EMT Chapter 8 Pathophysiology Study Questions Pre post

When considering the normal tidal​ volume, how much of that is accounted for by the​ "dead space?" A. 500 mL B. 150 mL C. ​1,000 mL D. 250 mL

B. 150 mL Dead space is always 150 Pg 173

Which of the following does not have a direct influence on normal​ perfusion? A. Heart rate B. Blood volume B. Blood volume D. Systemic vascular resistance

B. Blood volume 176-181

The majority of carbon dioxide is transported in the body by this​ mechanism? A. Attached to red blood cells B. By the bloodstream as a bicarbonate ion C. Dissolved in plasma D. Chemically bound by hemoglobin

B. By the bloodstream as a bicarbonate ion 178-179

If the baroreceptors in the aortic root sense a drop in aortic root systolic​ pressure, it will send an impulse to what region of the​ brain, and for what​ purpose? A. ​Hypothalamus; to stimulate the hormonal release of the adrenocorticotropic hormone​ (ACTH). B. ​Brainstem; to stimulate the sympathetic nervous system. C. ​Cerebellum; to stimulate the parasympathetic nervous system. D. ​Cerebrum; to stimulate the vasomotor center.

B. ​Brainstem; to stimulate the sympathetic nervous system 186-187

Cardiac output is composed​ of: A. blood pressure and heart rate. B. stroke volume and heart rate. C. systemic vascular resistance​ (SVR) and heart rate. D. blood pressure.

B. stroke volume and heart rate. Pg 181-182 CO = HR X SV

If a patient was breathing ambient​ air, how would you document the amount of oxygen present for alveolar ventilation in percentage​ form? A. ​2.1% B. ​21% C. ​0.21% D. 21

B. ​21%` pg 168

If a bleb on a lung tissue ruptures and air accumulates in the pleural​ space, what is the MOST likely result of​ this? A. A decrease in the respiratory rate B. Collapse of the lung with a change in alveolar ventilation C. An immediate change in the​ patient's mental status D. A rise in the oxygen content of the blood

Collapse of the lung with a change in alveolar ventilation If the negative intrapleural pressure is lost from a perforation in the lung tissue​ itself, the generation of a positive intrapleural pressure will cause the lung to collapse and disrupt normal alveolar ventilation. As the patient becomes​ hypoxic, the respiratory rate will actually​ increase, and there cannot be a rise in oxygen content of the blood if a lung is collapsed.​ Finally, there may be a change in mental​ status, but this will not occur until the patient is sufficiently​ hypoxic, which may take several minutes.

What generates the force that results in hydrostatic​ pressure? A. Blood flow through the lungs during breathing B. Contraction of the left ventricle C. The effects of large proteins in the blood D. Gravity flow of venous blood from the brain and upper extremities

Contraction of the left ventricle pg181 Hydrostatic pressure is the force inside the vessel or capillary bed generated by the contraction of the heart and the blood pressure. Hydrostatic pressure exerts a push inside the vessel or​ capillary; that​ is, it acts to push fluid out of the vessel or capillary through the vessel wall and into the interstitial space. Blood flow through the lungs is subject to the same hydrostatic pressure as blood flow in the rest of the body. Oncotic pressure is what is generated by large plasma proteins. Gravity return of blood to the heart does not play a role in hydrostatic pressure.

What is the name of the amount of air breathed in and out with each individual​ breath? A. Minute Volume B. Residual volume C. Tidal Volume D. Tidal Ventilation

C. Tidal Volume pg 172

The ability of the body to ventilate is an example of what law of​ physics? A. ​Dalton's law B. ​Henry's law C. ​Boyle's law D. ​Charles's law

C. Boyle' Law Pg 170

If the baroreceptors in the aortic root sense a drop in aortic root systolic​ pressure, it will send an impulse to what region of the​ brain, and for what​ purpose? A. ​Cerebrum; to stimulate the vasomotor center. B. ​Cerebellum; to stimulate the parasympathetic nervous system. C. ​Brainstem; to stimulate the sympathetic nervous system. D. ​Hypothalamus; to stimulate the hormonal release of the adrenocorticotropic hormone​ (ACTH).

C. ​Brainstem; to stimulate the sympathetic nervous system. Pg 186

The exchange of gases at the peripheral tissue capillary level is responsible for the removal of what waste substance from the​ cells? A. Oxygen B. Glucose C. CO2 D. Nitrogen

CO2 - carbonmonoxide 211

The inability to maintain a​ patient's airway or ventilatory status can lead to what detrimental cellular​ event? A. Drop in oxygen need by peripheral tissues B. Increased biochemical reactions C. Cellular death D. Hormonal hypersensitivity

Cellular death Cellular​ metabolism, also known as cellular​ respiration, is the process in​ which, normally, the cells break down molecules of glucose to produce energy for the body. There are two types of cellular​ metabolism: aerobic and anaerobic. Aerobic metabolism creates the most adenosine triphosphate​ (ATP) from glucose in the presence of oxygen. Anaerobic metabolism produces far less ATP and overwhelming acidosis when oxygen is inadequate or absent. Anaerobic​ metabolism, if not​ corrected, will cause so much acidosis that the cells will die.

If a patient has multiple ribs fractured that alter his ability to increase his intrathoracic​ volume, what kind of ventilatory disturbance would this​ be? A. Change in compliance B. Change in opposition C. Change in passivity D. Change in resistance

Change in compliance If two or more ribs are broken in two or more​ places, this causes a​ free-floating segment, which is referred to as a flail segment. The problem is that it inhibits normal lung inflation and alters lung compliance. As a​ reminder, compliance is the measure of the ability of the chest wall and lungs to​ stretch, distend, and expand. The harder it is for the lungs to expand​ (for whatever​ reason), the lower the lung compliance and vice versa. A change in resistance refers to changes in bronchiole muscle​ tone, and changes in opposition and passivity are both fictitious references to the lung.

If a patient is in​ shock, why may he have poor red blood cell​ oxygenation? A. The sugar level is too low in the cells. B. Decreased lung perfusion can contribute to cellular hypoxia. C. He is breathing too slowly. D. Too much blood leaks out of the capillaries.

Decreased lung perfusion can contribute to cellular hypoxia. pg 179 Cell​ hypoxia, due to decreased​ perfusion, can exhibit as shortness of breath in the shock patient. According to the​ V/Q ratio, this is because there is ventilation without an appropriate amount of perfusion. Oxygen saturation to the red blood cells will​ drop, which promotes peripheral tissue hypoxia. A perfusion deficit of the​ V/Q ratio will not cause blood to leak out of the​ capillaries, and glucose levels are regulated by the​ pancreas, not the​ V/Q ratio.​ Finally, breathing too slowly is a ventilatory​ concern, not a perfusion concern.

What is the basic function of hydrostatic​ pressure? A. It helps to shift fluid from the interstitial spaces into the cellular spaces. B. It helps to shift fluid from the interstitial spaces into the vascular spaces. C. It is a pulling force that keeps fluid in the cells. D. It is a force that pushes fluid out of the vessel or capillary bed.

D. It is a force that pushes fluid out of the vessel or capillary bed. 181

During anaerobic metabolism in​ cells, what is responsible for creating the acidic state of the​ blood? A. Pyruvate diminishment B. Acetaldehyde development C. Alcohol fermentation D. Lactic acid accumulation

D. Lactic acid accumulation 166 Lactic acid (pyruvic acid)

If the patient has a drop in the preload to the​ heart, what will be the effect in the​ patient's peripheral perfusion​ status? A. Blood vessels will dilate in order to elevate the systolic pressure. B. Peripheral perfusion will not be altered. C. Peripheral perfusion will increase whenever stroke volume decreases. D. Peripheral perfusion will likely drop.

D. Peripheral perfusion will likely drop. 182-183

What are the main constitutes of​ plasma? A. Water and intracellular fluids B. Intracellular fluid C. Water D. Water and proteins

D. Water and proteins pg 180

Oxygen is transported through the blood by binding​ to: A. potassium sites. B. alveoli. C. white blood cells. D. hemoglobin.

D. hemoglobin. 210

The distribution of blood flow through the microcirculation is primarily responsive​ to: A. sympathetic stimulation. B. parasympathetic stimulation. C. the postcapillary sphincter. D. local tissue needs.

D. local tissue needs.

Ambient air contains​ MOSTLY: A. carbon dioxide. B. argon. C. oxygen. D. nitrogen.

D. nitrogen. 79% page 168 O2 =21% N = 79% Argon =0.9% CO2 = .03%

In order to allow for proper metabolism of peripheral​ tissues, there must be a constant supply of blood​ flow, otherwise known​ as: A. supraperfusion. B. hyperperfusion. C. hypoperfusion. D. perfusion.

D. perfusion. pg

If a patient is in​ shock, why does his pulse​ increase? A. Because the body produces caffeine B. Because the afterload has been reduced C. Because the heart is stunned D. Because of sympathetic nervous system stimulation

D. Because of sympathetic nervous system stimulation 182

Because of dilation of the vascular system in neurogenic​ shock, you would expect the blood pressure​ to: A. Increase. B. Decrease. C. remain the same. D. increase as a result of an increase in the heart rate that occurs.

Decrease 183 Vasoconstriction - Decrease vessel diameter increase BP increase resistance (Raw) Vasodilation Increased vessel size Decreased BP Decreased resistance (Raw)

Red blood cells comprise about what percentage of blood volume in​ men? A. 25 percent B. 90 percent C. 42 percent D. 48 percent

48% pg 180 composition of blood: 48% = men 42%= women The formed elements in the blood are red blood​ cells, white blood​ cells, and platelets. Red blood cells​ (erythrocytes) make up approximately 48 percent of the blood cell volume in men and 42 percent in women.

A​ normal-sized adult has a tidal volume of approximately how many​ mL? A. 250 B. ​1,000 C. 750 D. 500

500 mL pg172-174 The tidal volume​ (VT) is the volume of air that is breathed in with each individual breath. An​ average-sized adult has a tidal volume of approximately 500 mL. The volumes of​ 250, 750, and​ 1,000 are either too large or too small for a normal tidal volume.

The normal minute volume is​ about: A. ​6,000 mL. B. 500 mL. C. ​12,000 mL. D. ​4,000 mL.

6000 mL pg 172: Normal Minute volume:6000 mL or 6L Minute​ ventilation, also known as minute​ volume, is the amount of air that is moved into and out of the lungs in one minute. It is determined by multiplying the tidal volume by the frequency of ventilation in one minute. An​ average-sized adult has a tidal volume of approximately 500 mL and breathes approximately 12 times per minute at rest. An​ average-sized adult moves approximately​ 6,000 mL, or 6​ L, of air into and out of the lungs in one minute.

During​ exhalation, what is the approximate pressure in the​ thorax? A. 761 mmHg B. 763 mmHg C. 760 mmHg D. 758 mmHg

761 mmHg After​ inhalation, the diaphragm and external intercostal muscles​ relax, allowing the chest wall to move inward and downward​ and, assisted by the inward pull of the elastic lung​ tissue, decrease the size of the thoracic cavity. As the size of the thorax​ decreases, the pressure inside increases to about 761 mmHg. Since this is higher than the atmospheric pressure of 760​ mmHg, air is forced out of the lungs. 763 is too high of a pressure value generated during​ exhalation, and a thoracic pressure of 758 mmHg would cause air to flow into the lungs.

If there is an increase stretch to the baroreceptors above​ normal, what will be the​ response? A. A message will be sent to the brainstem to increase the heart rate. B. The baroreceptors will slow the heart rate by direct nervous control and the release of hormones. C. A message will be sent to the kidneys to reabsorb more fluid. D. A message will be sent to the brainstem to increase parasympathetic tone.

A message will be sent to the brainstem to increase parasympathetic tone. pg 186-187 An increase in blood pressure prompts the baroreceptors to signal the brainstem to alter heart function and vessel size to decrease the blood pressure. The cardioinhibitory center responds by sending parasympathetic impulses that cause the heart to decrease heart rate and myocardial contractility. A decrease in stroke volume and heart rate decreases cardiac output.​ Additionally, the vasomotor center responds by sending parasympathetic impulses to dilate the blood vessels. Vasodilation increases the vessel diameter and decreases the systemic vascular​ resistance, which decreases the blood pressure.

What sensory structures are the FIRST to detect arterial blood pressure​ changes? A. Baroreceptors B. Chemoreceptors C. pH monitors D. Barometers

A. Baroreceptors pg 186

In a healthy​ adult, the respiratory rate and depth is regulated primarily by detecting the level of what in the blood​ stream? A. Carbon dioxide levels B. Oxygen levels C. Amounts of red blood cells D. Saturated hemoglobin

A. Carbon dioxide levels

What causes the pressure change known as plasma oncotic​ pressure? A. Effect of the large proteins in the bloodstream B. Contraction or relaxation of capillary beds C. Contraction of the left ventricle D. The difference between the arterial and venous concentration of electrolytes

A. Effect of the large proteins in the bloodstream pg 181

If a patient has an asthma attack with severe​ bronchoconstriction, what effect can it have on his ability to ventilate the​ alveoli? A. It will increase airway resistance. B. It will increase airway compliance. C. It will decrease airway resistance. D. It will decrease airway compliance.

A. It will increase airway resistance. 172

What are the two basic molecules that are necessary for normal cell​ metabolism, energy​ creation, and​ function? A. Oxygen and glucose B. Glucose and carbon dioxide C. Glucose and hydrogen D. Oxygen and carbon dioxide

A. Oxygen and glucose 165 - 167

The average size adult has a minute ventilation of how many liters per​ minute? A. Six B. Eight C. Two D. Four

A. Six (6) VT X f 500 X 12 6000 6000 divide by 1000 = 6 Lpm page 172

Why is it so important for the EMT to seal any open penetrations into the chest as quickly as​ possible? A. The lungs will collapse if air gets between the two pleural membranes. B. A rib may have been fractured which will decrease lung compliance. C. The heart cannot fill if there is not air in the chest. D. To keep the blood from leaking out of the wound and into the pleural cavity.

A. The lungs will collapse if air gets between the two pleural membranes. pg

What effect would systemic vasoconstriction have on the blood​ pressure? A. The​ B/P increases. B. The​ B/P decreases. C. The​ B/P increases only if the heart rate increases. D. The​ B/P remains the same.

A. The​ B/P increases 183 Vasoconstriction - Decrease vessel diameter increase BP increase resistance (Raw) Vasodilation Increased vessel size Decreased BP Decreased resistance (Raw)

​Ultimately, the​ sodium/potassium pump in the cell will fail because of a lack​ of: A. energy. B. oxygen. C. glucose. D. carbon dioxide.

A. energy. 166-167 ATP = energy

If too much sodium accumulates inside the​ cell, the cell begins​ to: A. expand. B. reproduce. C. lose its protective membrane. D. shrink.

A. expand.

The normal signal for the respiratory center of the brain to stimulate the respiratory muscles to increase ventilations would​ be: A. the amount of CO22 in the arterial blood. B. the amount of acids developing in the muscles. C. the amount of oxygen in the venous blood. D. the amount of CO22 in the capillaries.

A. the amount of CO22 in the arterial blood.

When a patient has a lower airway​ obstruction, the MOST likely problem​ is: A. bronchoconstriction. B. swelling of the tongue. C. a spasm of the mainstem bronchus. D. a piece of meat sitting on the epiglottis.

A. Bronchoconstriction 169 -170

If you are ventilating a patient with a puncture hole to the lung following a​ stabbing, what negative outcome may you actually produce or contribute​ to? A. Hypertension B. Hypoglycemia C. Bradycardia D. Hypoxia

Hypoxia pg 178 This question involves applying the principles learned about the pleural linings and their effect on the body. If there is a hole in the lung​ tissue, every time you squeeze the​ BVM, the positive pressure that you are creating can escape through the hole and into the pleural​ cavity, where it will act as a pressure that will cause the lung to collapse even further. This would interfere with alveolar ventilation and cause hypoxia. As a response to​ hypoxia, the heart rate​ increases, and hypertension is not likely as the body becomes hypoxic.​ Finally, glucose levels are determined by other variables outside of the ventilatory determinants.

If the heart rate increases​ slightly, how will this affect the cardiac​ output? A. It will diminish cardiac output. B. It will decrease pulmonary perfusion. C. It will enhance cardiac output. D. It will not affect the cardiac output.

It will enhance cardiac output. Pg 183 Increase HR = Increase CO Because cardiac output is determined by the stroke volume and heart​ rate, if the heart rate​ increases, then so should the cardiac output. Although a faster heart rate increases cardiac​ output, if the rate is extremely​ fast, the cardiac output may actually decrease. With excessively fast heart​ rates, usually​ >160 bpm in the adult​ patient, the time between beats is so short that there is not an adequate amount of time for the ventricles to fill. This reduces the​ preload, which in turn reduces the cardiac output.

A patient has sustained significant blood loss due to an injury. Why does this lead to​ shock? A. The cells leak out fluid to surrounding tissue. B. Loss of blood causes diminished cellular perfusion. C. Because the blood he loses has the​ cell's sugar supply. D. The loss of clotting factors causes all the​ body's cells to bleed.

Loss of blood causes diminished cellular perfusion. Rationale Blood volume is a major determinant of the preload to the​ heart, which translates into cardiac output and blood pressure. If blood volume is​ lost, it can translate into a drop in systolic pressure and perfusion to the​ body's cells.

What is the name of the ventilatory volume that is calculated by multiplying the tidal volume by the frequency of​ ventilation? A. Respiration Frequency B. Minute Ventilation C. Tidal Volume D. Ventilation Volume

Minute Ventilation Tidal Volume X frequency VT X f 172

Why should EMS providers administer oxygen to a patient suspected of​ hypoxia? A. More oxygen in the inspired air will raise the respiratory rate. B. More oxygen in the inspired air will decrease the absorption of other gases present. C. More oxygen in the inspired air will increase the amount absorbed by the blood. D. More oxygen in the inspired air will slow the respiratory rate.

More oxygen in the inspired air will increase the amount absorbed by the blood.

The peripheral chemoreceptors are MOST sensitive​ to: A. sugar levels. B. CO2 level. C. acid-base balance. D. oxygen concentration.

Oxygen concentration 175 The peripheral chemoreceptors are located in the aortic arch and the carotid bodies in the neck. These chemoreceptors are also somewhat sensitive to CO22 and pH but are most sensitive to the level of oxygen in the arterial blood. As the level of oxygen in the blood​ decreases, the peripheral chemoreceptors signal the respiratory center in the brainstem to increase the rate and depth of respiration. It takes a significant decrease in the arterial oxygen content to trigger the peripheral chemoreceptors to stimulate the respiratory center. CO22 levels are monitored primarily by the central​ chemoreceptors, as are​ acid-base (pH) levels. Glucose levels are not detected by the chemoreceptors.

Which one of the patients would have a perfusion deficit according to the​ V/Q ratio? A. Asthma B. Pneumonia C. Pulmonary embolus D. Bronchial obstruction

Pulmonary embolus pg 176 (456) A patient with a perfusion deficit of the​ V/Q ratio would not be receiving adequate blood to the​ lungs; hence, the patient cannot effectively oxygenate the blood. Any patient with poor perfusion to the lungs will have a perfusion deficit of the​ V/Q ratio. One such patient would be someone with a pulmonary embolism. In this​ situation, the emboli would plug a pulmonary​ vein, making it difficult for the heart to perfuse the lungs with the clot in the way.​ Pneumonia, asthma, and bronchial obstruction would all prevent airflow from getting to the alveoli and would be ventilation deficits.

A lack of energy at the cellular level will cause the failure of what process within the cellular wall that result in the cell swelling and​ bursting? A. ​Sodium/potassium pump B. Oxidative phosphorylation C. Electron transfer chain D. Cellular respiration

​Sodium/potassium pump 166-167 For the​ sodium-potassium pump to​ work, as with any other​ pump, energy is required. If there is a lack of​ ATP/energy production by​ cells, as found in poor perfusion states and anaerobic​ metabolism, the​ sodium/potassium pump may fail. This would allow sodium to collect on the inside of the cell. Water follows sodium. So as sodium collects inside the​ cell, it attracts water. As the water continues to​ accumulate, the cell swells and eventually ruptures and dies.

What would be the expected result of the body when a patient has massive vasodilation secondary to a severe blood​ infection? A. The heart rate will slow down and the stroke volume will increase. B. Preload will increase due to venous congestion and thus stroke volume will rise. C. The heart rate and stroke volume will attempt to increase. D. The respiratory rate will slow down.

The heart rate and stroke volume will attempt to increase. Rationale Since blood pressure is determined by cardiac output and systemic vascular​ resistance, if the pressure drops owing to vasodilation from the severe blood​ infection, the cardiac output will attempt to compensate by increasing the rate and force of contraction. During this​ compensation, the respiratory rate also​ increases, and there is not an increase in​ preload, since the vasodilation will cause peripheral pooling of blood.

During the relaxation of the diaphragm and intercostal​ muscles, what happens to the intrathoracic size and​ pressure? A. The size decreases and the pressure increases. B. The size stays the​ same, but the pressure decreases. C. The size decreases and pressure decreases. D. The size stays the​ same, but the pressure increases.

The size decreases and the pressure increases. Rationale After​ inhalation, the diaphragm and external intercostal muscles​ relax, allowing the chest wall to move inward and downward​ and, assisted by the inward pull of the elastic lung​ tissue, decrease the size of the thoracic cavity. As the size of the thorax​ decreases, the pressure inside increases to about 761 mmHg at sea​ level, this causes air to be forced out of the lungs.

If the patient experiences a drop in the respiratory rate due to a drug​ overdose, what will be the effect on the​ patient's minute​ ventilation? A. The minute volume will initially​ increase, then it will drop. B. The minute volume will increase. C. The minute volume will decrease. D. There will be no change in the minute volume.

There will be no change in the minute volume. Minute​ ventilation, also known as minute​ volume, is the amount of air that is moved into and out of the lungs in one minute. It is determined by multiplying the tidal volume by the frequency of ventilation in one minute. If there is a drop in the frequency of​ ventilation, the minute ventilation will​ decrease, and the patient may start to hyperventilate.

An example of a patient having respiratory compromise due to a respiratory problem with the central nervous system would​ include: A. a spinal cord injury. B. asthma. C. hypoperfusion. D. an upper airway obstruction.

a spinal cord injury When the messages from the​ brain's respiratory center do not reach the muscles of​ breathing, the cause may be an injury to the​ spine, or there could be failure of the breathing centers in the brain from a stroke or brain trauma. The end result though is still the​ same: there is an inability to activate the respiratory muscles to breathe. Asthma is a lower airway bronchoconstrictive​ disease, upper airway obstructions do not have a neural​ component, and hypoperfusion is caused by inadequate perfusion of blood flow and oxygen to the cells of the body.

The restriction of airflow that is related to the diameter of the airways is called​ the: A. dead air space. B. pulmonary circulation. C. airway resistance. D. alveolar ventilation.

airway resistance. pg:171-172 RAW Airway resistance is related to the ease of airflow down the conduit of airway structures leading to the alveoli. A higher airway resistance from​ bronchoconstriction, for​ example, will make it more difficult to move air through the conducting airways. Higher airway resistance requires the patient to work harder to​ breathe, expending more energy and possibly using accessory​ muscles, which may accelerate respiratory muscle fatigue and failure. Compliance disorders are those that diminish the lungs ability to​ stretch, expand, or​ distend, such as a hemothorax or multiple broken ribs. Alveolar ventilation is how much air the alveoli receive per​ minute, and pulmonary circulation refers to the blood flow to and from the lungs. Dead air space is a fictitious term.

In order to BEST understand​ pathophysiology, the EMT should FIRST​ understand: A. signs and symptoms. B. anatomy and physiology. C. what the​ patient's underlying diagnosis is. D. patient assessment.

anatomy and physiology. 165 If pathophysiology is the study or understanding of the body in a disease​ state, it makes sense that the EMT should first understand normal anatomy and physiology. It is difficult to understand what is wrong with the body if you do not know what is supposed to be right or normal in the first place. Knowing what patients have been diagnosed with previously will help the EMT to identify​ patients' disease​ states, but that is not the best way to understand pathology. During the patient​ assessment, the EMT will need to relate the presenting signs and symptoms into the body systems affected​ and, from​ there, integrate how the pathophysiology has affected those body systems.

In​ hypoperfusion, the fall in cardiac​ output, as detected by the​ baroreceptors, activates several body systems that attempt to reestablish a normal blood pressure in a process known​ as: A. decompensation. B. compensation c. poor peripheral perfusion. D. vasoconstriction.

compensation

When an increase of blood in the left ventricle causes stretching of the​ ventricle, the​ heart: A. contracts more forcefully. B. contracts less forcefully. C. remains unchanged. D. can no longer contract.

contracts more forcefully.

To ensure adequate breathing in a​ patient, the patient must have both an adequate rate of ventilations and an​ adequate: A. decrease in the depth of ventilations. B. thoracic chest wall. C. depth of ventilations. D. number of alveoli.

depth of ventilation pg 172 tidal volume (depth of ventilation) and adequate rate (frequency) TV X f

Pressure and volume of blood in the left ventricle at the end of diastole is​ called: A. systolic blood pressure. B. afterload. C. cardiac output. D. preload.

preload. pg 182 Preload is the pressure generated in the left ventricle at the end of diastole​ (the resting phase of the cardiac​ cycle). Preload pressure is created by the blood volume in the left ventricle at the end of diastole. The available venous​ volume, which determines the volume of blood in the​ ventricle, consequently plays a major role in determining preload. Afterload pertains to the resistance the left ventricle has to overcome to open the aortic valve. Systolic blood pressure is determined by multiplying the cardiac output by the systemic vascular resistance.

The EMT should know that the role of oxygen in the body​ is: A. carried in the blood as a dissolved ion. B. an end product of normal cell metabolism. C. required for normal cell metabolism. D. an end product of abnormal cell metabolism.

required for normal cell metabolism. Cellular​ metabolism, also known as cellular​ respiration, is the process in​ which, normally, the cells break down molecules of glucose to produce energy for the body. There are two types of cellular​ metabolism: aerobic and anaerobic. Which of these two types of cellular metabolism occurs is based on whether there is an effective and continuous delivery of oxygen and energy​ sources, or fuel. Glucose is the primary​ fuel, and oxygen is the primary catalyst for metabolism within the cell. In​ fact, oxygen is required by every cell of the body in order for normal cellular metabolism to occur. Oxygen is not an end product of either normal or abnormal metabolism​ (acid is,​ actually), and oxygen is not an ion found dissolved in the​ blood, since oxygen is a​ gas, not an electrolyte.

Which ion will start to accumulate within the cell should the​ sodium-potassium pump fail following a period of​ hypoxia? A. Sodium B. Carbon dioxide C. Magnesium D. Potassium

sodium pg 186-187 Sodium that is inside a cell wants to stay inside the cell where its concentration is less.​ (Molecules naturally move from an area of greater concentration to an area of lesser concentrationlong dash—moving with the concentration gradientlong dash—not the other way​ around.) So sodium molecules do not just flow out of the​ cell, they have to be actively pumped out against the concentration gradient. Should the pump​ fail, sodium will accumulate.

To calculate the cardiac​ output, the EMT knows to multiply the heart rate​ by: A. stroke volume. B. systolic blood pressure. C. left ventricular preload. D. frequency of contractions.

stroke volume. HR X SV Pg 182 The pumping function of the heart is typically expressed as the cardiac output. Cardiac output is defined as the amount of blood ejected by the left ventricle in one minute. Cardiac output is determined by multiplying the heart rate​ (or frequency of​ contractions) by the stroke volume​ (stroke volume is how much blood the heart propels forward with each individual​ contraction). The systolic blood pressure is determined by multiplying the cardiac output by the systemic vascular resistance. The left ventricular preload is how much blood is delivered to the ventricle before contraction.

How does the majority of carbon dioxide in the body get​ eliminated? A. Through the vascular system B. Through the renal system C. Through the pancreatic system D. Through the pulmonary system

through the pulmonary system The largest amount of CO22 produced by the body diffuses into the red blood cell and combines with water to form carbonic​ acid, which then dissociates into hydrogen and bicarbonate. The bicarbonate exits the cell and is transported to the pulmonary​ circulation, the bicarbonate diffuses back into the red blood cell where it combines with hydrogen and splits back into water and carbon dioxide. Regardless of the transport​ mechanism, the carbon dioxide diffuses into the alveoli and is released through exhalation.

The term​ "pathophysiology" means​ what? A. The study of the pathway of normal metabolism in the body B. The effects of cancer on the body C. Changes in normal physiology due to disease or injury D. The effect of normal metabolic activity on maintaining the​ body's systems

C. Changes in normal physiology due to disease or injury

The EMT should recall that if the patient has a mismatch between the ventilation and perfusion of the​ lungs, what negative outcome could​ happen? A. There is too much blood in the cells. B. The patient exhales too much carbon dioxide. C. Hypoxia can occur at the cellular level. D. There is too much glucose circulating in the bloodstream.

C. Hypoxia can occur at the cellular level. pg 176

From what negative affect regarding gas diffusion in the alveoli would a patient with pulmonary edema​ suffer? A. Respirations will start to slow and become shallow B. Excessive hyperoxia causing free radical damage to healthy tissue C. Inability to oxygenate the blood and remove carbon dioxide D. Too much blood flow causes too much carbon dioxide removal

C. Inability to oxygenate the blood and remove carbon dioxide 457,176-177

How much of the normal tidal volume does the alveolar ventilation account​ for? A. 150 mL B. 750 mL C. 250 mL D. 350 mL

D. 350 mL pg 173

What is the process that produces carbon dioxide in the​ body? A. It is formed to serve as the primary energy source for cellular mitochondria. B. The result of abnormal metabolism. C. A drop in cellular ATP creation. D. An end product of normal cell metabolism.

D. An end product of normal cell metabolism.

Which of the following situations could cause poor tissue oxygenation of the extremities despite the arterial blood being​ oxygenated? A. A narcotic overdose B. A brain tumor C. Spinal injury D. Dropping systolic blood pressure

Dropping systolic blood pressure This is a fundamental question that asks you to connect body physiology to pathophysiology as it relates to blood oxygenation. Since the lungs sit on either side of the​ heart, it does not take as high a perfusion pressure to perfuse the lungs adequately as it does to perfuse the distal extremities.​ Therefore, if the blood pressure is​ dropping, there may still be adequate levels of oxygen in the bloodstream from the​ lungs, but the pressure may not be high enough to get sufficient oxygen to the peripheral tissues. A spinal​ injury, a narcotic​ overdose, and a brain tumor can all affect the neural control of the respiratory​ muscles, causing a drop in the ability of the body to oxygenate the blood because of ineffective respirations.

What does FDO2 stand​ for? A. Fraction of desired oxygen B. Failure of dormant oxygen C. Function of delivered oxygen D. Fraction of delivered oxygen

Fraction of delivered oxygen pg168 An FDO22 is a fraction of delivered oxygen. The difference between an FiO22 and an FDO22 is that the FiO22 is administered to a patient who is breathing spontaneously and inhaling the air on his own​ effort, whereas the FDO22 is delivered by a ventilation device to a patient who is not able to breathe adequately on his own.

The basic primary fuel for the cell​ is: A. oxygen. B. carbon dioxide. C. glucagon. D. glucose.

Glucose 165 - 167

What is the effect of a decreased tidal volume in a patient who has a rib​ fracture? A. He will breathe faster to keep the minute volume normal. B. The blood flow through the heart slows down. C. The heart rate slows to compensate. D. The perfusion will increase.

He will breathe faster to keep the minute volume normal. If the tidal volume is decreased secondary to a lung or thoracic wall​ injury, the patient will increase his ventilation rate in an attempt to keep the minute volume the same. This may or may not​ work, depending on how diminished the tidal volume is. This should not have an effect on blood flow through the heart or on perfusion status of any consequence. The heart rate tends to speed up with​ hypoxia, not slow down.

Which of the following factors is not considered to be a determinant of stroke​ volume? A. Heart rate B. Afterload C. Preload D. Contractility

Heart rate pg 182 Stroke volume is defined as the volume of blood ejected by the left ventricle with each contraction. Stroke volume is determined by​ preload, myocardial​ contractility, and afterload. The heart rate is a determinant of cardiac output and is affected by both intrinsic and extrinsic influences on the conduction system of the heart.

Which of the following cellular effects will NOT likely happen to a patient who is breathing in toxic​ gases? A. The cells may be unable to adequately pick up and carry oxygen to the tissues. B. Oxygen will take on a toxic effect in the body and cause cellular death. C. Oxygen molecules may be displaced and the cells can suffocate. D. The cells may be unable to use the oxygen present.

Oxygen will take on a toxic effect in the body and cause cellular death. Rational Some toxic gases displace the amount of oxygen in the air and basically suffocate the patient. Other​ gases, such as carbon​ monoxide, disrupt the ability of the blood to carry adequate amounts of oxygen to the cells. In either​ condition, the cells end up hypoxic. Some toxic gases may not severely reduce the concentration of oxygen in the air or disrupt the ability of the blood to carry oxygen but may interfere with its use by the cell. One example is cyanide poisoning.

What two divisions of the nervous system help to control blood flow through the​ arterioles? A. Sympathetic and antisympathetic B. Voluntary and cerebellar C. Parasympathetic and sympathetic D. Autonomic and voluntary

Parasympathetic and sympathetic Neural factors are associated with the influence of the sympathetic and parasympathetic nervous systems on the arterioles and precapillary sphincters. Sympathetic nervous stimulation would cause the arterioles to constrict and precapillary sphincters to close. Parasympathetic stimulation would cause the arterioles to dilate and the precapillary sphincters to open. The other choices are fictitious.

You are treating a patient who has lost a significant amount of blood volume after a traumatic​ injury, and his systolic pressure is low. What body function will NOT be part of the compensatory mechanism trying to maintain a normal perfusion​ pressure? A. Baroreceptors B. Parasympathetic stimulation C. Heart rate D. Medulla oblongata

Parasympathetic stimulation During a hypoperfusive​ state, the baroreceptors will detect the drop in the heart rate and send an impulse to the medulla. The medulla will then stimulate the sympathetic nervous​ system, which in turn will increase​ (among other​ things) the heart rate in order to improve cardiac output and blood pressure.

Why would a hypoxic patient who has severe bleeding NOT be benefited that greatly by the administration of supplemental​ oxygen? A. People with heavy bleeding also have dysfunctional alveoli. B. Bleeding blocks the ability of tissues to use oxygen. C. People who have lost blood have also lost the hemoglobin that carries oxygen. D. He does not have white blood cells to carry the oxygen.

People who have lost blood have also lost the hemoglobin that carries oxygen. Without​ hemoglobin, the negligible amount of oxygen that can be transported by plasma would not be enough to sustain normal cellular function or life. A loss of​ hemoglobin, which commonly occurs as a result of​ bleeding, can easily lead to severe cellular​ hypoxia, even though an adequate amount of oxygen is available in the alveoli. White blood cells are part of the immune​ system, and bleeding does not block the tissues use of​ oxygen, nor does bleeding directly cause dysfunction to the alveoli.

Which of the following​ elements, if diminished or absent in a​ patient's bloodstream, could cause uncontrolled​ bleeding? A. Albumin proteins B. Red blood cells C. Platelets D. White blood cells

Platelets (180) Rationale The platelets​ (thrombocytes) are not actual cells but fragments that play a major role in blood clotting and the control of bleeding. Red blood cells carry​ oxygen, white blood cells fight​ infections, and albumin proteins are used for fluid balance and other purposes in the bloodstream.

You are caring for a patient who was involved in a farming accident where he was exposed to insecticides used on vegetation. You contact the Poison Control​ Center, which advises you that the chemical will have significant parasympathetic effects on the body. What would you expect this to mean to the​ patient's body? A. The patient may experience significant hypertension. B. The patent may experience significant hypotension. C. The patient may experience heightened sensitivity. D. The patient may experience excessive hyperglycemia.

The patent may experience significant hypotension. Rationale Because the toxin is a parasympathetic​ stimulator, the patient will experience significant bradycardia and vasodilation. These will result in a drop in blood pressure. Remember also that the parasympathetic nervous system would cause the arterioles to dilate and the precapillary sphincters to open. Stimulation of the parasympathetic system does not result in heightened​ sensitivity, nor does it promote hyperglycemia. Hypertension would be from sympathetic​ tone, not parasympathetic.

A patient has an initial blood pressure of​ 120/78, with a heart rate of 86 per minute. Five minutes later his blood pressure is​ 128/92, with a heart rate of 82 per minute. Which of the following statements about the change in the vitals is MOST​ correct? A. The patient has arterial constriction and venous dilation. B. The patient has experienced an increase in his systemic vascular resistance. C. The patient has experienced an increase in his pulmonic vascular resistance. D. The patient is probably bleeding into his GI system unnoticed.

The patient has experienced an increase in his systemic vascular resistance. pg 183 decreased vessel size = increase in SVR The determinants of blood pressure are heart rate and systemic vascular resistance. In this​ situation, the systolic pressure climbed 8 mmHg and the diastolic pressure climbed 14 mmHg with a concurrent drop in the heart rate. The likely cause is an increase in​ vasoconstriction, which would elevate the systolic​ pressure, narrow the pulse​ pressure, and slow the heart rate owing to the baroreceptor reflex arc. An increase in pulmonic resistance cannot be determined by the vital​ signs, and if there was a bleed in the GI​ system, the heart rate would continue to climb to ensure an adequate cardiac output.​ Finally, arterial constriction and venous dilation would widen​ (not narrow) the pulse pressure.

Why should the patient who is in shock be administered​ oxygen? A. The patient may be hypoxic at the cellular level. B. The oxygen helps to increase the blood flow through the lungs. C. The vessels in the brain are dilated. D. The oxygen will help to lower the body temperature.

The patient may be hypoxic at the cellular level. Since blood pressure is determined by cardiac output and systemic vascular​ resistance, if the pressure drops owing to vasodilation from the severe blood​ infection, the cardiac output will attempt to compensate by increasing the rate and force of contraction. During this​ compensation, the respiratory rate also​ increases, and there is not an increase in​ preload, since the vasodilation will cause peripheral pooling of blood.

If there were a pathological change to the​ alveoli, what finding may the EMT note in the​ patient? A. A severe headache or double vision B. Trouble breathing C. An increase in the urinary output D. A drop in the heart rate

Trouble breathing If there was a pathological change to the alveoli​ (meaning that there is a disease state to the lungs that is affecting the​ alveoli), then the patient would likely have trouble oxygenating the blood and eliminating carbon​ dioxide, which would eventually lead to respiratory distress as the chemoreceptors in the body detect the changes in blood gas concentration and employ a negative feedback system in an attempt to correct the abnormality.

While working with an ALS​ partner, you observe her starting an IV on a trauma patient with an arterial bleed. You know that this is beneficial​ because: A. it will help carry and prevent free radical formations from hyperoxia. B. it will cause the heart rate to slow down. C. extra fluid will increase the preload to the heart. D. it will increase the amount of clotting factors in the​ patient's blood.

extra fluid will increase the preload to the heart pg 182-183 When a patient is in​ shock, fluid is administered to fill the container​ (the vascular​ space). By filling the vascular​ space, there will be an increase in the preload to the​ heart, which will increase diastolic filling and subsequent stroke volume and cardiac output. This will help to maintain peripheral perfusion. The fluid is not given to carry free radicals from​ hyperoxia, as these should be avoided by titrating oxygen on the basis of​ need, and fluids do not increase the clotting speed of the body.

One of the fundamental underlying causes of respiratory compromise​ is: A. failure of the​ alveolar/capillary exchange of gases. B. dilated capillaries in the systemic system. C. increased conductivity of the heart muscle causing abnormal blood flow through the lungs. D. increased tidal volume that washes out too much carbon dioxide.

failure of the​ alveolar/capillary exchange of gases. pg 179-180 Rationale The​ alveolar/capillary exchange occurs when oxygen and carbon dioxide travel down their partial pressure gradients in the lungs so that the blood can be oxygenated while excessive waste carbon dioxide is eliminated during exhalation. This can fail as a result of problems of ventilation or problems of perfusion. Dilation of capillaries in the systemic system will cause vasodilation and a drop in blood pressure. Increased conductivity in the heart would actually enhance blood flow to the lungs via better​ contractions, and increased tidal volumes will remove more CO2 from the​ body, but that does not cause respiratory failure.

The inadequate delivery of oxygen and essential nutrients​ to, and removal of wastes​ from, all the tissues of the body is​ called: A. hypoperfusion. B. abnormal circulatory patterns. C. suffocation. D. decreased cardiac output.

hypoperfusion. One of the most fundamental purposes of emergency care is maintaining adequate perfusion of the body cells to ensure continuous delivery of oxygen and glucose and removal of waste​ by-products. These basic​ molecules, oxygen and​ glucose, are necessary for normal cell metabolism. Many illnesses and injuries can disturb the delivery of oxygen and glucose and the removal of waste​ by-products (which is a disturbance known as​ hypoperfusion). The outcome of hypoperfusion is always the inadequate delivery of oxygen and essential nutrients​ to, and removal of wastes​ from, all the tissues of the body. Decreased cardiac output is a process that typically occurs during​ hypoperfusion, but the term hypoperfusion defines the entire process that occurs to the body.

When the diaphragm​ contracts, the​ patient: A. exhales. B. coughs. C. inhales. D. is able to speak.

inhales 208 - inhation -Diaphragm contracts downward on Inhalation + positive pressure exhalation - Diaphragm relaxes upward - negative pressure

When a patient is severely burned over MOST of his​ body, the cellular and vascular damage created by the burn results in large protein molecules leaving the vascular space. As a result of​ this, which of the choices will the patient​ experience? A. High oncotic pressure B. High hydrostatic pressure C. Low hydrostatic pressure D. Low oncotic pressure

low oncotic pressure pg 181 This question involves applying the principles of hydrostatic pressure and oncotic pressure of the body as it relates to a traumatic burn injury. As a result of the loss of plasma​ proteins, the​ patient's oncotic pressure will drop and not exert an adequate pull effect to counteract the push of hydrostatic pressure. This will result in the loss of greater than normal amounts of vascular volume to the interstitial spaces​ (promoting global tissue​ edema). High hydrostatic pressure occurs when the systolic pressure in the capillary beds​ increases, high oncotic pressure occurs when there is a greater pull of fluids back into the vascular​ space, and a low hydrostatic pressure just means the fluid will not cause as much fluid to exit the capillary bed.

The component of whole blood that is primarily composed of water is​ the: A. electrolytes. B. albumin. C. electrolytes in solute. D. plasma.

plasma Pg 180-181 Plasma - fluid component that makes up 55% of blood composition 45% = formed elements (which are cells and proteins) 45% of blood composition

An example of a patient having respiratory compromise due to a disruption of pleural linings would​ include: A. an overdose on a narcotic drug. B. a mechanical airway obstruction. C. a pneumothorax. D. asthma.

pneumothorax 947