to a 32-year-old female who is having a seizure. You arrive on the scene to find the patient drowsy, confused, and complaining of a headache. This patient is demonstrating the: A. aura phase. B. postictal phase. C. tonic phase. D. clonic phase.
B. postictal phase.
Which is NOT one of the steps in managing a patient experiencing dizziness and syncope? A. Loosen any tight clothing around the neck. B. Lay the patient flat. C. Apply cold packs to the patient's head. D. Administer oxygen.
C. Apply cold packs to the patient's head.
Which of the following is the cause of most strokes? A. A spasm in an artery supplying part of the brain B. A ruptured cerebral artery due to hypertension C. Blockage of an artery supplying part of the brain D. A ruptured cerebral artery due to an aneurysm
C. Blockage of an artery supplying part of the brain
Which of the following is NOT a sign or symptom of stroke? A. Seizure B. Vomiting C. Chest pain D. Sudden impairment of vision
C. Chest pain
Which of the following is LEAST important for the patient who has stopped seizing before the EMT's arrival at the scene? A. Suctioning B. Checking for mechanism of injury C. Determining when the patient was last transported to the hospital for seizures D. Administering oxygen
C. Determining when the patient was last transported to the hospital for seizures
Which of the following is the LEAST important question in obtaining the history of a seizure patient in the prehospital setting? A. What was the patient doing before the seizure? B. How did the patient behave during the seizure? C. Does the patient have a family history of seizures? D. Did the patient lose control of his bladder?
C. Does the patient have a family history of seizures?
Your patient is a 59-year-old female with a sudden onset of slurred speech and weakness on her right side. Which of the following measures is appropriate? A. Test the patient's sensation with a series of pinpricks, beginning at the feet and working upward. B. Administer oral glucose and then assess the patient's blood sugar. C. Immediately transport the patient to a hospital with specialized treatment for stroke patients. D. Withhold oxygen unless the patient exhibits signs of profound hypoxia.
C. Immediately transport the patient to a hospital with specialized treatment for stroke patients.
Which statement below is NOT true about seizures? A. The most common seizure that EMTs are likely to be called on is a tonic-clonic seizure. B. A partial seizure affects one part, or one side, of the brain. C. Many seizures are followed by an aura. D. A generalized seizure affects the entire brain.
C. Many seizures are followed by an aura.
Your patient is a 44-year-old male with a history of diabetes. He is lying on the living room floor, unresponsive to all stimuli. He has a respiratory rate of 12 breaths per minute, heart rate of 112 beats per minute, and is pale and sweaty. Which of the following should you do to treat this patient? A. Place the patient in the recovery position to protect the airway and place oral glucose solution under the patient's tongue. B. Apply oral glucose solution to a tongue depressor and insert it between the patient's cheek and gums. C. Place the patient in the recovery position, administer oxygen, and monitor his airway status. D. Encourage the patient's family to administer his insulin.
C. Place the patient in the recovery position, administer oxygen, and monitor his airway status.
The most common medical emergency for the diabetic is hypoglycemia, or low blood sugar. Which one of the factors below is NOT a cause of hypoglycemia? A. Overexercises or overexerts himself B. Vomits a meal C. Reduces sugar intake by eating too much D. Takes too much insulin
C. Reduces sugar intake by eating too much
Which of the following is NOT a sign of a hypoglycemic diabetic emergency? A. Combativeness B. Anxiety C. Slow heart rate D. Cold, clammy skin
C. Slow heart rate
Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the reticular activating system (RAS). The RAS has simple requirements to function properly. Which one of the following items is NOT one of those requirements? A. Oxygen B. Water C. Sodium D. Glucose
C. Sodium
Looking at the following list, which of the items does NOT correctly compare the signs and symptoms of hypoglycemia and hyperglycemia? A. Hyperglycemic patients often have warm, red, dry skin, whereas hypoglycemic patients have cold, pale, moist, or clammy skin. B. Hyperglycemia usually has a slower onset than hypoglycemia. C. The hypoglycemic patient is usually complaining of a headache, whereas the hyperglycemic patient is not. D. The hyperglycemic patient often has acetone breath, whereas the hypoglycemic patient does not.
C. The hypoglycemic patient is usually complaining of a headache, whereas the hyperglycemic patient is not.
When someone is experiencing hypoglycemia, the body attempts to compensate by using the fight-or-flight mechanism of the autonomic nervous system. Which one of the statements below is NOT one of the fight-or-flight responses? A. The heart pumps faster. B. Blood vessels constrict. C. The skin is hot and dry. D. Breathing accelerates.
C. The skin is hot and dry.
Patients displaying altered mental status were lost for several hours in a desert area without food and water and temperatures in the high 90s. You would expect their altered mental status to be from: A. hypoglycemia. B. hyperglycemia. C. dehydration. D. hypoxia.
C. dehydration.
Many stroke patients are candidates for thrombolytic drugs. One of the most important things that an EMT can do to optimize the care of a stroke patient who is a candidate for the drugs is: A. do a thorough physical exam of the patient. B. transport the patient to a Level I Trauma Center. C. determine the exact time of onset of symptoms. D. transport to the closest hospital.
C. determine the exact time of onset of symptoms.
The Cincinnati Prehospital Stroke Scale assesses for: A. agitated emotional response, facial droop, and abnormal speech. B. arm drift, leg lift, and facial droop. C. facial droop, arm drift, and abnormal speech. D. abnormal speech, lack of pattern recognition, and lack of facial recognition.
C. facial droop, arm drift, and abnormal speech.
A seizure that occurs spontaneously from an unknown cause is called: A. hypoglycemic. B. tonic-clonic. C. idiopathic. D. hypoxic.
C. idiopathic.
A hormone called insulin is secreted by the: A. gallbladder found in the pancreas. B. kidneys. C. islets of Langerhans in the pancreas. D. islets of Langerhans in the liver.
C. islets of Langerhans in the pancreas.
Your patient is a 70-year-old man whose wife called EMS because her husband began exhibiting unusual behavior. Upon your arrival, you introduce yourself to the patient, who responds, "Not until nine o'clock," but shows no actual understanding of what you just said. This phenomenon is BEST described as: A. expressive aphasia. B. disorientation to time. C. receptive aphasia. D. unresponsive to verbal stimuli.
C. receptive aphasia.
You are called to a scene at which multiple patients are seizing at the same time. The likely cause is: A. hypoglycemia. B. hypoxia. C. something environmental at the scene. D. metabolic.
C. something environmental at the scene.
Some EMS systems allow administration of intranasal glucagon to patients who are A. combative because their fight-or-flight response. B. intolerant of the taste of oral glucose. C. unable to safely swallow oral glucose. D. responsive and alert.
C. unable to safely swallow oral glucose.
Which of the following is the most critical piece of equipment to have immediately available for the seizure patient who has just stopped convulsing? A. Cervical collar B. Suctioning equipment C. Bite block D. Glucometer
C. Suctioning equipment
The signs and symptoms of a transient ischemic attack (TIA) may last up to: A. 1 hour. B. 30 minutes. C. 6 hours. D. 24 hours.
D. 24 hours.
With advances in clot-busting (thrombolytic) drugs, the patient has a window of ________ hours to receive treatment. A. 5 B. 4 C. 6 D. 3
D. 3
What is a sign of sepsis becoming systemic? A. Lowered respiratory rate B. Lowered heart rate C. High blood pressure D. Altered mental status
D. Altered mental status
Which of the following is characteristic of a patient with hyperglycemia? A. Cool, moist skin, agitated behavior, and increased heart rate B. Sudden onset of altered mental status C. Use of excessive amounts of insulin or lack of adequate food intake D. A "fruity" odor of the breath
D. A "fruity" odor of the breath
If the blood sugar level is very high, which of the following may result? A. Hyperactivity, excessive thirst, and polyuria B. Excessive insulin, excessive glucose, and excessive urination C. Polyuria and hyperactivity D. Excessive urination, excessive thirst, and excessive hunger
D. Excessive urination, excessive thirst, and excessive hunger
Your patient is a 21-year-old female with a history of epilepsy. She is having a convulsion upon your arrival. Which of the following should you do? A. Restrain the patient's extremities to prevent injury from flailing of the arms and legs. B. Insert a bite block, cloth, wallet, or similar item between the patient's teeth to prevent her from biting her tongue. C. Place a tongue depressor or spoon in the back of the mouth to prevent the patient from swallowing her tongue. D. Move furniture and other objects away from the patient to prevent injury.
D. Move furniture and other objects away from the patient to prevent injury.
A patient complains of dizziness followed by brief syncope of several seconds. Regardless of this patient's history, it is likely that the dizziness and syncope are related to interference with the function of the patient's: A. kidneys. B. peripheral nervous system. C. lungs. D. brain.
D. brain.
Treatment of someone with a seizure disorder includes all of the following EXCEPT: A. placing the patient on the floor or ground. B. loosening restrictive clothing. C. removing objects that might harm the patient. D. placing a bite block in the patient's mouth so he does not bite his tongue.
D. placing a bite block in the patient's mouth so he does not bite his tongue.
In hyperglycemia, increasing blood sugar levels starve the cells of the body for: A. oxygen. B. insulin. C. fats. D. sugar.
D. sugar.
One of the criteria for administering oral glucose is the patient having a history of diabetes. The point at which you would typically ask about whether the patient has a history of diabetes is when: A. gathering a history of the present episode. B. performing a primary assessment. C. reassessing the patient. D. taking the SAMPLE history.
D. taking the SAMPLE history.