Chapter 8 Ems
11) A patient is hemorrhaging internally within his colon, which in turn is impairing perfusion to the cells of his body. Aside from the bleeding, the patient has no other problems. In this scenario, the problem impairing adequate perfusion would be: A) Decreased blood volume B) Inability to get oxygen to the alveoli C) Poor myocardial pump function D) Inadequate ventilation to eliminate carbon dioxide
A
16) The EMT would document an FDO2 level when the patient is: A) Assisting breathing with a bag-valve-mask device B) Inserting a nasopharyngeal airway C) Providing oxygen at greater than 10 liters per minute D) Using a nonrebreather face mask that delivers high-concentration O2
A
18) A young patient is experiencing epiglottitis. He is working hard to breathe, has stridorous respirations, and is extremely hypoxic. His skin is cyanotic and his pulse is rapid but strong. What is the most likely cause (not result) of the poor delivery of oxygen to the cells? A) Partial occlusion of the airway B) Impaired transfer of O2 between the lungs and blood C) Poor function of the heart as a pump D) Elevation of the heart rate
A
2) When cells undergo normal metabolism in the body, which byproduct(s) is (are) produced? A) Heat, carbon dioxide, and water B) Lactic acid C) Protein, carbon dioxide, and water D) Adenosine monophosphate
A
23) What situation could impair a patient's respiratory status by directly damaging the central chemoreceptors of the body? A) Brainstem stroke or injury B) Lung cancer C) Aerobic metabolism D) Collapsed lung
A
28) What is the primary stimulus to breathe in human beings without pulmonary diseases? A) Level of CO2 in the body B) Amount of oxygen required by the body C) Level of oxygen in the body D) Amount of nitrogen in air
A
30) A 100-kilogram patient with a 500-milliliter tidal volume, breathing 16 times each minute, would have a minute ventilation of how many milliliters? A) 8000 mL B) 1200 mL C) 1600 mL D) 2400 mL
A
36) What is the primary way in which oxygen is transported to the cells? A) Red blood cells B) White blood cells C) Plasma D) Platelets
A
39) Which condition must be met for carbon dioxide to move from the cell to the bloodstream? A) The perfusing blood must be low in carbon dioxide B) The sodium-potassium pump must be functional C) There must be a large amount of oxygen in the blood D) There must be a large number of red blood cells in the blood
A
41) A patient has failure of the left side of his heart. Consequently, his blood is backing up into the pulmonary artery and seeping into the lung tissue, causing the patient to be short of breath and moderately hypoxic. The EMT should recognize this condition as a product of: A) Increased hydrostatic pressure B) Decreased circulating blood volume C) Increased osmotic pressure D) Decreased pulmonary perfusion
A
43) While completing some clinical time in the hospital for his EMT class, an EMT student observed a patient being administered an IV fluid with a high oncotic pressure. Once this fluid is in the patient's body, the EMT student would expect which action to occur? A) Fluid from the tissues will move into the bloodstream B) Fluid will move evenly from the bloodstream into the cells C) Fluid from the IV will move into the cells and rehydrate them D) The patient's blood pressure will decrease dramatically
A
46) What would be a direct result of increasing a patient's preload? A) Increased cardiac output B) Increased oxygen delivery into the lungs C) Decreased blood pressure D) Decreased myocardial contraction
A
49) What definition best describes the concept of afterload? A) Pressure that the left ventricle must pump blood against to open the aortic valve B) Ability of the heart to adequately contract and pump blood out of the pulmonic valve C) Amount of blood that a person has in the arteries at any given moment D) Amount of blood returned to the lungs for oxygenation by the right ventricle
A
5) A patient's brain cells are undergoing anaerobic metabolism. As a result, those cells: A) Are becoming dysfunctional in an environment that is increasingly acidic B) Have too much adenosine triphosphate to function properly C) Are producing elevated quantities of carbon dioxide (CO2) as a result of aerobic metabolism D) Cannot make any energy in the form of ATP due to a lack of glucose
A
55) The EMT would most likely see a narrowed pulse pressure in a patient who: A) Is bleeding internally B) Has a fever C) Has diabetes D) Has an irregular heartbeat
A
59) The body will initially compensate for a decrease in cardiac output by: A) Increasing systemic vascular resistance B) Increasing the respiratory rate C) Dilating to arteries, veins, and capillaries D) Decreasing the heart rate
A
66) Which condition would directly compromise the average patient's cardiac output? A) Heart rate of 190 beats/min B) Circulatory volume of 5 liters C) Increased number of circulating WBCs D) Blood pressure of 118/52 mmHg
A
68) A patient with asthma is extremely short of breath and hypoxic. Related to the ventilation/perfusion ratio (V/Q), the EMT would recognize the problem as related to: A) Inadequate oxygen in the alveoli B) Decreased cardiac output to circulate oxygen C) Inadequate oxygen in the ambient air D) Decreased blood volume to carry oxygen
A
74) A confused and lethargic 24-year-old male patient has intentionally overdosed on a narcotic medication. His vital signs are as follows: pulse, 36; respirations, 10 breaths/min; blood pressure, 50/20 mmHg; and SpO2, 88% with 15 liters per minute of oxygen applied by Emergency Medical Responders. What is the greatest danger to this patient's well-being? A) Decreased cellular perfusion B) Altered mental status C) Increased sympathetic nervous system stimulation D) Left ventricular heart failure
A
75) What is the result of an opening developing that allows air into the space between the visceral and parietal pleura of the thorax? A) Progressive collapse of the lung B) Hyperventilation C) Hypocarbia D) Left ventricular heart failure
A
76) Which process of ventilation is correctly adhering to Boyle's law as it relates to ventilation? A) When the diaphragm contracts, it creates a negative intrathoracic pressure causing air to enter the lungs B) When the diaphragm relaxes, it creates a negative intrathoracic pressure causing air to enter the lungs C) When the diaphragm contracts, it creates a positive intrathoracic pressure causing air to enter the lungs D) When the diaphragm relaxes, it creates a positive intrathoracic pressure causing air to enter the airways
A
77) Which gas law is disrupted when a patient sustains a spinal cord injury resulting in paralysis to the diaphragm and intercostal muscles? A) Charles' law B) Boyle's law C) Henry's law D) Dalton's law
A
1) Normal cellular metabolism can be defined as: A) Oxygenated B) Aerobic C) Glycolytic D) Anaerobic
B
12) What is required for normal perfusion to occur? A) Airway patency, proper amounts of carbon dioxide, and adequate glucose levels B) Adequate breathing, sufficient numbers of red blood cells, and sufficient heart function C) Intact breathing, an ample number of red blood cells, and body temperature of 98.6°F D) Patent airway, sufficient breathing, high amounts of glucose, and good heart function
B
15) For a patient breathing in room air, the EMT would estimate the FiO2 to be: A) 0.15 B) 0.21 C) 0.55 D) 1.00
B
17) A patient with a low blood sugar is unresponsive with snoring respirations. His breathing is labored and his pulse is rapid and weak. Examination of the skin reveals it to be cool and diaphoretic. Your partner informs you of the following vital signs: pulse, 120; respirations, 18 breaths/min; blood pressure, 132/60 mmHg; and SpO2 at 84% on room air. Which action would you perform first? A) Administer oral glucose B) Perform a head-tilt, chin-lift maneuver C) Provide high-concentration oxygen D) Start positive pressure ventilation
B
21) Assessment of a hypoxic patient who is showing signs of fatigue and has a history of lung disease reveals him to be using well-developed accessory muscles to exhale. As an EMT, you should recognize that the patient: A) Is inadequately exhaling oxygen from his lungs, which is causing hypoxia B) Is using energy to exhale and is in danger of respiratory failure if hypoxia continues C) Has a problem with the red blood cells' ability to transport oxygen, which is causing hypoxia D) Is adequately compensating for the problem with his breathing so he does not become hypoxic
B
27) For a patient who relies on the hypoxic drive to breathe, the respiratory rate will increase when: A) CO2 levels increase B) O2 levels decrease C) CO2 levels decrease and O2 levels increase D) O2 and CO2 levels both increase
B
29) What is the best description of minute ventilation? A) Number of breaths a patient breathes in 1 minute B) Amount of air moved into and out of the lungs in 1 minute C) Total milliliters of air moving into and out of the lungs in one breath D) Amount of oxygen needed by the body in 1 minute
B
33) Which statement about the ventilation/perfusion (V/Q) ratio in a healthy person is true? A) Blood flow and amount of ventilation are equal throughout the lungs B) The upper portion of the lungs has wasted ventilation C) The amount of blood perfusion throughout the lungs is greater than the amount of oxygen in the lungs D) The lower portion of the lungs has more oxygen than perfusion
B
38) Which condition would most likely account for an elevated CO2 level in a patient's body? A) Renal failure B) Lung disease C) Liver injury D) Endocrine stem dysfunction
B
47) A patient has a blood pressure of 140/98 mmHg. What can the EMT ascertain from this reading? A) The pulse pressure is narrowed B) The afterload is increased C) The preload is diminished D) The SpO2 level must be abnormal
B
50) What is the best way to decrease a patient's afterload? A) Slow the heart rate B) Reduce the blood pressure C) Administer intravenous fluids D) Provide supplemental oxygen
B
54) Which situation would most likely cause a patient to have a simple episode of syncope (fainting)? A) Increase in systemic vascular resistance B) Parasympathetic stimulation C) Activation of the sympathetic nervous system D) Sudden release of norepinephrine
B
56) Which blood pressure reading best indicates a narrowed pulse pressure? A) 120/76 mmHg B) 108/88 mmHg C) 210/138 mmHg D) 88/58 mmHg
B
62) A drop in blood pressure below a critical threshold is a threat to the body because it directly impairs: A) Anaerobic metabolism B) Cellular perfusion C) Airway patency D) The sympathetic nervous system
B
63) A patient with cancer is receiving chemotherapy. As a side effect of the treatment, her white blood cell count is critically low. Given this situation, which sign or symptom should the EMT find particularly concerning? A) History of diabetes B) Oral temperature of 102.7°F C) Complaint of weakness D) Blood pressure of 102/64 mmHg
B
69) A patient has been shot three times in the abdomen and has massive internal hemorrhage and blood loss. Which treatment will give this patient the best chance at survival? A) High-concentration oxygen B) Stopping the bleeding C) Positive pressure ventilation D) Paramedic intervention for pain management
B
7) What happens after a cell in anaerobic metabolism breaks down glucose and creates energy in the form of adenosine triphosphate (ATP)? A) Oxygen and water are created B) Lactic acid is formed C) Carbon dioxide and water are formed D) Electrolytes in the cell become balanced
B
73) A 35-year-old male patient is lethargic and dehydrated after working at a construction site for 12 hours on a very hot day. You obtain the following vital signs: pulse, 136; respirations, 22 breaths/min; blood pressure, 102/88 mmHg; and SpO2, 100% with supplemental oxygen. As a knowledgeable EMT, you would recognize: A) Widened pulse pressure to circulate more blood B) Elevated heart rate to increase cardiac output C) Rapid respirations to decrease CO2 loss D) Low blood pressure to conserve the body's energy
B
79) Why would a drop in the oxygen content of the blood stream cause an increase in the patient's blood pressure? A) Parasympathetic stimulation of the pulmonary system improves oxygen on-loading to the red blood cells passing through the alveoli B) Sympathetic stimulation of the cardiovascular system improves oxygen delivery to the brain and tissues C) Vasoconstriction caused by the parasympathetic nervous system causes oxygenated blood to be shunted from the peripheral capillary beds and to the brain D) Vasodilation will allow more blood flow to reach the lungs, thereby increasing the oxygen content of the blood and providing for better perfusion to the brain and body
B
10) Perfusion is best described as: A) Availability of oxygen in the lungs for movement into the blood B) An adequate number of white blood cells to carry oxygen to the cells C) Delivery of essential products and nutrients to the cell for its use D) Exchange of oxygen and carbon dioxide between the lungs and blood
C
13) A patient who has lost one liter of blood is conscious with a patent airway, but her extremities are pale and cold to the touch. Vital signs are as follows: pulse is 130, respirations are 22 breaths/min and adequate, blood pressure is 74/56 mmHg, and SpO2 is 95% on room air. What is most needed by this patient to increase perfusion to the cells? A) Increased blood pressure as a result of paramedics administering IV fluids B) Administration of oxygen via nonrebreather mask C) Increased number of red blood cells and plasma volume D) Keeping the patient warm by covering her with a blanket
C
14) The EMT is administering oxygen at 95% through a nonrebreather face mask. He would document this as a FiO2 of: A) 0.21 B) 0.50 C) 0.95 D) 1.00
C
24) Which condition is most likely to cause acidosis? A) Irregular heart rhythm B) Hypothyroidism C) Depressed respirations D) Low blood glucose level
C
26) Which statement is true of a patient who relies on the hypoxic drive to breathe? A) The primary gas affecting the respiratory rate is carbon dioxide B) The peripheral chemoreceptors have become less sensitive to oxygen C) The respiratory rate is set according to the level of O2 in the body D) The central chemoreceptors are the primary influence on the respiratory rate
C
3) Under normal circumstances, carbon dioxide is excreted from the body through the: A) Kidneys B) Urinary tract C) Lungs D) Sweat ducts
C
31) An unresponsive patient with a pulse is breathing with very shallow respirations at a rate of 6 breaths per minute. Which intervention would be most beneficial for this patient? A) Positive pressure ventilation with supplemental O2 at a rate of 30 breaths/min and a tidal volume of 200 mL B) Oxygen at 15 liters per minute delivered through a nonrebreather face mask and then reevaluate in 60 seconds C) Positive pressure ventilation with a rate of 12 breaths/min and a tidal volume of 500 mL D) Oral airway and positive pressure ventilation at 40 breaths/min, supplemental O2, and a tidal volume of 100 mL
C
34) Which condition is recognized as one that will affect the ventilation component of the ventilation/perfusion ratio? A) Blood clot in the pulmonary blood vessels B) Loss of blood plasma from dehydration C) Infection and pus in the distal airways and alveoli D) Decreased amount of hemoglobin in the blood
C
40) A patient who is weak informs you that she has a history of her "iron being too low." This should concern the EMT because iron is needed to: A) Manufacture the white blood cells required for fighting infection B) Help the blood to clot C) Carry oxygen throughout the body D) Maintain an adequate blood pressure in the body
C
42) On scene, a 43-year-old male states that he has a history of liver failure and does not produce enough of the protein albumin. Given this condition, which finding(s) would you expect? A) Elevated temperature and signs of infection B) Low SpO2 reading from significant edema C) Swelling of the extremities and abdomen D) Decreased heart rate and signs of hypoxia
C
45) Paramedics have administered a medication to a patient with heart failure. The medication specifically causes the veins (only) to dilate, thereby decreasing the amount of blood that returns to the heart for pumping. The EMT would recognize this action as decreasing: A) Afterload B) Pulse pressure C) Preload D) Systemic vascular resistance
C
52) A patient with a temperature of 105.4°F is experiencing systemic vasodilation. Which finding would be consistent with this condition? A) Slow heart rate B) Elevated afterload C) Decreased blood pressure D) Pale and cool skin
C
53) If a patient's blood pressure cannot be increased by adding volume, then which other action would most likely be successful in increasing it? A) Blocking beta actions of the sympathetic nervous system B) Decreasing the patient's preload C) Vasoconstriction of the body's arteries D) Decreasing the patient's afterload
C
57) When a patient has a narrowed pulse pressure, what is occurring? A) The heart rate is decreasing B) The veins and arteries are dilating C) The blood vessels are constricting D) The blood is being pumped more quickly
C
6) A patient's lungs are full of fluid and cannot transfer oxygen to the blood. As a result, she is undergoing anaerobic metabolism. She has a decreased level of consciousness with a patent upper airway and inadequate respirations. Her pulse is rapid and weak. Which prehospital treatment would best address this situation? A) High-concentration oxygen through a nonrebreather face mask B) Administration of one tube of oral glucose by the EMT C) Positive pressure ventilation with supplemental oxygen D) Insertion of a nasal airway and delivery of oxygen through a nasal cannula
C
61) What is baroreceptors' role in the body? A) Monitor the heart rate B) Ensure adequate oxygenation of the red blood cells C) Monitor the blood pressure D) Stimulate the production of red blood cells
C
64) A patient with liver disease has a low platelet count. Which additional finding would the EMT directly correlate to this condition? A) Pale skin color B) SpO2 of 90% C) Excessive bruising to arms D) Heart rate of 92 beats/min
C
70) A patient with a severe infection is very sick. Circulating toxins from bacteria in his blood have decreased his systemic vascular resistance (SVR). Which blood pressure change would the EMT correlate to this condition? A) Blood pressure of 174/126 mmHg B) Diastolic blood pressure greater than 200 mmHg C) Blood pressure of 64/26 mmHg D) Systolic blood pressure of 160 mmHg
C
72) For a patient who is acutely bleeding, what is the immediate response of the human body? A) Vasoconstriction caused by the parasympathetic nervous system B) Increased production of red blood cells and hemoglobin C) Vasoconstriction caused by the sympathetic nervous system D) Increased pulse pressure to promote better circulation of oxygen
C
78) A patient has sustained a gunshot injury to his right thorax. When you listen to his breath sounds, they are diminished over the right thorax. What is the most logical explanation for this finding? A) The gunshot wound has damaged the brainstem, causing the patient to stop breathing B) The pressure between the visceral pleura and the lung tissue has become higher than the atmospheric pressure C) The negative pressure between the pleural linings has been lost, causing the lung tissue to collapse D) The pressure between the parietal pleura and the rib cage has become lower than the atmospheric pressure
C
19) A 20-year-old female patient has called 911 for chest pain. On scene, you find that she has shallow breathing with an SpO2 reading of 91% on room air. She states she was in a car crash yesterday and diagnosed in the hospital with broken ribs. Her pain is right where the ribs are broken, and she rates the pain as a 10/10. Breath sounds are present bilaterally. In this situation, the EMT should attribute the hypoxia to which cause? A) The fractured ribs have pierced the lung, causing it to collapse B) Swelling from the rib fractures has compressed the lung C) The patient is bleeding into the lungs, compressing the alveoli D) Pain from rib injury prevents full expansion of the chest cage
D
20) A patient who is hypoxic has a pulmonary disease that involves low lung compliance. With this condition, you realize that: A) The lung tissue is easily inflated and can be damaged B) Oxygen and carbon dioxide cannot be exchanged across the alveolar wall C) The patient has tremendous swelling of the small airways D) Ventilation with a bag-valve mask will likely require more effort
D
22) A patient with a high fever has an accelerated metabolism and is producing abnormally large amounts of carbon dioxide at the cellular level. To compensate for this effect, what will occur? A) Decreased levels of acid in the blood B) Decreased respiratory rate C) Decreased depth of breathing D) Increased respiratory rate
D
25) Which statement about chemoreceptors in the human body is true? A) The central chemoreceptors are located in the lungs and provide the primary stimulus to breathe B) The peripheral chemoreceptors are extremely sensitive to oxygen and are located in the brain C) The central chemoreceptors constantly monitor the oxygen levels in the body and increase the rate when more O2 is needed D) The peripheral chemoreceptors are more sensitive to oxygen than carbon dioxide
D
32) What is the best description of the ventilation/perfusion (V/Q) ratio? A) The ability of the red blood cells to offload oxygen to the cells of the body B) The amount of blood and the pressure at which it carries oxygen throughout the body C) The amount of air that is moved into and out of the lungs in 1 minute D) The ability of the body to exchange gases across the alveolar capillary membrane
D
35) A patient's SpO2 increased from 89% to 95% after he received a bronchodilating drug for his asthma. Where did the patient's problem most likely originate? A) Perfusion portion of the V/Q ratio B) Minute volume of the V/Q ratio C) Cellular perfusion portion of the V/Q ratio D) Ventilation portion of the V/Q ratio
D
37) What is the actual site of attachment of oxygen in the red blood cell? A) Oxygen dissolves into the liquid portion of the red blood cell for transport B) On oxygen receptor sites on the surface of the red blood cell C) Within the nucleus of the red blood cell D) Iron sites on hemoglobin within the red blood cell
D
4) The patient in anaerobic metabolism is deficient in/of: A) Glucose (sugar) B) Protein C) Lactic acid D) Oxygen
D
44) A patient with high blood pressure takes a medication to slow his heart rate, thereby lowering his blood pressure. The EMT would recognize this action as impacting: A) Preload B) Afterload C) Systemic vascular resistance D) Cardiac output
D
48) A chronically elevated afterload increases the patient's chance for developing which pathological condition? A) Liver disease B) Hypotension C) Diabetes D) Heart failure
D
51) A slightly confused but conscious 61-year-old female patient with generalized weakness has a heart rate of 190 beats/min. She has a history of high blood pressure and diabetes. Her blood pressure is 78/56 mmHg, and she has a pulse oximetry reading of 93%. Which disturbance would best explain this patient's presentation? A) Unrecognized hemorrhage B) Hypoglycemia C) Hypoxia D) Excessive tachycardia
D
58) What is the protective mechanism underlying a narrowed pulse pressure? A) Increase the amount of oxygen entering the lungs B) Stop the loss of blood internally or externally C) Increase the oxygen-carrying capacity of the red blood cells D) Maintain an adequate blood pressure for perfusion
D
60) When a healthy person has a sudden increase in blood pressure, what will occur next? A) Chemoreceptors will increase the rate and depth of breathing B) Baroreceptors will directly stimulate the parasympathetic nervous system C) The heart rate will increase and blood vessels will constrict D) Baroreceptors will signal the brain to decrease the heart rate
D
65) You are caring for a 66-year-old male patient who is severely dehydrated. How does severe dehydration affect the cardiovascular system? A) It reduces the hemoglobin available to carry oxygen B) It impairs the ability of oxygen to diffuse from the lungs to the blood C) It slows the production of white blood cells to fight the infection D) It decreases the blood volume available for circulation
D
67) You and the critical care transport team are taking a critically ill patient to another hospital. Among many IV infusions and monitors, the patient is also on a ventilator. You note that the FDO2 is set at 0.50. What does this mean? A) Fifty percent of the patient's respirations are provided by the ventilator B) Ventilations are provided when the patient breathes fewer than 50 times per minute C) Oxygen is not provided by the ventilator until the patient's pulse oximetry drops below 50% D) The provided oxygen concentration is set at 50 percent
D
71) What blood pressure change as most likely to cause left ventricular failure? A) Chronically elevated systolic blood pressure between 140 and 160 mmHg B) Chronically decreased diastolic blood pressure between 30 and 50 mmHg C) Chronically decreased systolic blood pressure between 60 and 80 mmHg D) Chronically elevated diastolic pressure between 120 and 140 mmHg
D
8) For cells to undergo the process of aerobic metabolism, the cells require: A) Water and oxygen B) Sugar (glucose) and protein C) Adenosine triphosphate (ATP) and lactic acid D) Oxygen and glucose
D
80) A patient has a pulmonary condition known as asthma that results in significant bronchoconstriction. If this patient is found to be hypoxic during an asthma attack, which type of disturbance is most likely causing the hypoxia? A) Neurological disturbance B) Perfusion disturbance C) Myocardial disturbance D) Ventilation disturbance
D
9) Failure of the sodium-potassium pump can result in: A) Accumulation of acidic wastes B) Excess amounts of sodium outside the cell C) Large amounts of potassium inside the cell D) Cellular damage, swelling, and rupture
D
