Every block and quiz

In contrast to negative-pressure ventilation, positive-pressure ventilation: A. is the forcing of air into the lungs. B. is provided with a nonrebreathing mask. C. occurs when the diaphragm descends. D. can only be provided to intubated patients.

Anatomy and Physiology Review, page 908 The answer is: is the forcing of air into the lungs.

The left main coronary artery subdivides into the: A. left anterior ascending and descending arteries. B. right coronary and left posterior descending arteries. C. left anterior descending and circumflex arteries. D. left posterior ascending and circumflex arteries.

Anatomy and Physiology Review, page 963 The answer is: left anterior descending and circumflex arteries.

The left main coronary artery subdivides into the: A. left anterior descending and circumflex arteries. B. right coronary and left posterior descending arteries. C. left anterior ascending and descending arteries. D. left posterior ascending and circumflex arteries.

Anatomy and Physiology Review, page 963 The answer is: left anterior descending and circumflex arteries.

In contrast to the right side of the heart, the left side of the heart: A. is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs. B. drives blood out of the heart against the relatively low resistance of the pulmonary circulation. C. is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta. D. drives blood out of the heart against the relatively high resistance of the systemic circulation.

Anatomy and Physiology Review, page 963 The answer is: drives blood out of the heart against the relatively high resistance of the systemic circulation.

When cells are exposed to adverse conditions, they go through a process called: A. apoptosis. B. crenation. C. adaptation. D. hypertrophy.

Adaptation in Cells and Tissues, page 420 The answer is: adaptation.

A patient with chronic hypertension is diagnosed with left ventricular hypertrophy. This means that: A. an increase in the number of cells has caused an increase in the size of the ventricle. B. cells of the left ventricular myocardium have undergone irregular, atypical changes. C. cells of the left ventricular myocardium have been replaced by another cell type. D. an increase in the size of the cells has caused an increase in the size of the ventricle.

Adaptation in Cells and Tissues, page 420 The answer is: an increase in the size of the cells has caused an increase in the size of the ventricle.

Following a stroke, a man has atrophy of his left leg. This means that: A. the shape of the cells in his thigh are irregular. B. overuse of his left leg has caused it to enlarge. C. his left leg is smaller in size than his right leg. D. the number of cells in his thigh have decreased.

Adaptation in Cells and Tissues, page 420 The answer is: his left leg is smaller in size than his right leg.

An increase in the number of cells in an organ or tissue is called: A. hyperplasia. B. atrophy. C. hypertrophy. D. metaplasia.

Adaptation in Cells and Tissues, page 420 The answer is: hyperplasia.

The MOST common swift water rescue scenario involves: A. a swift water rescue technician who does not wear a flotation device. B. a canoer who is entrapped in thick brush in fast-moving water. C. people who attempt to drive their vehicles across a flooded bridge. D. undertow ocean currents that force the victim under water.

Additional Specialized Rescue Situations, page 2381 The answer is: people who attempt to drive their vehicles across a flooded bridge.

As soon as you reach an unresponsive victim who is floating in the water, you should: A. move the victim's face above water and manually open his or her airway. B. turn the patient supine without manipulating his or her head or neck. C. float a buoyant backboard under the patient and initiate ventilations. D. immediately assess for the presence of breathing and for a central pulse.

Additional Specialized Rescue Situations, page 2383 The answer is: turn the patient supine without manipulating his or her head or neck.

A 7-year-old child was playing near a large pile of sand when the ground underneath her collapsed. You can hear her crying and asking for her mother. Until the technical rescue team arrives at the scene, you should: A. get as close to the edge of the trench as possible and attempt to visualize the child. B. use several long backboards as shoring to decrease the risk of a secondary collapse. C. throw the child a rope and ask her to tie it around her waist so you can pull her out. D. maintain verbal contact with the child, but avoid going near the edge of the trench.

Additional Specialized Rescue Situations, pages 2379-2380 The answer is: maintain verbal contact with the child, but avoid going near the edge of the trench.

A 29-year-old man was pulled from icy water after being submerged for approximately 10 minutes. He is unresponsive, apneic, and pulseless. He does not appear to have any injuries. The MOST appropriate treatment for this patient involves: A. defibrillating up to three times if he is in ventricular fibrillation, removing his wet clothing and applying blankets, and transporting. B. assessing his cardiac rhythm, but attempting resuscitation only if the cardiac monitor reveals ventricular fibrillation or ventricular tachycardia. C. immobilizing his spine, initiating CPR, removing his wet clothing, and ceasing resuscitative efforts if unsuccessful after 5 minutes. D. protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

Additional Specialized Rescue Situations, pages 2380-2381 The answer is: protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

The chemical mediators that initiate and maintain the immune response are: A. macrophages and cytokines. B. eosinophils and neutrophils. C. basophils and mast cells. D. heparin and T cells.

Anatomy and Physiology Review, page 1320 The answer is: basophils and mast cells.

Histamine release causes all of the following effects, EXCEPT: A. increased cardiac contractility, which results in hypertension. B. increased vascular permeability, which results in tissue edema. C. vasodilation, which results in flushed skin and hypotension. D. contraction of the smooth muscles of the respiratory system.

Anatomy and Physiology Review, page 1321 The answer is: increased cardiac contractility, which results in hypertension.

The anterior weight-bearing structure of the vertebra is the: A. spinous process. B. pedicle. C. lamina. D. vertebral body.

Anatomy and Physiology Review, page 1717 The answer is: vertebral body.

What do the spleen and liver have in common? A. They are less likely to be crushed by blunt trauma than other organs. B. The liver and spleen are well protected by the abdominal muscles. C. The liver and spleen are the only solid organs in the abdominal cavity. D. They are both highly vascular and bleed profusely when injured.

Anatomy and Physiology Review, page 1824 The answer is: They are both highly vascular and bleed profusely when injured.

Which of the following structures is NOT part of the axial skeleton? A. Femoral shaft B. Basilar skull and face C. Vertebral column D. Ribs and sternum

Anatomy and Physiology Review, page 1845 The answer is: Femoral shaft

The mainstem bronchus ends at the level of the: A. subsegmental bronchi. B. segmental bronchi. C. bronchioles. D. lobar bronchi.

Anatomy and Physiology Review, page 905 The answer is: bronchioles.

In contrast to negative-pressure ventilation, positive-pressure ventilation: A. is the forcing of air into the lungs. B. can only be provided to intubated patients. C. occurs when the diaphragm descends. D. is provided with a nonrebreathing mask.

Anatomy and Physiology Review, page 908 The answer is: is the forcing of air into the lungs.

In contrast to treatment for supraventricular tachycardia, treatment for multifocal atrial tachycardia in the prehospital setting: A. is often more effective. B. is generally not effective. C. includes synchronized cardioversion. D. involves atropine sulfate.

Electrophysiology, page 1001 The answer is: is generally not effective.

A "run" of ventricular tachycardia occurs if at least ____ PVCs occur in a row. A. four B. five C. three D. two

Electrophysiology, page 1004 The answer is: three

Ventricular bigeminy occurs when: A. a 6-second strip contains at least two PVCs. B. two premature ventricular complexes (PVCs) occur in a row. C. every second complex is a PVC. D. at least two differently shaped PVCs occur.

Electrophysiology, page 1005 The answer is: every second complex is a PVC.

An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT: A. QRS complexes greater than 0.12 seconds in duration. B. regular R-R intervals and a rate between 40 and 100 beats/min. C. irregular R-R intervals and a rate less than 40 beats/min. D. wide QRS complexes with P waves buried in the T waves.

Electrophysiology, page 1006 The answer is: irregular R-R intervals and a rate less than 40 beats/min.

Monomorphic ventricular tachycardia: A. presents with wide QRS complexes of a common shape. B. is treated as ventricular fibrillation if a pulse is present. C. is often irregular with occasional nonconducted P waves. D. is characterized by QRS complexes that vary in size.

Electrophysiology, page 1006 The answer is: presents with wide QRS complexes of a common shape.

Torsade de pointes: A. is a lethal ventricular rhythm that is usually caused by ingestion or injection of CNS-depressant drugs. B. is generally less serious than monomorphic ventricular tachycardia and is usually not treated in the field. C. presents with wide QRS complexes that are all of the same shape, size, and vector direction. D. is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.

Electrophysiology, page 1007 The answer is: is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.

Common causes of cardiac arrest include all of the following, EXCEPT: A. pulmonary embolism. B. hyperglycemia. C. hypovolemia. D. cardiac tamponade.

Electrophysiology, page 1014 The answer is: hyperglycemia.

The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the: A. intubation kit and equipment for vascular access. B. pocket face mask and equipment for intubation. C. defibrillator and airway management equipment. D. drug kit and stretcher with a long backboard.

Electrophysiology, page 1015 The answer is: defibrillator and airway management equipment.

A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next? A. Administer 300 mg of amiodarone via rapid IV push. B. Rapidly infuse 2 liters of normal saline solution. C. Give 40 units of vasopressin followed by defibrillation. D. Give amiodarone followed by 1.5 mg/kg of lidocaine.

Electrophysiology, page 1016 The answer is: Administer 300 mg of amiodarone via rapid IV push.

Which of the following statements regarding treatment for a first-degree heart block is ? A. Transcutaneous cardiac pacing should be initiated without delay for patients with a first-degree heart block. B. Most first-degree heart blocks are associated with significant bradycardia and require atropine. C. Treatment is generally not indicated unless the rate is slow and cardiac output is impaired. D. First-degree heart block is often accompanied by a compensatory tachycardia that requires treatment.

Electrophysiology, page 1020 The answer is: Treatment is generally not indicated unless the rate is slow and cardiac output is impaired.

Q waves are considered abnormal or pathologic if they are: A. greater than 0.02 seconds wide and consistently precede the R wave. B. not visible in leads I or II when the QRS gain sensitivity is increased. C. present in a patient who is experiencing chest pressure or discomfort. D. more than one-third the overall height of the QRS complex in lead II.

Electrophysiology, page 983 The answer is: more than one-third the overall height of the QRS complex in lead II.

Osmosis is the movement of a: A. solute from an area of high solvent concentration to one of low concentration. B. solute from an area of low solvent concentration to one of high concentration. C. solvent from an area of high solute concentration to one of low concentration. D. solvent from an area of low solute concentration to one of high concentration.

Cellular Level, page 250 The answer is: solvent from an area of low solute concentration to one of high concentration.

When oxygen levels are low or absent, the cells revert to a process of: A. anaerobic metabolism. B. aerobic metabolism. C. anaerobic anabolism. D. aerobic catabolism.

Cellular Level, pages 247-248 The answer is: anaerobic metabolism.

The separation of the intracellular and extracellular areas by a selectively permeable membrane helps to maintain: A. exocytosis. B. endocytosis. C. hemostasis. D. homeostasis.

Cellular Level, pages 248-249 The answer is: homeostasis.

Unlike bacteria, viruses: A. can only multiply outside a host. B. are larger and reproduce outside the cell. C. die when exposed to the environment. D. can only be contracted by direct contact.

Chain of Infection, page 1356 The answer is: die when exposed to the environment.

In the context of a communicable disease, a ___________ is a place where organisms may live and multiply. A. host B. reservoir C. carrier D. contaminant

Chain of Infection, page 1356 The answer is: reservoir

Unless the fluid level is low, you should NOT uncap the brake fluid reservoir because: A. the reservoir is pressurized and may cause burns. B. doing so releases pressure within the brake lines. C. air will be drawn into the hydraulic brake lines. D. brake fluid absorbs moisture from the atmosphere.

Checking the Emergency Vehicle, page 2307 The answer is: brake fluid absorbs moisture from the atmosphere.

MARK 1 and DuoDote antidote kits contain: A. pralidoxime chloride and epinephrine. B. midazolam and atropine sulfate. C. atropine and pralidoxime chloride. D. lorazepam and 2-PAM chloride.

Chemical Agents, page 2445 The answer is: atropine and pralidoxime chloride.

A patient with a pH of 7.30 indicates: A. a basic pH. B. acidosis. C. a neutral pH. D. alkalosis.

Chemical Level, page 240 The answer is: acidosis.

A patient with a pH of 7.30 indicates: A. alkalosis. B. acidosis. C. a basic pH. D. a neutral pH.

Chemical Level, page 240 The answer is: acidosis.

The substance that contains all the cellular contents between the cell membrane and the nucleus is called the: A. protoplasm. B. endoplasmic reticulum. C. cytoplasm. D. Golgi apparatus.

Chemical Level, page 241 The answer is: cytoplasm.

Substances that release ions when dissolved in water are called: A. electrolytes. B. endocytes. C. exocytes. D. neutrons.

Chemical Level, page 293 The answer is: electrolytes.

Which of the following physiologic responses would you expect to see in a patient with a pH of 7.50? A. Decreased respirations B. Hydrogen ion excretion C. Increased respirations D. Bicarbonate retention

Chemical Level, pages 239-240 The answer is: Decreased respirations

Which of the following physiologic responses would you expect to see in a patient with a pH of 7.50? A. Hydrogen ion excretion B. Decreased respirations C. Bicarbonate retention D. Increased respirations

Chemical Level, pages 239-240 The answer is: Decreased respirations

What forms of child maltreatment are often difficult to identify and may go unreported? A. Neglect and physical abuse B. Sexual and emotional abuse C. Emotional abuse and neglect D. Physical and emotional abuse

Child Abuse and Neglect, page 2183 The answer is: Emotional abuse and neglect

Bruises that occur _________________ are rarely incurred accidentally. A. to both shins B. in a straight line C. to the forehead D. in a toddler

Child Abuse and Neglect, page 2185 The answer is: in a straight line

Which of the following is a drawback of using the ten-code system when communicating by radio? A. They do not convey accurate information. B. They are difficult to hear over the radio. C. The codes' meanings vary by jurisdiction. D. They disclose too much information.

Communicating by Radio, page 146 The answer is: The codes' meanings vary by jurisdiction.

Which of the following statements is LEAST descriptive when documenting the events of a cardiac arrest call on your patient care report? A. "Followed ACLS protocols." B. "Gave 1 mg of epinephrine at 1002." C. "Intubated with a 7.5-mm ET tube." D. "Inserted 18-gauge IV in right forearm."

Completing a PCR, page 179 The answer is: "Followed ACLS protocols."

Which of the following statements is LEAST descriptive when documenting the events of a cardiac arrest call on your patient care report? A. "Gave 1 mg of epinephrine at 1002." B. "Intubated with a 7.5-mm ET tube." C. "Inserted 18-gauge IV in right forearm." D. "Followed ACLS protocols."

Completing a PCR, page 179 The answer is: "Followed ACLS protocols."

Which of the following statements includes a pertinent negative? A. "The patient complains of nausea but denies vomiting." B. "The patient rates his pain as an 8 on a scale of 0 to 10." C. "The rapid head-to-toe exam revealed abrasions to the chest." D. "The possible smell of ETOH was noted on the patient."

Completing a PCR, page 181 The answer is: "The patient complains of nausea but denies vomiting."

A poorly written patient care report: A. generally results in a lawsuit, even if the patient outcome was favorable. B. often indicates that the paramedic was too busy providing patient care. C. may raise questions by others as to the paramedic's quality of patient care. D. is unavoidable during a mass-casualty incident and is generally acceptable.

Completing a PCR, pages 183-184 The answer is: may raise questions by others as to the paramedic's quality of patient care.

The fight-or-flight response is characterized by all of the following physiologic responses, EXCEPT: A. an increased flow of blood to the skeletal muscles. B. decreased sympathetic tone and pupil constriction. C. shunting of blood away from the gastrointestinal tract. D. mobilization of glucose and an increased heart rate.

Components of Well-Being, page 44 The answer is: decreased sympathetic tone and pupil constriction.

Which of the following habits will increase your exposure to injury from lifting your maximum weight? A. Removing all unnecessary equipment from the cot before loading it B. Utilizing a second person to help lift the foot end of the cot if needed C. Ensuring that the patient is aware that he or she is about to be lifted D. Routinely lowering the ambulance stretcher all the way to the ground

Components of Well-Being, pages 43-44 The answer is: Routinely lowering the ambulance stretcher all the way to the ground

You have loaded a cardiac arrest patient onto the stretcher and are preparing to lift the stretcher. When doing so, you should: A. remember to lift with your back, not your legs. B. take unnecessary equipment off the stretcher. C. recall that the foot end of the stretcher is the heaviest. D. keep your back in a slightly curved position.

Components of Well-Being, pages 43-44 The answer is: take unnecessary equipment off the stretcher.

It is MOST important to park your ambulance upwind and uphill from a hazardous materials incident scene because: A. if the chemical ignites and explodes, the fallout from the blast will most likely sink into valleys and ditches instead of rising. B. the risk of being contaminated is minimal if the chemical travels, and you will have greater visibility of the entire incident scene. C. the vapor density of many chemicals is less than that of the air, causing the vapor to rise and dissipate as it travels with the wind. D. hazardous chemicals that turn to gas rarely have a vapor density that is heavier than the air, regardless of the amount of chemical.

Contamination and Toxicology, page 2415 The answer is: the vapor density of many chemicals is less than that of the air, causing the vapor to rise and dissipate as it travels with the wind.

The temperature at which a liquid fuel gives off sufficient vapors to cause a fire when an ignition source is present is called the: A. flammable range. B. ignition temperature. C. flash point. D. vapor density.

Contamination and Toxicology, pages 2415-2416 The answer is: flash point.

Which of the following patients may benefit from CPAP? A. Patient with pulmonary edema who is unable to follow verbal commands B. Alert patient with respiratory distress following submersion in water C. Comatose patient with shallow breathing after overdosing on heroin D. Trauma patient with labored breathing and extensive chest wall bruising

Continuous Positive Airway Pressure, page 818 The answer is: Alert patient with respiratory distress following submersion in water

CPAP is NOT appropriate for patients with: A. slow, shallow respiratory effort. B. acute or chronic bronchospasm. C. an oxygen saturation less than 90%. D. evidence of congestive heart failure.

Continuous Positive Airway Pressure, page 818 The answer is: slow, shallow respiratory effort.

Signs of clinical improvement during CPAP therapy include: A. a decrease in systolic BP. B. an increase in the heart rate. C. increased ETCO2. D. increased ease of speaking.

Continuous Positive Airway Pressure, page 819 The answer is: increased ease of speaking.

Signs of clinical improvement during CPAP therapy include: A. an increase in the heart rate. B. increased ETCO2. C. increased ease of speaking. D. a decrease in systolic BP.

Continuous Positive Airway Pressure, page 819 The answer is: increased ease of speaking.

When administering CPAP therapy to a patient, it is important to remember that: A. the head straps must be secured immediately in order to achieve an adequate seal. B. SpO2 of 100% must be achieved within the first 5 minutes of CPAP application. C. the increased intrathoracic pressure caused by CPAP can result in hypotension. D. acute symptomatic bradycardia has been directly linked to CPAP therapy.

Continuous Positive Airway Pressure, pages 818-820 The answer is: the increased intrathoracic pressure caused by CPAP can result in hypotension.

When administering CPAP therapy to a patient, it is important to remember that: A. the increased intrathoracic pressure caused by CPAP can result in hypotension. B. acute symptomatic bradycardia has been directly linked to CPAP therapy. C. SpO2 of 100% must be achieved within the first 5 minutes of CPAP application. D. the head straps must be secured immediately in order to achieve an adequate seal.

Continuous Positive Airway Pressure, pages 818-820 The answer is: the increased intrathoracic pressure caused by CPAP can result in hypotension.

________ is a way of buffering bad news until a person can mobilize the resources to deal with that news more effectively. A. Denial B. Bargaining C. Anger D. Depression

Coping with Death and Dying, page 61 The answer is: Denial

A critical incident is MOST accurately defined as: A. a delayed stress reaction to an incident that is similar to what has been experienced in the past. B. an incident that overwhelms the ability of an EMS worker or system to cope with the experience, either at the scene or later. C. any incident that completely overwhelms a paramedic's ability to manage the short-term stress caused by the incident. D. a situation that completely incapacitates a person's ability to cope with the acute stress reaction at the scene.

Coping with Death and Dying, page 63 The answer is: an incident that overwhelms the ability of an EMS worker or system to cope with the experience, either at the scene or later.

Protocols, or standing orders, specify the paramedic's performance parameters, which: A. outline the care that is provided after contacting online medical control. B. allow the paramedic to function autonomously on every EMS call. C. define what the paramedic can or cannot do without direct medical control. D. limit the skills that the paramedic can perform in his or her EMS system.

Cornerstones of Effective Paramedic Practice, page 605 The answer is: define what the paramedic can or cannot do without direct medical control.

Scope of practice is defined as: A. protocols agreed upon by a consensus of emergency physicians. B. care that a paramedic is permitted to perform under the certifying state. C. the level of care that an EMS employer allows the paramedic to provide. D. national patient care guidelines established by the federal government.

Legal Accountability of the Paramedic, page 104 The answer is: care that a paramedic is permitted to perform under the certifying state.

Scope of practice is defined as: A. the level of care that an EMS employer allows the paramedic to provide. B. protocols agreed upon by a consensus of emergency physicians. C. national patient care guidelines established by the federal government. D. care that a paramedic is permitted to perform under the certifying state.

Legal Accountability of the Paramedic, page 104 The answer is: care that a paramedic is permitted to perform under the certifying state.

A reasonable paramedic should follow the same ______________ that another paramedic in a similar situation would. A. scope of practice B. standard of care C. medical practice act D. wishes of the family

Legal Accountability of the Paramedic, page 104 The answer is: standard of care

While en route to the scene of a patient in cardiac arrest, the driver of the vehicle in front of you does not hear your siren or see your lights. You should: A. remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so. B. quickly merge to the right, pass the vehicle, and then obtain the vehicle's license plate number. C. turn your siren off and ask the driver of the vehicle to pull over using the public address radio. D. get as close to the rear of the vehicle as possible, change the tone of your siren, and flash your headlights.

Legal Accountability of the Paramedic, page 107 The answer is: remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so.

While caring for an 80-year-old man with a possible fractured arm, you discover other injury patterns that are suggestive of abuse. The patient is conscious and alert. You should: A. advise the patient that you suspect he has been abused and that you are required by law to report this to the authorities. B. splint the patient's arm and contact his family to determine if they are aware of the fact that he has been physically abused. C. treat the patient's injury appropriately and then obtain his consent to report your suspicions to the emergency department physician. D. splint the patient's arm, transport him to the hospital, and report your suspicions to the emergency department physician.

Legal Accountability of the Paramedic, page 108 The answer is: splint the patient's arm, transport him to the hospital, and report your suspicions to the emergency department physician.

Which aspect of the HIPAA is MOST pertinent to the paramedic? A. Recovering funds from insurance companies B. Disclosing patient information to the media C. Documenting a thorough patient assessment D. Ensuring that the patient's privacy is protected

Legal Accountability of the Paramedic, pages 104-105 The answer is: Ensuring that the patient's privacy is protected

Which of the following is addressed in the EMTALA? A. Allowing a woman who is in active labor to be transported to a distant hospital B. Discouraging private individuals from suing if a hospital has violated the law C. Requiring EMS to transport all patients to the closest medical treatment facility D. Preventing medical facilities from denying medical screening and stabilization

Legal Accountability of the Paramedic, pages 106-107 The answer is: Preventing medical facilities from denying medical screening and stabilization

If an emergency physician is present at the scene of a mass-casualty incident, he or she would be the LEAST likely to: A. make initial and secondary triage decisions. B. provide on-scene medical direction for paramedics. C. assume control over complex rescuer operations. D. decide which patients require immediate transport.

Medical Incident Command, page 2343 The answer is: assume control over complex rescuer operations.

Q waves are considered abnormal or pathologic if they are: A. greater than 0.02 seconds wide and consistently precede the R wave. B. present in a patient who is experiencing chest pressure or discomfort. C. not visible in leads I or II when the QRS gain sensitivity is increased. D. more than one-third the overall height of the QRS complex in lead II.

Electrophysiology, page 983 The answer is: more than one-third the overall height of the QRS complex in lead II.

The __________ represents the end of ventricular depolarization and the beginning of repolarization. A. T-P interval B. J point C. ST segment D. T wave

Electrophysiology, page 984 The answer is: J point

The 6-second method for calculating the rate of a cardiac rhythm: A. is an accurate method for calculating the heart rate if the cardiac rhythm is grossly irregular and very fast. B. involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10. C. takes longer than other methods of calculating the rate and is thus impractical to use with critical patients. D. will yield an estimated heart rate that is typically within 2 to 3 beats per minute of the actual heart rate.

Electrophysiology, page 986 The answer is: involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10.

If the R-R interval spans ___ large boxes or less, the heart rate is greater than 100/min. A. 3 B. 4 C. 5 D. 6

Electrophysiology, page 987 The answer is: 3

If the R-R interval spans ___ large boxes or less, the heart rate is greater than 100/min. A. 6 B. 4 C. 3 D. 5

Electrophysiology, page 987 The answer is: 3

In sinus bradycardia, the: A. QRS complexes are often wide. B. heart rate is less than 70 beats/min. C. pacemaker site is the SA node. D. P waves are consistently upright.

Electrophysiology, page 988 The answer is: pacemaker site is the SA node.

Treatment for a patient with bradycardia and significantly compromised cardiac output includes: A. 1 mg of epinephrine 1:10,000. B. 1 mg of atropine via IV push. C. transcutaneous cardiac pacing. D. a dopamine infusion at 20 mg/min.

Electrophysiology, page 989 The answer is: transcutaneous cardiac pacing.

Treatment for a patient with bradycardia and significantly compromised cardiac output includes: A. 1 mg of epinephrine 1:10,000. B. a dopamine infusion at 20 mg/min. C. transcutaneous cardiac pacing. D. 1 mg of atropine via IV push.

Electrophysiology, page 989 The answer is: transcutaneous cardiac pacing.

The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: A. an epinephrine infusion. B. transcutaneous pacing. C. a dopamine infusion. D. atropine sulfate.

Electrophysiology, page 989 The answer is: transcutaneous pacing.

Electrical capture during transcutaneous cardiac pacing is characterized by: A. a pacemaker spike followed by a wide QRS complex. B. low-amplitude QRS complexes preceded by a pacemaker spike. C. the presence of a strong pulse, despite a slow rate. D. narrow QRS complexes that are preceded by a pacemaker spike.

Electrophysiology, page 990 The answer is: a pacemaker spike followed by a wide QRS complex.

The treatment for sinus tachycardia should focus on: A. ing the underlying cause. B. decreasing the heart rate. C. administering IV fluid boluses. D. relieving pain and anxiety.

Electrophysiology, page 992 The answer is: ing the underlying cause.

An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n): A. junctional escape complex. B. atrial escape complex. C. premature atrial complex. D. wandering atrial pacemaker.

Electrophysiology, page 993 The answer is: premature atrial complex.

Patients with a heart rate greater than 150 beats/min usually become unstable because of: A. reduced ventricular filling. B. a significantly reduced afterload. C. an increase in the atrial kick. D. increased right atrial preload.

Electrophysiology, page 993 The answer is: reduced ventricular filling.

Patients with a heart rate greater than 150 beats/min usually become unstable because of: A. reduced ventricular filling. B. a significantly reduced afterload. C. increased right atrial preload. D. an increase in the atrial kick.

Electrophysiology, page 993 The answer is: reduced ventricular filling.

When preparing an IV administration set, you should NOT: A. cleanse the piercing spike before inserting it into the IV bag. B. run IV fluid through the administration set to flush air out. C. fill the drip chamber of the administration set with IV fluid. D. invert the bag if the drip chamber contains too much fluid.

IV Techniques and Administration, pages 696-697 The answer is: cleanse the piercing spike before inserting it into the IV bag.

Which of the following medications possesses positive inotropic effects, allows the cellular uptake of glucose, and is used in the treatment of hyperkalemia? A. Glucophage B. Insulin C. Clopidogrel D. Osmitrol

Important Medications in the Prehospital Setting, page 656 The answer is: Insulin

What is a "low normal" blood glucose level in a newborn? A. 35 mg/dL B. 40 mg/dL C. 45 mg/dL D. 30 mg/dL

Infants, page 478 The answer is: 45 mg/dL

An infant's fontanelles are typically fused together by the age of: A. 12 months. B. 24 months. C. 18 months. D. 36 months.

Infants, page 479 The answer is: 24 months.

An infant's fontanelles are typically fused together by the age of: A. 18 months. B. 12 months. C. 36 months. D. 24 months.

Infants, page 479 The answer is: 24 months.

Barotrauma caused by bag-mask ventilation in an infant means that your ventilations: A. caused gastric distention. B. were too slow for the infant's age. C. were too forceful. D. did not produce visible chest rise.

Infants, page 479 The answer is: were too forceful.

In contrast to the oculomotor nerve, the optic nerve: A. is the second cranial nerve and provides the sense of vision. B. carries parasympathetic nerve fibers that constrict the pupil. C. innervates the muscles that cause motion of the upper eyelids. D. is the third cranial nerve and regulates movement of the eyes.

The Eye, pages 1140-1141 The answer is: is the second cranial nerve and provides the sense of vision.

What is the function of a baroreceptor? A. Monitoring changes in arterial pressure B. Monitoring the pH of cerebrospinal fluid C. Sensing changes in arterial oxygen levels D. Sensing the arterial level of carbon dioxide

The Nervous System, page 317 The answer is: Monitoring changes in arterial pressure

What is the function of a baroreceptor? A. Monitoring the pH of cerebrospinal fluid B. Sensing changes in arterial oxygen levels C. Monitoring changes in arterial pressure D. Sensing the arterial level of carbon dioxide

The Nervous System, page 317 The answer is: Monitoring changes in arterial pressure

The olfactory nerve (CN I) is responsible for: A. sight. B. vision. C. smell. D. hearing.

The Nervous System, pages 309, 318 The answer is: smell.

All of the following are functions of the parasympathetic nervous system, EXCEPT: A. constriction of the pupils. B. decreased gastrointestinal function. C. lowering of the blood pressure. D. mediating arousal in males and females.

The Nervous System, pages 315-317 The answer is: decreased gastrointestinal function.

All of the following are functions of the parasympathetic nervous system, EXCEPT: A. decreased gastrointestinal function. B. lowering of the blood pressure. C. mediating arousal in males and females. D. constriction of the pupils.

The Nervous System, pages 315-317 The answer is: decreased gastrointestinal function.

Which of the following is the MOST immediate and significant complication associated with posterior epistaxis? A. Nasal inflammation B. Severe sinus infection C. Nausea and vomiting D. Hemorrhagic shock

The Nose, pages 1154-1155 The answer is: Nausea and vomiting

The action of the body in response to a medication is called: A. pharmacology. B. pharmacokinetics. C. biotransformation. D. pharmacodynamics.

The Physiology of Pharmacology, page 628 The answer is: pharmacokinetics.

The term affinity, as it applies to pharmacology, is MOST accurately defined as the: A. ability of a medication to bind to a receptor. B. process of a medication binding to a receptor. C. blocking of a receptor site by a particular medication. D. strength of the bond between a medication and its receptor.

The Physiology of Pharmacology, page 630 The answer is: ability of a medication to bind to a receptor.

In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A. alpha-2 agonist. B. beta-2 agonist. C. alpha-1 agonist. D. beta-1 agonist.

The Physiology of Pharmacology, page 630 The answer is: beta-2 agonist.

In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A. beta-1 agonist. B. alpha-1 agonist. C. beta-2 agonist. D. alpha-2 agonist.

The Physiology of Pharmacology, page 630 The answer is: beta-2 agonist.

When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) _____________ effect. A. dromotropic B. chronotropic C. alpha agonistic D. inotropic

The Physiology of Pharmacology, page 630 The answer is: dromotropic

What term is used to describe a situation in which a patient experiences clinical effects from a medication that are opposite from the intended effects? A. Paradoxical reaction B. Side effect C. Idiosyncrasy D. Subtherapeutic effect

The Physiology of Pharmacology, page 632 The answer is: Paradoxical reaction

An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n): A. placebo effect. B. idiosyncrasy. C. side effect. D. adverse effect.

The Physiology of Pharmacology, page 637 The answer is: adverse effect.

An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n): A. side effect. B. idiosyncrasy. C. adverse effect. D. placebo effect.

The Physiology of Pharmacology, page 637 The answer is: adverse effect.

A medication that has a narrow therapeutic index: A. can be given, but not without close patient monitoring. B. should not be given because its effects are too harmful. C. is safe to give because the chance of toxicity is remote. D. should not be given to patients over 50 years of age.

The Physiology of Pharmacology, page 638 The answer is: can be given, but not without close patient monitoring.

The therapeutic index of a medication is defined as the: A. difference between the median effective dose and the median toxic dose. B. duration of therapeutic action for a given medication on the body. C. period of time in which the medication is excreted from the body. D. plasma level at which the medication begins to exert its effect.

The Physiology of Pharmacology, page 638 The answer is: difference between the median effective dose and the median toxic dose.

A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of: A. potentiation. B. summation. C. antagonism. D. synergism.

The Physiology of Pharmacology, page 639 The answer is: synergism.

When the paramedic administers a medication via the IV route: A. first-pass metabolism significantly alters the medication's effects, thereby requiring frequent dosing. B. it is important for him or her to remember that the medication's onset of action is relatively slow. C. he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. D. bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation.

The Physiology of Pharmacology, page 642 The answer is: he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

When the paramedic administers a medication via the IV route: A. he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. B. first-pass metabolism significantly alters the medication's effects, thereby requiring frequent dosing. C. it is important for him or her to remember that the medication's onset of action is relatively slow. D. bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation.

The Physiology of Pharmacology, page 642 The answer is: he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

Which of the following statements regarding the IM route of medication administration is ? A. Any medication given by the IV route can be given by the IM route. B. IM-administered medications are subject to first-pass metabolism in the liver. C. Muscle perfusion has minimal effect on the absorption of IM-administered drugs. D. Medications have a bioavailability of 75% to 100% following IM administration.

The Physiology of Pharmacology, page 643 The answer is: Medications have a bioavailability of 75% to 100% following IM administration.

In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? A. Acute renal failure B. Anaphylactic shock C. Seizure D. Respiratory failure

The Physiology of Pharmacology, page 644 The answer is: Seizure

In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? A. Anaphylactic shock B. Acute renal failure C. Seizure D. Respiratory failure

The Physiology of Pharmacology, page 644 The answer is: Seizure

Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption? A. Bone marrow B. Urinary tract C. Liver D. Vascular system

The Physiology of Pharmacology, page 645 The answer is: Urinary tract

Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption? A. Liver B. Urinary tract C. Bone marrow D. Vascular system

The Physiology of Pharmacology, page 645 The answer is: Urinary tract

Most medication biotransformation occurs in the: A. liver. B. lungs. C. GI tract. D. kidneys.

The Physiology of Pharmacology, page 646 The answer is: liver.

Patients with _________________ are at significant risk for toxic effects of medications or metabolic waste products in the body. A. heart failure B. renal failure C. diabetes mellitus D. stomach cancer

The Physiology of Pharmacology, page 647 The answer is: renal failure

Patients with _________________ are at significant risk for toxic effects of medications or metabolic waste products in the body. A. stomach cancer B. diabetes mellitus C. renal failure D. heart failure

The Physiology of Pharmacology, page 647 The answer is: renal failure

Which of the following factors would be the LEAST likely to affect a patient's response to a medication? A. Past medical history B. Body temperature C. Pregnancy D. Age and weight

The Physiology of Pharmacology, pages 632-633 The answer is: Past medical history

Which of the following statements regarding the sublingual administration of nitroglycerin is ? A. Sublingual nitroglycerin has a delayed onset of action, but nearly a 100% bioavailability. B. Sublingual nitroglycerin administration involves placing a tablet in between the patient's cheek and gum. C. Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability. D. Large doses of IV nitroglycerin are required to achieve the same effect as a single sublingual nitroglycerin dose.

The Physiology of Pharmacology, pages 643-644 The answer is: Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability.

Which of the following conditions or situations is the BEST example of a critical life threat that needs immediate care? A. An early onset of renal insufficiency B. A patient with multiple disease etiologies C. Partial-thickness burns on an extremity D. Acute presentation of a chronic condition

The Range of Patient Conditions, page 607 The answer is: Acute presentation of a chronic condition

The epiglottis can be BEST described as: A. a valve that covers the trachea during swallowing. B. cartilage that is inferior to the glottis and keeps the esophagus open. C. cartilage that closes the esophagus during breathing. D. a ligament that attaches the vocal cords to the glottic opening.

The Respiratory System, page 359 The answer is: a valve that covers the trachea during swallowing.

The most important nerve of the cervical plexus, which innervates the diaphragm, is the: A. vagus nerve. B. phrenic nerve. C. trochlear nerve. D. abducens nerve.

The Respiratory System, page 365 The answer is: phrenic nerve.

The process of moving air into and out of the lungs is called: A. tidal volume. B. oxygenation. C. respiration. D. ventilation.

The Respiratory System, page 365 The answer is: ventilation.

Approximately 97% of the oxygen that diffuses out of the alveoli: A. is dissolved in plasma. B. binds to bicarbonate. C. binds to hemoglobin. D. is exhaled from the body.

The Respiratory System, page 369 The answer is: binds to hemoglobin.

Oxygen and carbon dioxide pass across the alveolar capillary membrane through a process called: A. perfusion. B. diffusion. C. osmosis. D. metabolism.

The Respiratory System, page 369 The answer is: diffusion.

The hypoxic drive, a backup system to control breathing, is stimulated when: A. arterial PaO2 levels increase. B. arterial PaCO2 levels decrease. C. arterial PaCO2 levels increase. D. arterial PaO2 levels decrease.

The Respiratory System, page 372 The answer is: arterial PaO2 levels decrease.

The hypoxic drive, a backup system to control breathing, is stimulated when: A. arterial PaO2 levels increase. B. arterial PaO2 levels decrease. C. arterial PaCO2 levels increase. D. arterial PaCO2 levels decrease.

The Respiratory System, page 372 The answer is: arterial PaO2 levels decrease.

During an acidotic state, the kidneys attempt to maintain a normal pH by: A. secreting hydrogen ions. B. excreting bicarbonate. C. retaining bicarbonate. D. retaining hydrogen ions.

The Respiratory System, page 373 The answer is: retaining bicarbonate.

Normal inhalation is the result of: A. diaphragmatic relaxation. B. negative pressure in the thoracic cavity. C. air passively entering the lungs. D. positive pressure in the thoracic cavity.

The Respiratory System, pages 365-366 The answer is: negative pressure in the thoracic cavity.

Which of the following structures comprise the axial skeleton? A. Pelvic girdle, vertebral column, skull B. Skull, shoulders, upper extremities, ribs C. Skull, face, thoracic cage, vertebral column D. Ribs, shoulders, lower extremities, skull

The Skeletal System, page 266 The answer is: Skull, face, thoracic cage, vertebral column

A 2-year-old child has experienced a proximal humeral fracture involving the growth plate. This plate is also called the: A. diaphyseal plate. B. metaphyseal plate. C. endosteum plate. D. epiphyseal plate.

The Skeletal System, page 268 The answer is: epiphyseal plate.

The brain and spinal cord are connected through a large opening at the base of the skull called the: A. lamboid suture. B. mastoid process. C. vertebral foramen. D. foramen magnum.

The Skeletal System, page 274 The answer is: foramen magnum.

A fracture of the orbital bone is commonly referred to as a: A. LeFort fracture. B. midface fracture. C. basilar fracture. D. blowout fracture.

The Skeletal System, page 276 The answer is: blowout fracture.

Which of the following statements regarding the thyroid cartilage is ? A. It lies directly posterior to the larynx. B. It is not easily seen in most people. C. It is the anterior part of the larynx. D. It is inferior to the cricoid cartilage.

The Skeletal System, page 277 The answer is: It is the anterior part of the larynx.

The first and second cervical vertebrae are called the: A. atlas and axis. B. axis and dens. C. dens and atlas. D. odontoid and axis.

The Skeletal System, page 278 The answer is: atlas and axis.

The upper section of the sternum is called the: A. angle of Louis. B. jugular notch. C. manubrium. D. xiphoid process.

The Skeletal System, page 280 The answer is: manubrium.

The ilium is defined as the: A. bony prominences of the pelvis. B. lower portion of the small intestine. C. ligament that overlies the femoral vessels. D. structure that overlies the bladder.

The Skeletal System, page 283 The answer is: bony prominences of the pelvis.

The shoulders and hips are examples of __________ joints. A. amphiarthrotic B. biaxial C. diarthrotic D. synarthrotic

The Skeletal System, pages 270-271 The answer is: diarthrotic

All of the following are facial bones, EXCEPT the: A. maxilla. B. palatine. C. lacrimal. D. parietal.

The Skeletal System, pages 275-276 The answer is: parietal.

A young female presents with a headache, severe aching around her right ear, and difficulty chewing. Assessment and treatment for her should focus on: A. avoiding the use of a nasopharyngeal airway. B. placing her in a semi-Fowler position. C. anticipating airway compromise. D. analgesia as needed and transport.

The Throat, page 1162 The answer is: analgesia as needed and transport.

When attempting to resuscitate a patient in cardiac arrest, which of the following questions would you pose if you suspect that the patient is hyperkalemic? A. "Does this patient undergo dialysis?" B. "Does this patient take blood thinners?" C. "Is this patient a known diabetic?" D. "Has this patient had vomiting or diarrhea?"

The answer is: "Does this patient undergo dialysis?"

Anterior-posterior placement of the defibrillation pads should be used if the patient is younger than ___ year(s) of age or less than ___ kg. A. 4, 20 B. 5, 30 C. 3, 15 D. 1, 10

The answer is: 1, 10

You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned? A. 27% B. 18% C. 36% D. 45%

The answer is: 36%

A newborn born between ___ and ___ weeks of gestation is described as term. A. 36, 38 B. 40, 42 C. 38, 42 D. 42, 44

The answer is: 38, 42

Which of the following blood pressures is MOST consistent with a pericardial tamponade? A. 100/60 mm Hg B. 90/70 mm Hg C. 80/50 mm Hg D. 110/80 mm Hg

The answer is: 90/70 mm Hg

Hypothermia is defined as a decrease in core body temperature, generally starting at: A. 94°F. B. 96°F. C. 95°F. D. 93°F.

The answer is: 95°F.

Which of the following roles would the code team leader MOST likely perform? A. Establishing IV access B. Interpreting the ECG C. Chest compressions D. Managing the airway

The answer is: Interpreting the ECG

What level of personal protective equipment is typically worn by the hazardous materials decontamination team in the warm zone? A. Level B B. Level A C. Level D D. Level C

The answer is: Level B

Which of the following statements regarding gas exchange in the lungs is ? A. Carbon dioxide molecules move from the alveoli into the blood by diffusion. B. There are more oxygen molecules in the blood than in the alveoli. C. There are more carbon dioxide molecules in the blood than in inhaled air. D. Oxygen molecules move from the alveoli into the blood by diffusion.

The answer is: Oxygen molecules move from the alveoli into the blood by diffusion.

How can you BEST assist law enforcement at the scene of a crime involving a gunshot wound or stabbing? A. Place any of the patient's clothing you removed in a paper bag. B. Collect blood on a 4-inch by 4-inch dressing and give it to the police. C. Begin patient care after all evidence has been collected. D. Examine an expended gun casing to identify the caliber.

The answer is: Place any of the patient's clothing you removed in a paper bag.

According to the military, which of the following practices can reduce the level of contamination of a person by as much as 80%? A. Using large pads to absorb the chemical B. Flushing with copious amounts of water C. Removing the patient's clothing D. Using an agent to neutralize the chemical

The answer is: Removing the patient's clothing

Which of the following statements regarding shivering is ? A. Shivering increases the basal metabolic rate by up to five times. B. The body initially responds to cold with involuntary shivering. C. Shivering is the body's mechanism for retaining heat. D. Only patients with severe hypothermia present with shivering.

The answer is: Shivering increases the basal metabolic rate by up to five times.

Which of the following statements regarding clandestine drug labs is ? A. Some drug producers use fragmentation and incendiary devices and animal traps to protect their operations. B. Cocaine and heroin are the two most popular substances manufactured in clandestine drug labs. C. Common chemicals found in a clandestine drug lab include distilled water, ibuprofen, and diphenhydramine. D. If you unknowingly enter a clandestine drug lab, your priority is to quickly remove any patients.

The answer is: Some drug producers use fragmentation and incendiary devices and animal traps to protect their operations.

You are transporting a chronic heroin abuser to whom you have just administered naloxone. The patient is responsive to verbal stimuli, and his respirations, blood pressure, and pulse rate have improved following your treatment. With an estimated time of arrival at the hospital of 20 minutes, which of the following should concern you the MOST? A. The patient may deteriorate and require further naloxone administration. B. The patient will require immediate intubation if his respirations decrease. C. Low doses of naloxone often precipitate seizures in chronic heroin abusers. D. There is a high potential that the patient will suddenly become violent.

The answer is: The patient may deteriorate and require further naloxone administration.

Which of the following is the MOST accurate definition of distributive shock? A. Sustained constriction of the small venules and small arterioles B. Decreased perfusion due to sympathetic nervous system failure C. Widespread dilation of the resistance and capacitance vessels D. Shunting of blood from the periphery to the body's vital organs

The answer is: Widespread dilation of the resistance and capacitance vessels

A 39-year-old man presents with severe abdominal cramping accompanied by nausea, vomiting, and bloody diarrhea. During your assessment, the patient tells you that in an attempt to kill himself, he intentionally ingested some castor beans because he heard they were poisonous. The patient's blood pressure is 96/58 mm Hg, heart rate is 112 beats/min, and respirations are 24 breaths/min. Which of the following statements regarding this scenario is ? A. This patient has exposed himself to botulinum toxin and will soon experience diaphragmatic paralysis. B. Your patient has ingested the key ingredient for ricin and is at high risk for vascular collapse and death. C. Castor beans commonly cause the symptoms your patient is experiencing but rarely result in death. D. You should quickly don a mask and gown because this patient's condition is highly communicable.

The answer is: Your patient has ingested the key ingredient for ricin and is at high risk for vascular collapse and death.

According to the START triage system, a nonbreathing patient should be triaged as immediate if: A. he or she does not respond to two rescue breaths. B. he or she is in need of immediate intubation. C. a manual airway maneuver restores breathing. D. the airway is completely blocked by swelling.

The answer is: a manual airway maneuver restores breathing.

During a disaster, all patients who are transported to the hospital should have: A. been triaged at least three times to trend their condition. B. at least one paramedic caring for them in the ambulance. C. an IV line established in case fluids are needed. D. a patient care report written, in addition to a triage tag.

The answer is: a patient care report written, in addition to a triage tag.

In contrast to delirium, dementia is: A. an acute state of confusion that may last for up to 1 week. B. often caused by conditions such as poisonings and infection. C. often reversible if the underlying cause is identified rapidly. D. a progressive disease that produces irreversible brain failure.

The answer is: a progressive disease that produces irreversible brain failure.

When assessing a patient with abdominal trauma for distention, you must recall that: A. abdominal distention is usually caused by muscle tensing rather than intraabdominal bleeding. B. a significant amount of blood volume in the abdominal cavity is required to produce distention. C. because distention is a late sign of intraabdominal bleeding, it should not be assessed for in the field. D. a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma.

The answer is: a significant amount of blood volume in the abdominal cavity is required to produce distention.

During the third collision in a motor vehicle crash: A. hollow abdominal organs rupture upon impact. B. the person's abdomen collides with the steering wheel. C. abdominal organs shear from their points of attachment. D. rapid deceleration propels an unrestrained person forward.

The answer is: abdominal organs shear from their points of attachment.

Signs of compensated shock in the infant or child include all of the following, EXCEPT: A. prolonged capillary refill. B. abnormal mentation. C. decreased peripheral perfusion. D. tachycardia and pallor.

The answer is: abnormal mentation.

A 30-year-old woman presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. This patient is MOST likely experiencing: A. a ruptured uterus. B. abruptio placenta. C. placenta previa. D. a threatened abortion.

The answer is: abruptio placenta.

A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 beats/min, narrow QRS complexes, and a PR interval of 0.16 seconds should be interpreted as a(n): A. accelerated junctional rhythm. B. supraventricular tachycardia. C. junctional escape rhythm. D. ectopic atrial rhythm.

The answer is: accelerated junctional rhythm.

You have successfully controlled a large arterial hemorrhage from a 42-year-old man's leg with direct pressure and a pressure dressing. He is conscious, but restless. His blood pressure is 84/58 mm Hg, pulse is 120 beats/min, and respirations are 24 breaths/min. You should: A. administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route. B. administer high-flow oxygen, start two large-bore IV lines at the scene and give a 2- to 3-L fluid bolus, and transport. C. keep him warm, administer high-flow oxygen, establish one large-bore IV line at the scene, and transport. D. Keep him warm, assist his ventilations, place a hemostatic agent in the wound, transport, and start a large-bore IV en route.

The answer is: administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route.

A 21-year-old woman was thrown from a horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and has her head turned to the side. As you attempt to move her head to a neutral in-line position, she screams in pain. You should: A. gently continue to move her head until it is in a neutral in-line position. B. perform a quick neurologic exam prior to attempting further movement of her head. C. maintain her head in the position found and continue with your assessment. D. administer an analgesic to relieve the pain so you can move her head to a neutral position.

The answer is: maintain her head in the position found and continue with your assessment.

The destructive capability of a dirty bomb is: A. directly related to the radioactive material within it. B. not affected by the presence of radioactive material. C. sufficient to injure thousands of people. D. limited to the explosives that are attached to it.

The answer is: limited to the explosives that are attached to it.

Seizures during pregnancy should be treated with: A. phenobarbital. B. diazepam. C. valproic acid. D. magnesium sulfate.

The answer is: magnesium sulfate.

Medical monitoring and rehabilitation of rescuers at the scene of a hazardous materials incident should routinely include all of the following, EXCEPT: A. prophylactic IV boluses of an isotonic crystalloid. B. documentation of the hazardous material involved. C. assessment of the person's hydration status. D. a complete set of vital signs and ECG monitoring.

Medical Monitoring and Rehabilitation, pages 2422-2423 The answer is: prophylactic IV boluses of an isotonic crystalloid.

When treating a dialysis patient, it is especially important to: A. keep the patient in a supine position. B. carefully titrate any IV fluids given. C. elevate the arm with the AV fistula. D. treat acidosis with sodium bicarbonate.

Medical Technology in the Prehospital Setting, page 2273 The answer is: carefully titrate any IV fluids given.

Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A. 10 mL B. 0.5 mL C. 0.25 mL D. 5 mL

Medication Administration, pages 725-726 The answer is: 5 mL

A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer? A. 0.01 mg B. 0.15 mg C. 0.2 mg D. 0.1 mg

Medication Administration, pages 726-727 The answer is: 0.1 mg

The generic name of a medication: A. does not require FDA approval. B. is proposed by the manufacturer. C. is proprietary and cannot be reproduced. D. contains a string of letters and numbers.

Medication Management for Paramedics, page 625 The answer is: is proposed by the manufacturer.

Unlike Schedule I drugs, Schedule II drugs have: A. accepted medical uses. B. a higher abuse potential. C. limited dependence potential. D. no accepted medical application.

Medication and Drug Regulation, page 623 The answer is: accepted medical uses.

Which of the following is the MOST easily able problem in a child with an altered mental status? A. Ingestion of aspirin 2 hours ago B. Blood glucose reading of 40 mg/dL C. High fever with a widespread rash D. Dehydration associated with hypokalemia

Pathophysiology, Assessment, and Management of Neurologic Emergencies, page 2167 The answer is: Blood glucose reading of 40 mg/dL

A 50-year-old man presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation? A. Antidepressant use B. Nitroglycerin use C. Head trauma D. Renal failure

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1229 The answer is: Antidepressant use

A 50-year-old man presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation? A. Antidepressant use B. Nitroglycerin use C. Renal failure D. Head trauma

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1229 The answer is: Antidepressant use

Pelvic inflammatory disease MOST commonly affects: A. sexually active women. B. women over 30 years of age. C. postmenopausal women. D. the external genitalia.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1242 The answer is: sexually active women.

A young female with experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should: A. administer an analgesic. B. perform a quick internal exam to locate the bleeding. C. transport immediately. D. place a trauma dressing into her vagina.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1242 The answer is: transport immediately.

Pelvic inflammatory disease commonly affects all of the following organs, EXCEPT the: A. fallopian tubes. B. uterus. C. urinary bladder. D. ovaries.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1242 The answer is: urinary bladder.

Risk factors for pelvic inflammatory disease include all of the following, EXCEPT: A. an intrauterine device. B. heterosexual sex with multiple partners. C. 20- to 24-year-old age group. D. monogamy.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1243 The answer is: monogamy.

An increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs: A. when the relative humidity is low. B. when people travel during a holiday. C. during an influenza outbreak. D. during sudden weather changes.

Patient Assessment, page 922 The answer is: during sudden weather changes.

Digital clubbing is MOST indicative of: A. acute hypoxemia. B. peripheral vascular disease. C. right heart failure. D. chronic hypoxia.

Patient Assessment, page 925 The answer is: chronic hypoxia.

Digital clubbing is MOST indicative of: A. right heart failure. B. chronic hypoxia. C. acute hypoxemia. D. peripheral vascular disease.

Patient Assessment, page 925 The answer is: chronic hypoxia.

A pulse oximetry reading would be LEAST accurate in a patient: A. with poor peripheral perfusion. B. whose extremities are cool. C. with chronic hypoxia. D. with persistent tachycardia.

Patient Assessment, page 926 The answer is: with poor peripheral perfusion.

With regard to pulse oximetry, the more hypoxic a patient becomes: A. the faster he or she will desaturate. B. the slower his or her PaO2 will fall. C. the slower he or she will desaturate. D. the less reliable the pulse oximeter is.

Patient Assessment, page 927 The answer is: the faster he or she will desaturate.

Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT: A. palpitations. B. fatigue. C. headache. D. chest pain.

Patient Assessment, page 964 The answer is: headache.

Paroxysmal nocturnal dyspnea is defined as: A. sitting upright in a chair in order to facilitate effective breathing. B. acute shortness of breath that suddenly awakens a person from sleep. C. dyspnea that is brought on by excessive movement during sleep. D. the inability to function at night due to severe difficulty breathing.

Patient Assessment, page 965 The answer is: acute shortness of breath that suddenly awakens a person from sleep.

Full-thickness circumferential burns to the chest: A. necessitate immediate intubation and ventilatory support. B. may cause significant restriction of respiratory excursion. C. require the paramedic to incise the burn to decompress it. D. are generally not significant unless the skin is unyielding.

Patient Assessment, pages 1650-1651 The answer is: may cause significant restriction of respiratory excursion.

You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: A. carefully straighten his legs and assess distal pulses. B. remove his helmet and apply a cervical collar. C. manually stabilize his head and assess his airway. D. immediately stabilize both lower extremities.

Patient Assessment, pages 1852-1853 The answer is: manually stabilize his head and assess his airway.

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in: A. large changes in oxygen saturation when large changes in PaO2 occur. B. large changes in oxygen saturation when small changes in PaO2 occur. C. small changes in oxygen saturation when large changes in PaO2 occur. D. small changes in oxygen saturation when small changes in PaO2 occur.

Patient Assessment, pages 926-927 The answer is: large changes in oxygen saturation when small changes in PaO2 occur.

When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in: A. small changes in oxygen saturation when large changes in PaO2 occur. B. small changes in oxygen saturation when small changes in PaO2 occur. C. large changes in oxygen saturation when large changes in PaO2 occur. D. large changes in oxygen saturation when small changes in PaO2 occur.

Patient Assessment, pages 926-927 The answer is: large changes in oxygen saturation when small changes in PaO2 occur.

A patient with orthopnea: A. has dyspnea while lying flat. B. is breathing through pursed lips. C. has blood-tinged sputum. D. awakens at night with dyspnea.

Patient Assessment: Airway Evaluation, page 783 The answer is: has dyspnea while lying flat.

The condition in which the body's tissues and cells do not receive enough oxygen is called: A. anoxia. B. hypoxemia. C. asphyxia. D. hypoxia

Patient Assessment: Airway Evaluation, page 783 The answer is: hypoxia

Asymmetric chest wall movement is characterized by: A. a part of the chest wall that bulges during exhalation. B. chest rise that is minimally visible. C. one side of the chest moving less than the other. D. alternating movement of the chest and abdomen.

Patient Assessment: Airway Evaluation, page 784 The answer is: one side of the chest moving less than the other.

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia? A. Agonal respirations B. Biot respirations C. Kussmaul respirations D. Cheyne-Stokes respirations

Patient Assessment: Airway Evaluation, page 785 The answer is: Kussmaul respirations

Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia? A. Biot respirations B. Cheyne-Stokes respirations C. Kussmaul respirations D. Agonal respirations

Patient Assessment: Airway Evaluation, page 785 The answer is: Kussmaul respirations

A patient with a suppressed cough mechanism: A. often requires ventilation support. B. is at serious risk for aspiration. C. should be intubated at once. D. should have continuous airway suctioning.

Patient Assessment: Airway Evaluation, page 785 The answer is: is at serious risk for aspiration.

After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should: A. begin positive pressure ventilations. B. apply a nonrebreathing mask. C. suction his mouth for 15 seconds. D. intubate him at once.

Patient Assessment: Airway Evaluation, pages 783-784 The answer is: begin positive pressure ventilations.

Patient autonomy is MOST accurately defined as the: A. patient's right to direct his or her own care and to decide how end-of-life care should be provided. B. inability of the patient to refuse medical treatment once he or she has given appropriate consent.8 C. court's support and upholding of the rights of a patient with regard to health care decisions. D. right of the patient to determine which medications the paramedic should administer for a given situation.

Patient Autonomy, page 116 The answer is: patient's right to direct his or her own care and to decide how end-of-life care should be provided.

In contrast to adults, children: A. experience head injury less frequently. B. have proportionately larger heads. C. lose most body heat through the chest. D. land on their feet when they fall.

Pediatric Anatomy, Physiology, and Pathophysiology, page 2121 The answer is: have proportionately larger heads.

A conscious child who is in the sniffing position: A. is trying to align the axes of the airway to improve ventilation. B. will refuse to lie down and leans forward on outstretched arms. C. is clearly experiencing an obstruction of the lower airway. D. assumes a physical position that optimizes accessory muscle use.

Pediatric Patient Assessment, page 2128 The answer is: is trying to align the axes of the airway to improve ventilation.

In contrast to adults, retractions in children are: A. more evident in the intercostal area. B. usually less prominent above the clavicles. C. less commonly seen below the sternum. D. evident in the sternocleidomastoid muscles.

Pediatric Patient Assessment, page 2128 The answer is: more evident in the intercostal area.

While assessing the airway of a 3-year-old girl who is unresponsive, you hear a snoring sound during each of her slow, shallow breaths. You should: A. insert an oropharyngeal airway and apply high-flow oxygen. B. provide free-flow oxygen as you nasotracheally intubate her. C. manually maneuver her head and reassess her breathing status. D. begin bag-mask ventilations to improve her low tidal volume.

Pediatric Patient Assessment, pages 2127-2128 The answer is: manually maneuver her head and reassess her breathing status.

A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. Upon noting this, it is MOST important to: A. contact online medical control. B. prepare for immediate transport. C. start an IV line of normal saline. D. position the patient on her side.

Primary Survey, page 516 The answer is: prepare for immediate transport.

A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. Upon noting this, it is MOST important to: A. position the patient on her side. B. prepare for immediate transport. C. start an IV line of normal saline. D. contact online medical control.

Primary Survey, page 516 The answer is: prepare for immediate transport.

After performing your primary assessment of a patient, your next action should be to: A. decide what care is needed at the scene versus en route to the hospital. B. transport the patient to the closest medical treatment facility. C. perform a secondary assessment to narrow your differential diagnosis. D. move the patient to the ambulance as expeditiously as possible.

Primary Survey, pages 515-516 The answer is: decide what care is needed at the scene versus en route to the hospital.

A patient in shock due to internal bleeding will benefit MOST from: A. two large-bore IV lines of normal saline. B. oxygen and thermal management. C. a comprehensive physical examination. D. limited scene time and rapid transport.

Primary Survey, pages 515-516 The answer is: limited scene time and rapid transport.

Being empathetic toward a patient means that you: A. know exactly how the patient feels. B. feel a sense of sorrow for the patient. C. reassure the patient of your competence. D. acknowledge the patient's feelings.

Professionalism, page 17 The answer is: acknowledge the patient's feelings.

While caring for an elderly man with abdominal pain, you are very open with the patient and answer his questions honestly. These actions will MOST likely show the patient that you: A. are competent. B. have integrity. C. are empathetic. D. are self-motivated.

Professionalism, page 17 The answer is: have integrity.

While caring for an elderly man with abdominal pain, you are very open with the patient and answer his questions honestly. These actions will MOST likely show the patient that you: A. have integrity. B. are self-motivated. C. are empathetic. D. are competent.

Professionalism, page 17 The answer is: have integrity.

When examining the anterior abdomen of a patient who complains of abdominal pain: A. routinely palpate the least painful area(s) first. B. you should first percuss over the four quadrants. C. auscultate bowel sounds for at least 5 minutes. D. it is often necessary to administer analgesia first.

Secondary Assessment, page 570 The answer is: routinely palpate the least painful area(s) first.

Most EMS agencies require a double signature system any time a: A. controlled substance is checked, used, discarded, or replaced. B. medication that alters a patient's physiology is given. C. patient's condition warrants diversion to a closer hospital. D. patient is given more than one dose of any medication.

Situations Requiring Additional Documentation, page 179 The answer is: controlled substance is checked, used, discarded, or replaced.

Most EMS agencies require a double signature system any time a: A. patient's condition warrants diversion to a closer hospital. B. controlled substance is checked, used, discarded, or replaced. C. medication that alters a patient's physiology is given. D. patient is given more than one dose of any medication.

Situations Requiring Additional Documentation, page 179 The answer is: controlled substance is checked, used, discarded, or replaced.

If a patient has a stoma and no tracheostomy tube in place: A. you should not seal the nose and mouth when ventilating. B. ventilations can be performed by placing a mask over the stoma. C. you must perform a head tilt-chin lift maneuver before ventilating. D. suctioning of the stoma must be performed before ventilating.

Special Patient Considerations, page 824 The answer is: ventilations can be performed by placing a mask over the stoma.

A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves: A. suctioning her airway until it is clear of blood and other secretions, administering a sedative and paralytic, and performing endotracheal intubation. B. providing positive pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy. C. suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present. D. vigorously suctioning her oropharynx for no longer than 30 to 45 seconds and then inserting a multilumen airway device.

Special Patient Considerations, page 828 The answer is: suctioning her airway until it is clear of blood and other secretions, administering a sedative and paralytic, and performing endotracheal intubation.

Whether you are providing ventilations to a patient with a stoma using a resuscitation mask or bag-mask device, you must FIRST: A. adequately cleanse the stoma site with iodine. B. suction the stoma for no longer than 10 seconds. C. perform a head tilt-chin lift maneuver. D. place the patient's head in a neutral position.

Special Patient Considerations, pages 826-827 The answer is: place the patient's head in a neutral position.

A newborn with a pulse rate of 80 beats/min: A. is likely under the influence of maternal opiates. B. requires ventilations and chest compressions. C. requires immediate positive pressure ventilation. D. should be treated with 0.02 mg/kg of atropine.

Specific Interventions and Resuscitation Steps, page 2079 The answer is: requires immediate positive pressure ventilation.

The MOST common reasons for ineffective bag-mask ventilations in the newborn are: A. hyperflexion of the newborn's head and thick mucous plugs. B. inadequate mask-to-face seal and head position. C. pneumothorax and a face mask that is too large for the infant. D. equipment malfunction and a ventilation rate that is too rapid.

Specific Interventions and Resuscitation Steps, page 2080 The answer is: inadequate mask-to-face seal and head position.

Chest compressions are indicated in the newborn if its heart rate remains less than ____ beats/min despite effective positive pressure ventilations for ____ seconds. A. 60, 30 B. 60, 60 C. 80, 30 D. 80, 60

Specific Interventions and Resuscitation Steps, page 2083 The answer is: 60, 30

What hormone targets the adrenal cortex, resulting in cortisol secretion? A. Adrenocorticotropic hormone B. Norepinephrine C. Thyroid stimulating hormone D. Antidiuretic hormone

Stress and Disease, page 466 The answer is: Adrenocorticotropic hormone

What hormone targets the adrenal cortex, resulting in cortisol secretion? A. Thyroid stimulating hormone B. Norepinephrine C. Antidiuretic hormone D. Adrenocorticotropic hormone

Stress and Disease, page 466 The answer is: Adrenocorticotropic hormone

The resistance stage of the stress reaction is characterized by: A. stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure. B. a reduction of cortisol in the body, which predisposes the person to acute inflammatory processes. C. an immediate release of the catecholamines epinephrine and norepinephrine, which causes the fight-or-flight response. D. adrenal gland depletion, which leads to decreased blood glucose levels, physical exhaustion, and immunocompromise.

Stress and Disease, page 466 The answer is: stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure.

Severe, prolonged stress: A. is frequently a direct cause of death. B. results in chronically low levels of cortisol. C. causes the body to lose its ability to fight disease. D. results in the destruction of cholesterol and fat.

Stress and Disease, page 467 The answer is: causes the body to lose its ability to fight disease.

All of the following are common triggers of distress, EXCEPT: A. having children that leave home. B. excessive responsibility at work. C. planning a lengthy vacation. D. the loss of a loved one.

Stress, page 53 The answer is: planning a lengthy vacation.

During a crisis, the paramedic is able to focus and function, but afterwards, he or she may be left with nervous, excited energy that continues to build. This is indicative of: A. a cumulative stress reaction. B. burnout. C. an acute stress reaction. D. a delayed stress reaction.

Stress, page 55 The answer is: a delayed stress reaction.

A patient with different cultural beliefs will not maintain eye contact with you. He is very pleasant, but looks down at the ground when answering your questions. What does this indicate? A. He cannot express his feelings accurately. B. He is not forthcoming to your questions. C. He is showing respect for your authority. D. He fears your presence and is intimidated.

Stress, page 56 The answer is: He is showing respect for your authority.

The ECG of a patient clearly indicates that he is experiencing a heart attack. The paramedic advises the patient of this, but the patient states, "No, I don't care what your machine says; it's not my heart." This is an example of: A. projection. B. displacement. C. denial. D. regression.

Stress, page 56 The answer is: denial.

When caring for a confused elderly patient, it is MOST important for the paramedic to: A. explain what he or she is doing at all times. B. recognize that this is normal in elderly people. C. request the presence of a family member. D. avoid talking to the patient to minimize anxiety.

Stress, page 56 The answer is: explain what he or she is doing at all times.

People who overreact at the scene of an emergency, such as an incident with multiple casualties, will MOST likely: A. have a history of anxiety. B. be in a numbed, dazed state. C. experience bodily dysfunction. D. be compulsively talkative.

Stress, page 57 The answer is: be compulsively talkative.

Which of the following is NOT an early warning sign of stress? A. Dry, irritated skin B. Heart palpitations C. Difficult or rapid breathing D. Chest pain or tightness

Stress, page 58 The answer is: Dry, irritated skin

Progressive relaxation is a technique of anxiety relief that: A. utilizes sedative medications to facilitate anxiety relief. B. involves tightening and relaxing specific muscle groups. C. can easily be used even if you are on an emergency call. D. allows you to relax without being noticed by others.

Stress, page 58 The answer is: involves tightening and relaxing specific muscle groups.

Burnout is MOST accurately defined as: A. the exhaustion of physical or emotional strength. B. a person's emotional reaction to a stressful event. C. cynicism after being a paramedic for many years. D. an acute reaction to an overwhelming situation.

Stress, page 58 The answer is: the exhaustion of physical or emotional strength.

Placing a suction catheter past the base of the tongue: A. commonly causes bradycardia in adult patients. B. is effective in thoroughly clearing the airway. C. will result in aspiration of gastric contents. D. may cause the patient to gag or vomit.

Suctioning, page 799 The answer is: may cause the patient to gag or vomit.

Sudden infant death syndrome (SIDS) is a term used when the unexpected death of an infant under 1 year of age: A. occurs in the absence of any obvious trauma. B. when signs of physical abuse are not present. C. occurs between the months of January and March. D. cannot be explained after a complete autopsy.

Sudden Infant Death Syndrome, page 2186 The answer is: cannot be explained after a complete autopsy.

When administering oxygen via a nonrebreathing mask, you must ensure that the: A. flow rate is set to at least 6 L/min. B. reservoir is half-filled first. C. one-way valves are disabled. D. patient has adequate tidal volume.

Supplemental Oxygen-Delivery Devices, page 808 The answer is: patient has adequate tidal volume.

Dysfunction of the mitral valve may cause backflow of blood into the: A. left atrium. B. right atrium. C. left ventricle. D. right ventricle.

The Circulatory System, page 339 The answer is: left atrium.

Freshly oxygenated blood is returned to the left atrium through the: A. superior vena cava. B. pulmonary veins. C. pulmonary arteries. D. inferior vena cava.

The Circulatory System, page 340 The answer is: pulmonary veins.

Blood enters the right atrium of the heart from the: A. aorta and coronary sinus. B. vena cava and aorta. C. pulmonary vein and aorta. D. vena cavae and coronary sinus.

The Circulatory System, page 340 The answer is: vena cavae and coronary sinus.

Cardiac output is equal to: A. stroke volume multiplied by heart rate. B. systole minus diastole. C. heart rate minus systolic blood pressure. D. blood pressure multiplied by heart rate.

The Circulatory System, page 341 The answer is: stroke volume multiplied by heart rate.

Cardiac output is equal to: A. systole minus diastole. B. stroke volume multiplied by heart rate. C. heart rate minus systolic blood pressure. D. blood pressure multiplied by heart rate.

The Circulatory System, page 341 The answer is: stroke volume multiplied by heart rate.

Increased myocardial contractility secondary to stretching of the myocardial walls is called the: A. Frank-Beck mechanism. B. Frank-Starling mechanism. C. Beck-Cushing's reflex. D. Ernest-Henry effect.

The Circulatory System, page 342 The answer is: Frank-Starling mechanism.

Afterload is defined as the: A. degree of pressure against which the left ventricle pumps. B. volume of blood pumped ejected from the heart per minute. C. volume of blood returned to the left and right atrium. D. amount of blood pumped from the heart per contraction.

The Circulatory System, page 342 The answer is: degree of pressure against which the left ventricle pumps.

Afterload is defined as the: A. volume of blood pumped ejected from the heart per minute. B. degree of pressure against which the left ventricle pumps. C. amount of blood pumped from the heart per contraction. D. volume of blood returned to the left and right atrium.

The Circulatory System, page 342 The answer is: degree of pressure against which the left ventricle pumps.

A medication that possesses a positive chronotropic effect is one that: A. decreases cardiac contractility. B. increases heart rate. C. increases the conduction of electricity. D. decreases heart rate.

The Circulatory System, page 342 The answer is: increases heart rate.

The heart's primary pacemaker, which is located in the right atrium, is the: A. AV junction. B. AV node. C. SA node. D. bundle of His.

The Circulatory System, page 343 The answer is: SA node.

The myocardium is the only muscle that can generate its own electrical impulses. This process is called: A. dromotropy. B. conductivity. C. excitability. D. automaticity.

The Circulatory System, page 343 The answer is: automaticity.

Which layer of the blood vessel wall is composed of elastic tissue and smooth muscle cells? A. Tunica media B. Lumen C. Tunica intima D. Tunica adventitia

The Circulatory System, page 344 The answer is: Tunica media

The two major veins that drain the head and neck of blood are the: A. cephalic veins. B. vertebral veins. C. cerebral veins. D. jugular veins.

The Circulatory System, page 350 The answer is: jugular veins.

A specialized part of the venous system that filters the blood and metabolizes various drugs is called the: A. hepatic portal system. B. renal portal system. C. splenic portal system. D. duodenal portal system.

The Circulatory System, pages 351-352 The answer is: hepatic portal system.

A specialized part of the venous system that filters the blood and metabolizes various drugs is called the: A. renal portal system. B. hepatic portal system. C. duodenal portal system. D. splenic portal system.

The Circulatory System, pages 351-352 The answer is: hepatic portal system.

If a 16-year-old child is killed in a car crash, how many years of potential life are lost? A. 37 B. 49 C. 42 D. 54

The Cost of Public Health Threats, page 74 The answer is: 49

Which of the following results in the MOST years of potential life lost? A. Suicide B. Heart disease C. Cancer D. Traumatic injury

The Cost of Public Health Threats, page 74 The answer is: Traumatic injury

Which of the following organs/structures lie(s) in the retroperitoneal space of the abdomen? A. Kidneys B. Liver C. Superior vena cava D. Spleen

The Digestive System, page 376 The answer is: Kidneys

Which of the following organs/structures lie(s) in the retroperitoneal space of the abdomen? A. Kidneys B. Spleen C. Liver D. Superior vena cava

The Digestive System, page 376 The answer is: Kidneys

The first portion of the small intestine that receives food from the stomach is the: A. duodenum. B. ileum. C. jejunum. D. ilium.

The Digestive System, page 379 The answer is: duodenum.

Severe injuries to the liver are life threatening because it is: A. poorly protected by the rib cage. B. avascular and relatively small. C. highly vascular and very fragile. D. normally enlarged in most people.

The Digestive System, page 380 The answer is: highly vascular and very fragile.

What are the functions of the pancreas? A. Production of insulin and certain enzymes that aid in digestion B. Storage and movement of food into the small intestine C. Concentration and storage of bile until it is needed for digestion D. Production of renin and regulation of blood pressure

The Digestive System, page 381 The answer is: Production of insulin and certain enzymes that aid in digestion

You are dispatched to a residence at 3:00 AM for a 39-year-old man with signs of a common cold. When caring for this patient, you should: A. realize that this clearly is not a call to which you should have been dispatched. B. educate the patient and tactfully discuss why a cold is not an emergency. C. tell the patient to schedule an appointment with his physician the next day. D. advise the patient that this is not an emergency and obtain a signed refusal.

The EMS System, page 11 The answer is: educate the patient and tactfully discuss why a cold is not an emergency.

You are dispatched to a residence at 3:00 AM for a 39-year-old man with signs of a common cold. When caring for this patient, you should: A. tell the patient to schedule an appointment with his physician the next day. B. educate the patient and tactfully discuss why a cold is not an emergency. C. realize that this clearly is not a call to which you should have been dispatched. D. advise the patient that this is not an emergency and obtain a signed refusal.

The EMS System, page 11 The answer is: educate the patient and tactfully discuss why a cold is not an emergency.

A patient has requested to be transported to a specific hospital; however, the hospital does not have the proper resources to meet the patient's needs. You should: A. advise the patient that his or her hospital of choice is a poorly equipped medical facility. B. remember that the hospital can always transfer the patient to a more appropriate facility. C. determine if there is a more appropriate medical facility within a reasonable distance. D. contact medical control and request permission to transport the patient to his or her choice hospital.

The EMS System, page 12 The answer is: determine if there is a more appropriate medical facility within a reasonable distance.

A patient has requested to be transported to a specific hospital; however, the hospital does not have the proper resources to meet the patient's needs. You should: A. contact medical control and request permission to transport the patient to his or her choice hospital. B. remember that the hospital can always transfer the patient to a more appropriate facility. C. advise the patient that his or her hospital of choice is a poorly equipped medical facility. D. determine if there is a more appropriate medical facility within a reasonable distance.

The EMS System, page 12 The answer is: determine if there is a more appropriate medical facility within a reasonable distance.

The large cartilaginous external portion of the ear is called the: A. cochlea. B. auricle. C. oval window. D. ossicle.

The Ear, page 1149 The answer is: auricle.

A 55-year-old female complains of severe vertigo, tinnitus, nausea, and a sense of fullness in her right ear. You should: A. administer an antiemetic and monitor her airway in case she vomits. B. carefully inspect her ear with an otoscope and administer furosemide. C. administer diphenhydramine to reduce any swelling in her inner ear. D. keep her supine, administer crystalloid fluid boluses, and inspect her ear.

The Ear, page 1152 The answer is: administer an antiemetic and monitor her airway in case she vomits.

A 55-year-old female complains of severe vertigo, tinnitus, nausea, and a sense of fullness in her right ear. You should: A. keep her supine, administer crystalloid fluid boluses, and inspect her ear. B. administer diphenhydramine to reduce any swelling in her inner ear. C. carefully inspect her ear with an otoscope and administer furosemide. D. administer an antiemetic and monitor her airway in case she vomits.

The Ear, page 1152 The answer is: administer an antiemetic and monitor her airway in case she vomits.

Molecules that bind to a receptor's cells and trigger a response by that cell, thereby resulting in some kind of action or biologic effect, are called: A. agonists. B. hormones. C. proteins. D. steroids.

The Endocrine System, page 324 The answer is: agonists.

Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the: A. adrenal islets. B. adrenal medulla. C. islets of Langerhans. D. medullary cortex.

The Endocrine System, page 328 The answer is: islets of Langerhans.

A patient is found to have a high blood sugar level (hyperglycemia). What is a cause of this? A. Hyperactivity of the pancreatic beta cells B. Deficient insulin levels in the blood C. Excessive insulin levels in the blood D. Decreased production of glucagon

The Endocrine System, page 329 The answer is: Deficient insulin levels in the blood

Glycogenolysis is the physiologic process in which: A. the kidneys produce additional glucose. B. the pancreas secretes glycogen. C. glycogen is converted to glucose. D. glucose is converted to glycogen.

The Endocrine System, page 329 The answer is: glycogen is converted to glucose.

Glycogenolysis is the physiologic process in which: A. the pancreas secretes glycogen. B. glucose is converted to glycogen. C. the kidneys produce additional glucose. D. glycogen is converted to glucose.

The Endocrine System, page 329 The answer is: glycogen is converted to glucose.

In addition to facilitating the uptake of sugar into the cells, insulin is responsible for: A. the chemical conversion of glucose to glycogen. B. the production of amino acids and carbohydrates. C. stimulating the liver and kidneys to produce glucose. D. the chemical conversion of glycogen to glucose.

The Endocrine System, page 329 The answer is: the chemical conversion of glucose to glycogen.

Which of the following statements regarding anisocoria is ? A. Anisocoria is a condition in which the pupils are unequal. B. Physiologic anisocoria indicates significant intracranial pressure. C. Anisocoria is a normal finding in the majority of the population. D. Anisocoria is a condition characterized by bilateral pupillary dilation.

The Eye, page 1143 The answer is: Anisocoria is a condition in which the pupils are unequal.

Which of the following statements regarding conjunctivitis is ? A. Allergic conjunctivitis is extremely contagious. B. Viral and bacterial conjunctivitis are not contagious. C. Conjunctivitis usually spreads to the opposite eye. D. Lower respiratory infections often cause conjunctivitis.

The Eye, page 1144 The answer is: Conjunctivitis usually spreads to the opposite eye.

Glaucoma is a condition caused by: A. decreased vitreous humor. B. a loss of peripheral vision. C. retinal artery occlusion. D. increased intraocular pressure.

The Eye, page 1147 The answer is: increased intraocular pressure.

Aqueous humor: A. cannot be replenished by the body if it is lost. B. is found between the iris and the lens of the eye. C. is contained in the anterior chamber of the eye. D. is contained in the posterior chamber of the eye.

The Eye, page 1147 The answer is: is contained in the anterior chamber of the eye.

Headaches, nausea and vomiting, narrowing vision fields, and a "graying" in the field of vision are consistent with: A. papilledema. B. anterior uveitis. C. corneal abrasion. D. glaucoma.

The Eye, page 1148 The answer is: papilledema.

You respond to the scene of an assault, where a 20-year-old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. The MOST appropriate next intervention is to: A. perform 5 cycles of well-coordinated CPR. B. immediately assess the patient's cardiac rhythm. C. give 2 minutes of 15 compressions and 2 breaths. D. look for evidence of a pericardial tamponade.

The answer is: perform 5 cycles of well-coordinated CPR.

Several cycles of chest compressions have failed to remove a foreign body airway obstruction in an unresponsive infant. Your next action should be to: A. open the infant's airway and sweep the infant's mouth with your finger. B. perform back slaps and chest thrusts and then look in the mouth. C. continue chest compressions and perform a cricothyrotomy. D. perform laryngoscopy and try to visualize the foreign body.

The answer is: perform laryngoscopy and try to visualize the foreign body.

The major complication associated with hollow organ injury is: A. peritonitis caused by rupture and spillage of toxins. B. delayed treatment due to the absence of external signs. C. massive internal hemorrhage and profound shock. D. immediate death secondary to a massive infection.

The answer is: peritonitis caused by rupture and spillage of toxins.

Secondary contamination with a hazardous material occurs when: A. toxins are transferred to another person by contaminated objects. B. toxic gases diffuse from one person to another person. C. systemic effects of the hazardous material are observed. D. an acutely contaminated person coughs near another person.

The answer is: toxins are transferred to another person by contaminated objects.

A 6-year-old male was struck in the abdomen. He is restless; his skin is cool, pale, and clammy; and his blood pressure is 94/60 mm Hg. After applying high-flow oxygen and keeping him warm, you should: A. defer vascular access unless his blood pressure begins to decrease. B. position him on his side and transport without delay. C. transport promptly and establish vascular access en route. D. establish vascular access at the scene and then transport.

The answer is: transport promptly and establish vascular access en route.

During a disaster, logging of all patients and the hospitals to which they were transported is primarily the responsibility of the: A. treatment supervisor. B. incident commander. C. transportation supervisor. D. triage supervisor.

The answer is: transportation supervisor.

The BEST way to protect yourself from the effects of radiation is to: A. wear a lead suit and self-contained breathing apparatus. B. use time, distance, and shielding to your advantage. C. wear a suit designed to completely shield yourself. D. limit your exposure at an incident to less than 10 minutes.

The answer is: use time, distance, and shielding to your advantage.

Epinephrine is primarily administered during cardiac arrest because its ________effects cause ________. A. beta-2 agonistic, dilation of the bronchioles B. vasoconstrictive, enhanced coronary blood flow C. antidysrhythmic, decreased cardiac irritability D. vasodilatory, a reduction in cardiac afterload

The answer is: vasoconstrictive, enhanced coronary blood flow

While responding to a call for a pediatric cardiac arrest, you approach a school bus with its red warning lights on. You should: A. wait for the bus driver to turn off the red warning lights and close the door before carefully passing. B. carefully pass the bus on the right, if possible, so the children exiting the bus will be able to see you. C. turn your emergency lights and siren off and carefully proceed past the bus at a slow speed. D. use your PA system to advise the students to remain on the bus as you carefully pass it on the left.

The answer is: wait for the bus driver to turn off the red warning lights and close the door before carefully passing.

Any electrical impulse that originates in the ventricles will produce: A. a rapid rhythm with wide QRS complexes and no pulse. B. low-amplitude QRS complexes and dissociated P waves. C. bizarre-looking QRS complexes and a rate less than 60 beats/min. D. wide QRS complexes and a rate between 20 and 40 beats/min.

The answer is: wide QRS complexes and a rate between 20 and 40 beats/min.

Premature ventricular complexes (PVCs) that originate from different sites in the ventricle: A. are also called fusion PVCs. B. are called unifocal PVCs. C. will appear differently on the ECG. D. produce a palpable pulse.

The answer is: will appear differently on the ECG.

If a patient is unable to tell you who he or she is, where he or she is, and what day of the week it is: A. you should suspect decreased blood flow to the brain. B. he or she likely has an intracerebral hemorrhage or lesion. C. you should ask him or her questions that require more thought. D. he or she is most likely scared and unable to remember.

Therapeutic Communication, page 151 The answer is: you should suspect decreased blood flow to the brain.

If a patient is unable to tell you who he or she is, where he or she is, and what day of the week it is: A. you should suspect decreased blood flow to the brain. B. you should ask him or her questions that require more thought. C. he or she likely has an intracerebral hemorrhage or lesion. D. he or she is most likely scared and unable to remember.

Therapeutic Communication, page 151 The answer is: you should suspect decreased blood flow to the brain.

Which of the following questions would be appropriate to ask a patient who has no medical training? A. "Do you have any endocrine-related illnesses?" B. "Have you ever had an acute myocardial infarction?" C. "Have you ever experienced a syncopal episode?" D. "Do you have any breathing or heart problems?"

Therapeutic Communication, page 152 The answer is: "Do you have any breathing or heart problems?"

Which of the following is an example of a closed-ended question? A. "Can you tell me how this all started?" B. "Does the pain radiate to your arm or jaw?" C. "How did you feel when you awoke today?" D. "Can you describe the pain you are feeling?"

Therapeutic Communication, page 152 The answer is: "Does the pain radiate to your arm or jaw?"

Which of the following is an example of a closed-ended question? A. "Does the pain radiate to your arm or jaw?" B. "How did you feel when you awoke today?" C. "Can you describe the pain you are feeling?" D. "Can you tell me how this all started?"

Therapeutic Communication, page 152 The answer is: "Does the pain radiate to your arm or jaw?"

Which of the following statements conveys empathy? A. "So if I understand you ly, you say that you want to kill yourself." B. "I understand exactly how you feel. In time, this will work out." C. "I understand how difficult this must be. I'm here to help you." D. "Based on my assessment, I think you may be having a heart attack."

Therapeutic Communication, page 153 The answer is: "I understand how difficult this must be. I'm here to help you."

If a woman who is 35 weeks pregnant is placed in a supine position: A. aortic compression will cause hypotension. B. a paradoxical bradycardia will occur. C. atrial preload may be reduced markedly. D. uterine circulation will increase exponentially.

Trauma and Pregnancy, page 2059 The answer is: atrial preload may be reduced markedly.

If a woman who is 35 weeks pregnant is placed in a supine position: A. aortic compression will cause hypotension. B. uterine circulation will increase exponentially. C. atrial preload may be reduced markedly. D. a paradoxical bradycardia will occur.

Trauma and Pregnancy, page 2059 The answer is: atrial preload may be reduced markedly.

If a paramedic is self-motivated, he or she should NOT: A. continuously educate himself or herself. B. possess an internal drive for excellence. C. be able to accept constructive

. D. require maximum supervision at work. [ Professionalism, page 18 The answer is: require maximum supervision at work.

The precordial leads do NOT view the __________ wall of the heart. A. anterior B. inferior C. septal D. lateral

12-Lead ECGs, page 1032 The answer is: inferior

A positive QRS deflection in lead I means the vector is heading toward the: A. left leg. B. left arm. C. right leg. D. right arm.

12-Lead ECGs, page 1026 The answer is: left arm.

On the 12-lead ECG, extreme right axis deviation is characterized by: A. a negative QRS in lead I and a positive QRS in lead aVF. B. a negative QRS in lead I and a negative QRS in lead aVF. C. a positive QRS in lead I and a negative QRS in lead aVF. D. a positive QRS in lead I and a positive QRS in lead aVF.

12-Lead ECGs, page 1027 The answer is: a negative QRS in lead I and a negative QRS in lead aVF.

The QRS in lead I is a positive deflection and the QRS in lead aVF is a negative deflection. This indicates: A. a normal axis. B. right axis deviation. C. left axis deviation. D. extreme right axis deviation.

12-Lead ECGs, page 1027 The answer is: left axis deviation.

The QRS in lead I is a positive deflection and the QRS in lead aVF is a negative deflection. This indicates: A. right axis deviation. B. extreme right axis deviation. C. left axis deviation. D. a normal axis.

12-Lead ECGs, page 1027 The answer is: left axis deviation.

Left ventricular hypertrophy should be considered in a 50-year-old patient if the sum of the depth of the S wave in lead V1 and the height of the R wave in either lead V5 or V6 exceeds: A. 28 mm. B. 32 mm. C. 35 mm. D. 22 mm.

12-Lead ECGs, page 1029 The answer is: 35 mm.

A STEMI should be suspected in a 45-year-old female if the ST segments in leads V2 and V3 are elevated by ____ or more. A. 0.5 B. 1.0 C. 1.5 D. 0.25

12-Lead ECGs, page 1031 The answer is: 1.5

A STEMI should be suspected in a 45-year-old female if the ST segments in leads V2 and V3 are elevated by ____ or more. A. 1.0 B. 0.5 C. 0.25 D. 1.5

12-Lead ECGs, page 1031 The answer is: 1.5

A pathologic Q wave: A. can only be substantiated by viewing at least two previous 12-lead ECGs. B. is deeper than one-quarter of the height of the R wave and indicates injury. C. is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. D. generally indicates that an acute myocardial infarction has occurred within the past hour.

12-Lead ECGs, page 1031 The answer is: is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past.

A prolonged QT interval indicates that the heart: A. has a shorter-than-normal refractory period, increasing the likelihood of severe bradycardia. B. is depolarizing too quickly, which significantly increases the potential for reentry in the AV junction. C. is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias. D. has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis.

12-Lead ECGs, page 1038 The answer is: is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias.

A prolonged QT interval indicates that the heart: A. is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias. B. is depolarizing too quickly, which significantly increases the potential for reentry in the AV junction. C. has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis. D. has a shorter-than-normal refractory period, increasing the likelihood of severe bradycardia.

12-Lead ECGs, page 1038 The answer is: is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias.

Left bundle branch block is characterized by: A. a QRS of greater than 120 milliseconds and a terminal R wave in lead V1. B. a QRS of greater than 120 milliseconds and a terminal S wave in lead V1. C. a QRS of less than 120 milliseconds and a terminal S wave in lead V1. D. a QRS of less than 120 milliseconds and a terminal R wave in lead V1.

12-Lead ECGs, pages 1027-1028 The answer is: a QRS of greater than 120 milliseconds and a terminal S wave in lead V1.

The majority of the circulating white blood cells are: A. leukocyte. B. lymphocyte. C. eosinophil. D. neutrophil.

Anatomy and Physiology Review, page 1296 The answer is: neutrophil.

A 29-year-old man was pulled from icy water after being submerged for approximately 10 minutes. He is unresponsive, apneic, and pulseless. He does not appear to have any injuries. The MOST appropriate treatment for this patient involves: A. defibrillating up to three times if he is in ventricular fibrillation, removing his wet clothing and applying blankets, and transporting. B. immobilizing his spine, initiating CPR, removing his wet clothing, and ceasing resuscitative efforts if unsuccessful after 5 minutes. C. assessing his cardiac rhythm, but attempting resuscitation only if the cardiac monitor reveals ventricular fibrillation or ventricular tachycardia. D. protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

Additional Specialized Rescue Situations, pages 2380-2381 The answer is: protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

You are dispatched to a local lake for a possible drowning. When you arrive, you can see a young woman floating face down in the water, approximately 20 feet from the bank. Witnesses state that they heard her scream, and then found her in her present condition. After you and your partner safely swim to the patient, you should FIRST: A. roll her face up as a single unit while manually stabilizing her head and neck. B. place her onto a floatable backboard and immediately remove her from the water. C. carefully roll her over, open her airway with the jaw-thrust, and assess for breathing. D. have your partner stabilize her head and neck as you palpate for a carotid pulse.

Additional Specialized Rescue Situations, pages 2381-2382, 2383 The answer is: roll her face up as a single unit while manually stabilizing her head and neck.

A disadvantage of ET intubation is that it: A. does not eliminate the incidence of gastric distention and can result in pulmonary aspiration. B. is only a temporary method of securing the patient's airway until a more definitive device can be inserted. C. is associated with a high incidence of vocal cord damage and bleeding into the oropharynx. D. bypasses the upper airway's physiologic functions of warming, filtering, and humidifying.

Advanced Airway Management, page 831 The answer is: bypasses the upper airway's physiologic functions of warming, filtering, and humidifying.

All of the following are complications associated with orotracheal intubation, EXCEPT: A. barotrauma from forceful ventilation. B. laryngeal swelling. C. damage to the vocal cords. D. necrosis of the nasal mucosa.

Advanced Airway Management, page 831 The answer is: necrosis of the nasal mucosa.

All of the following are complications associated with orotracheal intubation, EXCEPT: A. necrosis of the nasal mucosa. B. damage to the vocal cords. C. laryngeal swelling. D. barotrauma from forceful ventilation.

Advanced Airway Management, page 831 The answer is: necrosis of the nasal mucosa.

When inserting a stylet into an ET tube, you must ensure that: A. the stylet rests at least ½ inch back from the end of the tube. B. you use a petroleum-based gel to facilitate easy removal. C. the tube is bent in the form of a U to facilitate placement. D. the stylet is rigid and does not allow the ET tube to bend.

Advanced Airway Management, page 832 The answer is: the stylet rests at least ½ inch back from the end of the tube.

When inserting a stylet into an ET tube, you must ensure that: A. you use a petroleum-based gel to facilitate easy removal. B. the stylet is rigid and does not allow the ET tube to bend. C. the stylet rests at least ½ inch back from the end of the tube. D. the tube is bent in the form of a U to facilitate placement.

Advanced Airway Management, page 832 The answer is: the stylet rests at least ½ inch back from the end of the tube.

In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to: A. indirectly lift the epiglottis to expose the vocal cords. B. extend beneath the epiglottis and lift it up. C. fit into the vallecular space at the base of the tongue. D. move the patient's tongue to the left.

Advanced Airway Management, page 833 The answer is: extend beneath the epiglottis and lift it up.

Orotracheal intubation should be performed with the patient's head: A. slightly flexed. B. in a neutral position. C. hyperextended. D. in the sniffing position.

Advanced Airway Management, page 835 The answer is: in the sniffing position.

Which of the following structures is the MOST critical to visualize during orotracheal intubation? A. Epiglottis B. Tonsils C. Tongue D. Uvula

Advanced Airway Management, page 836 The answer is: Epiglottis

After properly positioning the patient's head for intubation, you should open his or her mouth and insert the laryngoscope blade: A. in the midline of the mouth and gently sweep the tongue to the left. B. in the midline of the mouth and gently lift upward on the tongue. C. into the left side of the mouth and move the blade to the midline. D. into the right side of the mouth and sweep the tongue to the left.

Advanced Airway Management, page 836 The answer is: into the right side of the mouth and sweep the tongue to the left.

You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see: A. the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope. B. the epiglottis lift when the tip of the curved blade is resting underneath it. C. two white fibrous bands that lie vertically within the glottic opening. D. the tip of the straight blade touching the posterior wall of the pharynx.

Advanced Airway Management, page 837 The answer is: two white fibrous bands that lie vertically within the glottic opening.

You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see: A. the tip of the straight blade touching the posterior wall of the pharynx. B. the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope. C. two white fibrous bands that lie vertically within the glottic opening. D. the epiglottis lift when the tip of the curved blade is resting underneath it.

Advanced Airway Management, page 837 The answer is: two white fibrous bands that lie vertically within the glottic opening.

After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then: A. attach an ETCO2 detector to the tube. B. secure the tube with a commercial device. C. attach the bag-mask device and ventilate. D. inflate the distal cuff with 5 to 10 mL of air.

Advanced Airway Management, page 838 The answer is: inflate the distal cuff with 5 to 10 mL of air.

After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should: A. slightly withdraw the tube as your partner auscultates breath sounds. B. immediately remove the ET tube and oxygenate the patient for 30 seconds. C. suspect that the patient has a pneumothorax on the right side of the chest. D. increase the force of your ventilations as your partner reauscultates the lungs.

Advanced Airway Management, page 839 The answer is: suspect that the patient has a pneumothorax on the right side of the chest.

Digital intubation can be performed on trauma patients because: A. orotracheal intubation is unsafe to perform on trauma patients. B. most trauma patients have distortion of the airway anatomy. C. the technique is easier to perform than other forms of intubation. D. the head does not have to be placed in a sniffing position.

Advanced Airway Management, page 851 The answer is: the head does not have to be placed in a sniffing position.

Rigorous tube confirmation protocol must be followed after performing digital intubation because: A. ET tubes that are placed digitally do not have a pilot balloon. B. inadvertent extubation of the patient is very common. C. capnography is unreliable in digitally intubated patients. D. the procedure of digital intubation is truly a blind technique.

Advanced Airway Management, page 852 The answer is: the procedure of digital intubation is truly a blind technique.

If the distance between the hyoid bone and the thyroid notch is at least ___ fingerbreadths wide, the difficulty of intubation should be low. A. one B. three C. two D. four

Advanced Airway Management, pages 829-830 The answer is: two

The opening on the distal side of an ET tube allows ventilation to occur: A. whether the tube is in the trachea or in the esophagus. B. even if the tip of the tube is occluded by blood or mucus. C. if the tube is inserted into the right mainstem bronchus. D. even if the ET tube does not enter the patient's trachea fully.

Advanced Airway Management, pages 831-832 The answer is: even if the tip of the tube is occluded by blood or mucus.

In which of the following situations should a helicopter generally NOT be utilized? A. Suspected internal hemorrhage in a hypotensive patient who lives in a rural area B. Motor vehicle crash involving a patient whose extrication will take 45 minutes C. Spinal injury in which the terrain over which the patient must be carried is rough D. A patient in cardiopulmonary arrest who has been unresponsive to defibrillation

Air Medical Transport, page 2320 The answer is: A patient in cardiopulmonary arrest who has been unresponsive to defibrillation

Air ambulances are advantageous for all of the following reasons, EXCEPT: A. faster transport to definitive care. B. more experience of the flight paramedics. C. the ability to access remote areas. D. the availability of specialized equipment.

Air Medical Transport, pages 2320-2321 The answer is: more experience of the flight paramedics.

After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should: A. remove the airway and have suction ready. B. spray an anesthetic medication into her mouth. C. suction her oropharynx for up to 15 seconds. D. turn the patient on her side in case she vomits.

Airway Adjuncts, page 800 The answer is: remove the airway and have suction ready.

A construction worker fell approximately 15 feet and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should: A. insert a nasopharyngeal airway and assist ventilations with a bag-mask device. B. administer oxygen via nonrebreathing mask and continue your assessment. C. suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula. D. insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask.

Airway Adjuncts, page 801 The answer is: administer oxygen via nonrebreathing mask and continue your assessment.

A 40-year-old man fell 20 feet from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A. insert a nasopharyngeal airway and assess his respirations. B. suction his oropharynx and reattempt the jaw-thrust maneuver. C. assist his ventilations and prepare to intubate him immediately. D. carefully open his airway with the head tilt-chin lift maneuver.

Airway Management, page 796 The answer is: carefully open his airway with the head tilt-chin lift maneuver.

Which of the following is NOT a major component of the hematologic system? A. Liver B. Bone marrow C. Pancreas D. Spleen

Anatomy and Physiology Review, page 1298 The answer is: Pancreas

The primary site for cell production in the human body is the: A. liver. B. kidney. C. bone marrow. D. spleen.

Anatomy and Physiology Review, page 1298 The answer is: bone marrow.

A 40-year-old man fell 20 feet from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A. suction his oropharynx and reattempt the jaw-thrust maneuver. B. insert a nasopharyngeal airway and assess his respirations. C. assist his ventilations and prepare to intubate him immediately. D. carefully open his airway with the head tilt-chin lift maneuver.

Airway Management, page 796 The answer is: carefully open his airway with the head tilt-chin lift maneuver.

You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to: A. insert an oral airway. B. manually open his airway. C. begin ventilation assistance. D. suction his oropharynx.

Airway Management, pages 794-795 The answer is: manually open his airway.

You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to: A. suction his oropharynx. B. insert an oral airway. C. begin ventilation assistance. D. manually open his airway.

Airway Management, pages 794-795 The answer is: manually open his airway.

A foreign body airway obstruction should be suspected in a child who presents with: A. diffuse wheezing and nasal flaring. B. progressive respiratory distress and hoarseness. C. acute respiratory distress without fever. D. a productive cough and flushed skin.

Airway Obstructions, page 802 The answer is: acute respiratory distress without fever.

A foreign body airway obstruction should be suspected in a child who presents with: A. progressive respiratory distress and hoarseness. B. diffuse wheezing and nasal flaring. C. a productive cough and flushed skin. D. acute respiratory distress without fever.

Airway Obstructions, page 802 The answer is: acute respiratory distress without fever.

Complications of aspiration include all of the following, EXCEPT: A. intrapulmonary infection. B. airway obstruction. C. excess surfactant production. D. bronchiolar tissue damage.

Airway Obstructions, page 803 The answer is: excess surfactant production.

Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by: A. sweeping the patient's mouth with your fingers. B. administering 15 subdiaphragmatic thrusts at once. C. reopening the airway and reattempting to ventilate. D. performing 30 chest compressions and reassessing.

Airway Obstructions, page 804 The answer is: reopening the airway and reattempting to ventilate.

A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should: A. look in her mouth and attempt to visualize a foreign body. B. perform abdominal thrusts until she becomes unconscious. C. deliver positive pressure ventilations via bag-mask device. D. encourage her to cough and closely monitor her condition.

Airway Obstructions, pages 803-804 The answer is: encourage her to cough and closely monitor her condition.

A synapse is: A. a cluster of sensory nerve cells. B. the point where a nerve cell terminates. C. the body's main neurotransmitter. D. the gap between an axon and dendrite.

Anatomy and Physiology Review, page 1084 The answer is: the gap between an axon and dendrite.

Pain over the suprapubic region is MOST suggestive of injury to the: A. urethra. B. iliac arteries. C. ureters. D. bladder.

Anatomy and Physiology Review, page 1173 The answer is: bladder.

Which of the following is NOT a function of the liver? A. Storage of bile B. Drug detoxification C. Storage of vitamins and minerals D. Completion of red and white blood cell breakdown

Anatomy and Physiology Review, page 1174 The answer is: Storage of bile

During normal menstruation, approximately ____ to ____ mL of blood is discharged from the vagina. A. 65, 80 B. 50, 75 C. 75, 100 D. 25, 65

Anatomy and Physiology Review, page 1239 The answer is: 25, 65

The onset of menses is called: A. menarche. B. the climacteric. C. menopause. D. menorrhea.

Anatomy and Physiology Review, page 1239 The answer is: menarche.

The MOST common cause of amenorrhea is: A. stress. B. pregnancy. C. hormone therapy. D. menopause.

Anatomy and Physiology Review, page 1239 The answer is: pregnancy.

The endocrine system comprises a network of ___________ that produce and secrete chemical messengers called ____________. A. glands, hormones B. synapses, neurotransmitters C. vessels, leukotrienes D. nodes, catecholamines

Anatomy and Physiology Review, page 1259 The answer is: glands, hormones

When the body's metabolic rate decreases: A. the thyroid gland secretes thyroxine. B. thyroid-stimulating hormone secretion is reduced. C. oxygen demand increases accordingly. D. the kidneys excrete more sodium and water.

Anatomy and Physiology Review, page 1259 The answer is: the thyroid gland secretes thyroxine.

The endocrine component of the pancreas: A. comprises the pancreatic duct. B. secretes digestive enzymes into the duodenum. C. releases epinephrine and norepinephrine. D. comprises the islets of Langerhans.

Anatomy and Physiology Review, page 1260 The answer is: comprises the islets of Langerhans.

The release of glucagon into the bloodstream stimulates: A. the vessels to constrict, thus increasing blood pressure. B. the liver to take in and store more glucose. C. the liver to convert glycogen to glucose. D. the cells to uptake sugar from the bloodstream.

Anatomy and Physiology Review, page 1260 The answer is: the liver to convert glycogen to glucose.

Formed elements of the blood account for approximately ___% of the total blood volume. A. 25 B. 45 C. 55 D. 35

Anatomy and Physiology Review, page 1294 The answer is: 45

Formed elements of the blood account for approximately ___% of the total blood volume. A. 55 B. 25 C. 35 D. 45

Anatomy and Physiology Review, page 1294 The answer is: 45

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should: A. preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea. B. apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations. C. suction his oropharynx, perform intubation, and then administer naloxone via slow IV push. D. assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Anatomy and Physiology Review, pages 909-910 The answer is: assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

If the amount of pulmonary surfactant is decreased: A. alveoli are able to expand more easily. B. diffuse alveolar hyperinflation occurs. C. alveolar surface tension increases. D. pulmonary gas exchange is enhanced.

Anatomy and Physiology Review, pages 947-948 The answer is: alveolar surface tension increases.

If the amount of pulmonary surfactant is decreased: A. alveoli are able to expand more easily. B. pulmonary gas exchange is enhanced. C. alveolar surface tension increases. D. diffuse alveolar hyperinflation occurs.

Anatomy and Physiology Review, pages 947-948 The answer is: alveolar surface tension increases.

Ricin is derived from: A. mash that is left from the castor bean. B. the seeds from a wide variety of fruits. C. a synthesized virus or bacterium. D. the leaves of the purple foxglove plant.

Biologic Agents, page 2452 The answer is: mash that is left from the castor bean.

During an explosion, secondary blast injuries occur when: A. the patient is struck by flying debris, such as shrapnel. B. the patient sustains severe burns from the intense heat. C. hollow organs rupture due to the pressure wave. D. the patient is thrown against a stationary object.

Blast Injuries, page 1561 The answer is: the patient is struck by flying debris, such as shrapnel.

If the windshield of a wrecked vehicle is cracked or broken: A. you should assume that the driver has a severe intracerebral hemorrhage. B. it is likely that the vehicle was traveling at least 55 mph at the time of impact. C. the front seat occupant has a cervical spine injury until proven otherwise. D. the rear seat passenger was likely thrust from the seat into the windshield.

Blunt Trauma, page 1548 The answer is: the front seat occupant has a cervical spine injury until proven otherwise.

Which of the following statements regarding rollover motor vehicle crashes is ? A. Ejection of the patient from the vehicle increases the chance of death by five times. B. Unrestrained passengers are struck with each change in direction the car makes. C. The restrained occupant's head and neck usually remain stationary during a rollover. D. Injuries to the passengers are usually not serious if seat belts are worn properly.

Blunt Trauma, page 1552 The answer is: Unrestrained passengers are struck with each change in direction the car makes.

After a motorcyclist is ejected from his or her motorcycle, secondary collisions: A. typically cause bilateral fractures of the femurs and tibias. B. most commonly involve a stationary object. C. result in less severe injuries if the rider is wearing leather. D. cause an unpredictable combination of blunt injuries.

Blunt Trauma, page 1555 The answer is: cause an unpredictable combination of blunt injuries.

Unlike adults, children who are struck by a motor vehicle are MORE likely to: A. be propelled onto the hood of the vehicle during the second impact. B. be run over by the vehicle as they are propelled to the ground. C. experience injuries to the lower extremities from the initial impact. D. turn away from the oncoming vehicle, resulting in posterior trauma.

Blunt Trauma, page 1556 The answer is: be run over by the vehicle as they are propelled to the ground.

The forces applied to the driver during a frontal vehicle collision will differ based on all of the following factors, EXCEPT: A. objects inside the vehicle. B. safety features of the motor vehicle. C. the physical size of the patient. D. the design of the motor vehicle.

Blunt Trauma, pages 1548-1550 The answer is: the physical size of the patient.

When an adult pedestrian is struck by a motor vehicle, lateral and posterior injuries are most common because: A. the patient is thrown and lands on his or her side or back. B. the patient is thrust onto the hood of the vehicle. C. adults tend to turn to the side or away from the impact. D. the initial impact by the bumper spins the patient to the side.

Blunt Trauma, pages 1555-1556 The answer is: adults tend to turn to the side or away from the impact.

You are assessing a 6-year-old Asian child who presents with a fever. During your assessment, you note red, flat, rounded lesions on the child's torso. This finding is MOST indicative of: A. cupping. B. phytophotodermatitis. C. coining. D. physical abuse.

Care of Patients When Abuse or Neglect Is Suspected, page 2256 The answer is: cupping.

You are assessing a 6-year-old Asian child who presents with a fever. During your assessment, you note red, flat, rounded lesions on the child's torso. This finding is MOST indicative of: A. phytophotodermatitis. B. coining. C. cupping. D. physical abuse.

Care of Patients When Abuse or Neglect Is Suspected, page 2256 The answer is: cupping.

By placing one hand on your forehead and your other hand over your abdomen, you are asking a hearing-impaired person if he or she: A. needs help. B. feels sick. C. is in pain. D. is hurt.

Care of Patients With Cognitive, Sensory, or Communication Impairment, page 2281 The answer is: feels sick.

Which of the following are often the primary tasks for paramedics who are caring for a patient with a terminal illness? A. ECG monitoring and antidysrhythmic therapy B. Airway care and thermal management C. Pain assessment and management D. Antibiotic and antipyretic therapy

Care of Patients With Terminal Illness, page 2258 The answer is: Pain assessment and management

You are caring for an elderly woman with terminal sarcoma. She is conscious, extremely weak, and in severe pain. Her son tells you that she has a living will and an out-of-hospital do not resuscitate order, and produces the appropriate documentation. The patient is on home oxygen at 2 L/min via nasal cannula. You should: A. apply high-flow oxygen via nonrebreathing mask, establish vascular access, and transport her to the hospital. B. recognize that the patient's death is imminent and remain at the scene to provide any needed emotional support. C. administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son. D. leave the patient on her nasal oxygen, keep her warm, and transport her safely to the hospital for further palliative care.

Care of Patients With Terminal Illness, pages 2258-2259 The answer is: administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son.

When cells are hypoxic for more than a few seconds: A. the respiratory system rapidly decompensates and breathing becomes slow. B. an increase in cytochrome production occurs and the body makes more energy. C. lysosomes quickly release enzymes that attempt to rebuild the structure of the cell. D. they produce substances that may damage other local or distant body systems.

Cellular Injury, page 429 The answer is: they produce substances that may damage other local or distant body systems.

Foreign material such as bacteria and other microorganisms are engulfed and destroyed by: A. phagocytes. B. basophils. C. lymphocytes. D. eosinophils.

Cellular Injury, page 431 The answer is: phagocytes.

In the presence of infection, white blood cells release endogenous chemicals called _________, which produce fever. A. pyrogens B. histamines C. catecholamines D. leukotrienes

Cellular Injury, page 431 The answer is: pyrogens

Unlike bacteria, viruses: A. do not produce exotoxins or endotoxins. B. are treated effectively with antibiotics. C. are unable to replicate. D. do not produce an immune response.

Cellular Injury, page 432 The answer is: do not produce exotoxins or endotoxins.

If an injury leading to cell degeneration is of sufficient intensity and duration: A. irreversible cell injury will lead to cell death. B. the cell will become inflamed and may burst. C. the cell will undergo coagulation necrosis. D. ischemia will result in simple necrosis.

Cellular Injury, page 433 The answer is: irreversible cell injury will lead to cell death.

Apoptosis is defined as: A. normal cell death. B. premature cell death. C. pathologic cell death. D. hypoxic cell death.

Cellular Injury, page 433 The answer is: normal cell death.

Which of the following structures comprise different types of tissues that work together to perform a particular function? A. Organs B. Cells C. Organisms D. Body systems

Cellular Level, page 240 The answer is: Organs

Extracellular fluid accounts for what percentage of the total body water? A. 19% B. 37% C. 24% D. 63%

Cellular Level, page 248 The answer is: 37%

The majority of the body's total body water is contained within the: A. extracellular space. B. interstitial fluid. C. intracellular space. D. intravascular fluid.

Cellular Level, page 248 The answer is: intracellular space.

Which of the following scenarios is the BEST example of independent decision making? A. Definitively diagnosing a patient with cholecystitis who has right upper quadrant abdominal pain and nausea that began shortly after eating a meal B. Contacting medical control and requesting permission to administer adenosine to a patient with a heart rate of 190 beats/min and a stable blood pressure C. Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital D. Selecting the appropriate patient care algorithm from your protocol book when treating a middle-aged female patient with symptomatic bradycardia

Cornerstones of Effective Paramedic Practice, page 606 The answer is: Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital

Which of the following scenarios is the BEST example of independent decision making? A. Definitively diagnosing a patient with cholecystitis who has right upper quadrant abdominal pain and nausea that began shortly after eating a meal B. Selecting the appropriate patient care algorithm from your protocol book when treating a middle-aged female patient with symptomatic bradycardia C. Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital D. Contacting medical control and requesting permission to administer adenosine to a patient with a heart rate of 190 beats/min and a stable blood pressure

Cornerstones of Effective Paramedic Practice, page 606 The answer is: Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital

Comments such as "I can't believe you called EMS for this!": A. are typically ignored by the patient because he or she is frightened at the time. B. are commonly made by paramedics with less than 5 years of field experience. C. demonstrate an illegal act for which the paramedic will be held accountable. D. show a lack of compassion and interest in providing the best possible care.

Critical Thinking and Clinical Decision Making, page 608 The answer is: show a lack of compassion and interest in providing the best possible care.

A working diagnosis is MOST accurately defined as: A. a reliable yet unofficial diagnosis of the patient. B. your interpretation of the patient's vital sign values. C. what you feel is the cause of your patient's problem. D. a firm explanation for the patient's symptomatology.

Critical Thinking and Clinical Decision Making, page 609 The answer is: what you feel is the cause of your patient's problem.

A working diagnosis is MOST accurately defined as: A. your interpretation of the patient's vital sign values. B. a firm explanation for the patient's symptomatology. C. what you feel is the cause of your patient's problem. D. a reliable yet unofficial diagnosis of the patient.

Critical Thinking and Clinical Decision Making, page 609 The answer is: what you feel is the cause of your patient's problem.

Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? A. A rigid abdomen and signs of shock B. Isolated tibia/fibula fracture from minor trauma C. An elderly patient with prolonged asystole D. A driver who passed out and then struck a tree

Critical Thinking and Clinical Decision Making, page 611 The answer is: A driver who passed out and then struck a tree

Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? A. An elderly patient with prolonged asystole B. Isolated tibia/fibula fracture from minor trauma C. A rigid abdomen and signs of shock D. A driver who passed out and then struck a tree

Critical Thinking and Clinical Decision Making, page 611 The answer is: A driver who passed out and then struck a tree

The hormonal effects associated with the fight-or-flight response can affect your performance as a paramedic by: A. diminishing your ability to concentrate. B. decreasing your visual acuity. C. enhancing your critical thinking skills. D. affecting your reflexes negatively.

Critical Thinking and Clinical Decision Making, page 611 The answer is: diminishing your ability to concentrate.

The hormonal effects associated with the fight-or-flight response can affect your performance as a paramedic by: A. diminishing your ability to concentrate. B. enhancing your critical thinking skills. C. decreasing your visual acuity. D. affecting your reflexes negatively.

Critical Thinking and Clinical Decision Making, page 611 The answer is: diminishing your ability to concentrate.

Uncertainty regarding the specific cause of a patient's problem is called: A. medical ambiguity. B. the differential diagnosis. C. the general impression. D. a working diagnosis.

Critical Thinking and Clinical Decision Making, page 611 The answer is: medical ambiguity.

Uncertainty regarding the specific cause of a patient's problem is called: A. the differential diagnosis. B. medical ambiguity. C. a working diagnosis. D. the general impression.

Critical Thinking and Clinical Decision Making, page 611 The answer is: medical ambiguity.

While treating a patient with chest pain, you administer fentanyl. Shortly after, you ask him if his pain has improved. This is an example of: A. application of principle. B. reflection on action. C. reflection in action. D. data interpretation.

Critical Thinking and Clinical Decision Making, pages 608-609 The answer is: data interpretation.

Islamic and Hindu cultures avoid: A. sitting with their legs crossed. B. touching with the left hand. C. clapping their hands together. D. touching the head.

Cross-Cultural Communication, page 158 The answer is: touching with the left hand.

The paramedic should NOT operate an emergency vehicle if he or she: A. has worked more than 12 straight hours. B. just finished an intense exercise regimen. C. is taking a cold remedy or an analgesic. D. is a personal acquaintance of the patient.

Defensive Emergency Vehicle Driving Techniques, page 2312 The answer is: is taking a cold remedy or an analgesic.

Safe practices when parking your emergency vehicle on a roadway at night include all of the following, EXCEPT: A. wearing a reflective vest. B. turning off the strobe lights. C. using your emergency flashers. D. leaving the headlights on.

Defensive Emergency Vehicle Driving Techniques, pages 2315-2316 The answer is: leaving the headlights on.

The FIRST step in examining a toddler in stable condition is to: A. place yourself at the child's level. B. let the child sit on a parent's lap. C. allow the child to hold a favorite toy. D. quickly examine any painful areas.

Developmental Stages, page 2119 The answer is: let the child sit on a parent's lap.

A 15-year-old child can be difficult to treat for all of the following reasons, EXCEPT: A. stranger anxiety. B. peer pressure. C. cognizance of body image. D. independence issues.

Developmental Stages, page 2120 The answer is: stranger anxiety.

In healthy adults, a loss of more than ____% of total body fluid is required to alter homeostasis and cause illness. A. 15 B. 30 C. 10 D. 20

Disturbances in Fluid Balance, page 420 The answer is: 30

Edema in an upper extremity following a mastectomy is the result of: A. surgery-induced inflammation. B. obstruction of a large blood vessel. C. localized vasoconstriction. D. decreased lymphatic drainage.

Disturbances in Fluid Balance, page 421 The answer is: decreased lymphatic drainage.

The cardinal sign of overhydration is: A. dyspnea. B. edema. C. tachycardia. D. hypertension.

Disturbances in Fluid Balance, page 421 The answer is: edema.

Dehydration is generally a more serious concern in older adults than in younger adults because: A. a person's total body water increases by 10% for each 10 years of life. B. total body water constitutes only 45% of body weight in older adults. C. older adults lose significantly more water through perspiration. D. renal function increases significantly in patients over 60 years of age.

Disturbances in Fluid Balance, page 421 The answer is: total body water constitutes only 45% of body weight in older adults.

Ascites is defined as: A. an abnormal accumulation of fluid in the peritoneal cavity. B. fluid buildup in the lungs due to decreased cardiac function. C. fluid backup in the periphery due to right atrial dysfunction. D. lower extremity edema caused by lymphatic obstruction.

Disturbances in Fluid Balance, page 422 The answer is: an abnormal accumulation of fluid in the peritoneal cavity.

A patient with kidney or liver failure would MOST likely develop: A. cellular shrinkage and death. B. severe dehydration. C. excessive hypertonic fluid levels. D. an increase in isotonic fluid.

Disturbances in Fluid Balance, page 422 The answer is: an increase in isotonic fluid.

A patient with kidney or liver failure would MOST likely develop: A. severe dehydration. B. cellular shrinkage and death. C. an increase in isotonic fluid. D. excessive hypertonic fluid levels.

Disturbances in Fluid Balance, page 422 The answer is: an increase in isotonic fluid.

Interventions used in patients with edema may include all of the following, EXCEPT: A. positional therapy. B. continuous positive airway pressure C. nitrates. D. catecholamines.

Disturbances in Fluid Balance, page 422 The answer is: catecholamines.

Acute pulmonary edema: A. commonly results from right-sided heart failure. B. is characterized by progressively worsening dyspnea. C. impairs oxygen diffusion into the pulmonary capillaries. D. results in excess elimination of carbon dioxide.

Disturbances in Fluid Balance, page 422 The answer is: impairs oxygen diffusion into the pulmonary capillaries.

If a patient is confined to bed for a prolonged period of time, you would expect edema to form in the: A. peritoneum. B. sacrum. C. face, neck, and chest. D. upper extremities.

Disturbances in Fluid Balance, page 422 The answer is: sacrum.

In a small child, loss of as little as ____% of total body fluid can cause illness. A. 3 to 5 B. 5 to 10 C. 20 to 25 D. 10 to 15

Disturbances in Fluid Balance, pages 420-421 The answer is: 10 to 15

In a small child, loss of as little as ____% of total body fluid can cause illness. A. 5 to 10 B. 10 to 15 C. 20 to 25 D. 3 to 5

Disturbances in Fluid Balance, pages 420-421 The answer is: 10 to 15

Acid-base balance normally remains in a physiologic pH range of: A. 7.25-7.35. B. 7.55-8.25. C. 7.45-7.55. D. 7.35-7.45.

Disturbances of Acid-Base Balance, page 425 The answer is: 7.35-7.45.

A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience: A. acute metabolic acidosis. B. a pH well above 7.45. C. increased CO2 retention. D. excess CO2 elimination.

Disturbances of Acid-Base Balance, page 426 The answer is: increased CO2 retention.

A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience: A. increased CO2 retention. B. acute metabolic acidosis. C. a pH well above 7.45. D. excess CO2 elimination.

Disturbances of Acid-Base Balance, page 426 The answer is: increased CO2 retention.

A person who ingests an excessive amount of salicylate would MOST likely experience: A. bradycardia. B. a fall in pH. C. alkalosis. D. hypoventilation.

Disturbances of Acid-Base Balance, page 429 The answer is: a fall in pH.

Which of the following conditions would be the LEAST likely to cause hyperventilation? A. Aspirin overdose B. Ketoacidosis C. Severe infection D. Metabolic alkalosis

Disturbances of Acid-Base Balance, pages 426-429 The answer is: Metabolic alkalosis

A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness is MOST likely: A. hypokalemic. B. hyperkalemic. C. hypocalcemic. D. hypoglycemic.

Electrolyte Imbalances, page 423 The answer is: hyperkalemic.

Muscle cramps and paresthesias in a malnourished patient with alcoholism are MOST likely the result of: A. hyperkalemia. B. hypernatremia. C. hypermagnesemia. D. hypocalcemia.

Electrolyte Imbalances, page 423 The answer is: hypocalcemia.

Muscle cramps and paresthesias in a malnourished patient with alcoholism are MOST likely the result of: A. hypermagnesemia. B. hyperkalemia. C. hypocalcemia. D. hypernatremia.

Electrolyte Imbalances, page 423 The answer is: hypocalcemia.

Half of the body's magnesium is stored in the: A. bones. B. extracellular fluid. C. kidneys. D. skeletal muscle.

Electrolyte Imbalances, page 425 The answer is: bones.

Which of the following incident times is NOT commonly documented on the patient care report? A. Time of arrival at the hospital B. Time of medication administration C. Time of departure from the scene D. Time of primary assessment

Documenting Incident Times, pages 185-186 The answer is: Time of primary assessment

Mobile transceivers: A. do not require an externally-mounted antenna. B. can have a line of sight range of up to 15 miles. C. are hand-carried devices used for on-scene operations. D. have transmission output power of less than 5 watts.

EMS Communication Systems, page 140 The answer is: can have a line of sight range of up to 15 miles.

At minimum, sending the 12-lead ECG of a patient with chest pain to the emergency department physician via telemetry would: A. decrease the likelihood of prehospital cardiac arrest. B. allow the physician to choose the appropriate fibrinolytic. C. enable the paramedic to begin treatment in the field. D. decrease the time from diagnosis to treatment.

EMS Communication Systems, page 143 The answer is: decrease the time from diagnosis to treatment.

In general, normal psychosocial factors that affect the life of a 35-year-old person include all of the following, EXCEPT: A. anxiety. B. work. C. family. D. stress.

Early Adults, page 487 The answer is: anxiety.

The paramedic should suspect hyperkalemia in a patient with: A. dehydration. B. vomiting and diarrhea. C. a crush injury. D. congestive heart failure.

Electrolyte Imbalances, page 420 The answer is: a crush injury.

Which of the following factors would MOST likely cause hyponatremia? A. Diuretic use B. A seizure C. Acute nausea D. Mild fever

Electrolyte Imbalances, page 422 The answer is: Diuretic use

What imbalance would MOST likely occur in a patient with diabetic ketoacidosis? A. Fluid excess with hypernatremia B. Fluid excess with hyponatremia C. Fluid deficit with hypernatremia D. Fluid deficit with hyponatremia

Electrolyte Imbalances, page 423 The answer is: Fluid deficit with hypernatremia

Hyperkalemia is defined as: A. excess potassium in the cells. B. an elevated serum potassium level. C. a relative deficit of sodium. D. a critically low magnesium level.

Electrolyte Imbalances, page 423 The answer is: an elevated serum potassium level.

A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness is MOST likely: A. hypocalcemic. B. hyperkalemic. C. hypoglycemic. D. hypokalemic.

Electrolyte Imbalances, page 423 The answer is: hyperkalemic.

A first-degree heart block has a PR interval greater than 0.20 seconds because: A. impulses generated by the SA node traverse the AV node at an accelerated rate. B. each impulse that reaches the AV node is delayed slightly longer than expected. C. depolarization of the atria occurs at a slightly slower rate than one would expect. D. the primary pacemaker is not the SA node, but rather an ectopic atrial pacemaker.

Electrophysiology, page 1020 The answer is: each impulse that reaches the AV node is delayed slightly longer than expected.

A second-degree heart block, Mobitz type I, occurs when: A. every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles. B. each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. C. the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex. D. more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.

Electrophysiology, page 1020 The answer is: each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.

Which of the following occurs at the AV node during a third-degree heart block? A. All impulses are blocked from entering the ventricles. B. Impulses bypass the AV node and enter the ventricles. C. There is an abnormal delay in conducting impulses. D. Every third impulse is allowed to enter the ventricles.

Electrophysiology, page 1021 The answer is: All impulses are blocked from entering the ventricles.

Which of the following occurs at the AV node during a third-degree heart block? A. Impulses bypass the AV node and enter the ventricles. B. All impulses are blocked from entering the ventricles. C. There is an abnormal delay in conducting impulses. D. Every third impulse is allowed to enter the ventricles.

Electrophysiology, page 1021 The answer is: All impulses are blocked from entering the ventricles.

During the refractory period: A. the heart is in a state of partial repolarization. B. the heart is partially charged, but cannot contract. C. the cell is depolarized or in the process of repolarizing. D. the heart muscle is depleted of energy and needs to recharge.

Electrophysiology, page 970 The answer is: the cell is depolarized or in the process of repolarizing.

During the refractory period: A. the heart is partially charged, but cannot contract. B. the cell is depolarized or in the process of repolarizing. C. the heart muscle is depleted of energy and needs to recharge. D. the heart is in a state of partial repolarization.

Electrophysiology, page 970 The answer is: the cell is depolarized or in the process of repolarizing.

During the refractory period: A. the heart is partially charged, but cannot contract. B. the heart muscle is depleted of energy and needs to recharge. C. the cell is depolarized or in the process of repolarizing. D. the heart is in a state of partial repolarization.

Electrophysiology, page 970 The answer is: the cell is depolarized or in the process of repolarizing.

Which of the following statements regarding the SA node is ? A. The SA node is located in the superior aspect of the right ventricle. B. SA nodal ischemia occurs when the left coronary artery is occluded. C. Impulses generated by the SA node travel through the right atrium only. D. The SA node is the dominant cardiac pacemaker in healthy patients.

Electrophysiology, page 971 The answer is: The SA node is the dominant cardiac pacemaker in healthy patients.

The area of conduction tissue in which electrical activity arises at any given time is called the: A. bundle of His. B. pacemaker. C. sinus node. D. myocyte.

Electrophysiology, page 971 The answer is: pacemaker.

Stimulation of the parasympathetic nervous system: A. causes a decrease in the production of epinephrine and norepinephrine. B. slows SA nodal discharge and decreases conduction through the AV node. C. is characterized by a large P wave and a PR interval that is shorter than normal. D. completely blocks the AV node, preventing ventricular depolarization.

Electrophysiology, page 972 The answer is: slows SA nodal discharge and decreases conduction through the AV node.

Stimulation of the parasympathetic nervous system: A. is characterized by a large P wave and a PR interval that is shorter than normal. B. completely blocks the AV node, preventing ventricular depolarization. C. causes a decrease in the production of epinephrine and norepinephrine. D. slows SA nodal discharge and decreases conduction through the AV node.

Electrophysiology, page 972 The answer is: slows SA nodal discharge and decreases conduction through the AV node.

Anatomically contiguous leads view: A. only the lateral wall of the heart. B. the same general area of the heart. C. opposite walls of the heart. D. only the anterior wall of the heart.

Electrophysiology, page 979 The answer is: the same general area of the heart.

Anatomically contiguous leads view: A. opposite walls of the heart. B. the same general area of the heart. C. only the anterior wall of the heart. D. only the lateral wall of the heart.

Electrophysiology, page 979 The answer is: the same general area of the heart.

On the ECG graph paper, 6 seconds is represented by how many large boxes? A. 50 B. 40 C. 30 D. 20

Electrophysiology, page 982 The answer is: 30

The P wave represents: A. a delay at the AV node. B. contraction of the atria. C. SA nodal discharge. D. atrial depolarization.

Electrophysiology, page 982 The answer is: atrial depolarization.

The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration. A. 0.16, 0.40 B. 0.18, 2.0 C. 0.12, 0.20 D. 0.14, 0.30

Electrophysiology, page 983 The answer is: 0.12, 0.20

The duration of the QRS complex should be ____ milliseconds or less in a healthy adult. A. 110 B. 130 C. 100 D. 120

Electrophysiology, page 983 The answer is: 110

The brief pause between the P wave and QRS complex represents: A. a momentary conduction delay at the AV node. B. the period of time when the atria are repolarizing. C. depolarization of the inferior part of the atria. D. full dispersal of electricity throughout both atria.

Electrophysiology, page 983 The answer is: a momentary conduction delay at the AV node.

The thick fibrous membrane that surrounds the heart is called the: A. epicardium. B. myocardium. C. pericardium. D. endocardium.

The Circulatory System, page 337 The answer is: pericardium.

Patients with Wolff-Parkinson-White syndrome: A. have an accessory pathway that bypasses the AV node and causes early ventricular depolarization. B. have a diseased SA node, resulting in ectopic atrial pacemakers and abnormal AV nodal conduction. C. are highly susceptible to a variety of bradycardic rhythms due to an abnormal delay at the AV node. D. experience independent atrial depolarization due to failure of the Bachmann bundle between the atria.

Electrophysiology, page 997 The answer is: have an accessory pathway that bypasses the AV node and causes early ventricular depolarization.

Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take? A. Lisinopril and aspirin B. Plavix and Vasotec C. Cordarone and furosemide D. Digitalis and Coumadin

Electrophysiology, page 999 The answer is: Digitalis and Coumadin

Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take? A. Plavix and Vasotec B. Lisinopril and aspirin C. Digitalis and Coumadin D. Cordarone and furosemide

Electrophysiology, page 999 The answer is: Digitalis and Coumadin

A major complication associated with atrial fibrillation is: A. a significant reduction in atrial filling. B. clot formation in the fibrillating atria. C. pulmonary congestion and hypoxemia. D. a profound increase in the atrial kick.

Electrophysiology, page 999 The answer is: clot formation in the fibrillating atria.

A wandering atrial pacemaker: A. may have variable PR intervals. B. has consistent P-wave shapes. C. is generally faster than 100 beats/min. D. is generally treated with atropine.

Electrophysiology, pages 1000-1001 The answer is: may have variable PR intervals.

A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 beats/min, narrow QRS complexes, and a PR interval of 0.16 seconds should be interpreted as a(n): A. ectopic atrial rhythm. B. junctional escape rhythm. C. accelerated junctional rhythm. D. supraventricular tachycardia.

Electrophysiology, pages 1002-1003 The answer is: accelerated junctional rhythm.

Any electrical impulse that originates in the ventricles will produce: A. low-amplitude QRS complexes and dissociated P waves. B. wide QRS complexes and a rate between 20 and 40 beats/min. C. a rapid rhythm with wide QRS complexes and no pulse. D. bizarre-looking QRS complexes and a rate less than 60 beats/min.

Electrophysiology, pages 1003, 1005 The answer is: wide QRS complexes and a rate between 20 and 40 beats/min.

A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on: A. searching for reversible causes. B. establishing a peripheral IV line. C. transcutaneous cardiac pacing. D. providing mild hyperventilation.

Electrophysiology, pages 1014-1017 The answer is: searching for reversible causes.

A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on: A. searching for reversible causes. B. providing mild hyperventilation. C. transcutaneous cardiac pacing. D. establishing a peripheral IV line.

Electrophysiology, pages 1014-1017 The answer is: searching for reversible causes.

A key to interpreting a Mobitz type II second-degree heart block is to remember that: A. unlike a Mobitz type I second-degree heart block, a type II heart block is always regular. B. the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant. C. in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted. D. most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.

Electrophysiology, pages 1020-1021 The answer is: the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.

Normal sinus rhythm is characterized by all of the following, EXCEPT: A. minimal variation between the R-R intervals. B. a consistent heart rate between 60 and 100 beats/min. C. QRS complexes that are up to 140 milliseconds. D. consistent PR intervals and upright P waves.

Electrophysiology, pages 987-988 The answer is: QRS complexes that are up to 140 milliseconds.

A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a PR interval of 0.14 seconds, and QRS complexes that measure 0.10 seconds should be interpreted as: A. normal sinus rhythm. B. sinus tachycardia. C. supraventricular tachycardia. D. junctional tachycardia.

Electrophysiology, pages 991-992 The answer is: sinus tachycardia.

Atrial fibrillation can be interpreted by noting: A. a regularly irregular rhythm with abnormal P waves. B. an irregularly irregular rhythm and absent P waves. C. PR intervals that vary from complex to complex. D. the presence of wide QRS complexes and a rapid rate.

Electrophysiology, pages 999-1000 The answer is: an irregularly irregular rhythm and absent P waves.

Atrial fibrillation can be interpreted by noting: A. the presence of wide QRS complexes and a rapid rate. B. a regularly irregular rhythm with abnormal P waves. C. PR intervals that vary from complex to complex. D. an irregularly irregular rhythm and absent P waves.

Electrophysiology, pages 999-1000 The answer is: an irregularly irregular rhythm and absent P waves.

A classic sign of atrial flutter is: A. the presence of sawtooth F waves. B. a ventricular rate less than 100 beats/min. C. a constant 2:1 conduction ratio. D. an irregular but consistent R-R interval.

Electrophysiology, pages 999-1000 The answer is: the presence of sawtooth F waves.

Agents such as Celox, HemCon, and QuikClot are used to: A. repair damaged vessels. B. replace lost blood. C. raise blood pressure. D. promote hemostasis.

Emergency Medical Care of Bleeding and Hemorrhagic Shock, page 1600 The answer is: promote hemostasis.

A 22-year-old man was struck in the forehead by a softball. He is conscious and alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should: A. apply an icepack to the hematoma and monitor his level of consciousness. B. start an IV of normal saline and administer 2 mg of morphine for the pain. C. place him in a sitting position and apply a chemical heat pack to his head. D. apply firm manual pressure to the hematoma to reduce internal bleeding.

Emergency Medical Care, pages 1617-1618 The answer is: apply an icepack to the hematoma and monitor his level of consciousness.

You are treating a 20-year-old woman with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should: A. control the bleeding by applying pressure to a proximal pressure point, administer high-flow oxygen, and transport. B. administer high-flow oxygen, establish vascular access at the scene, transport, and apply a proximal tourniquet en route. C. apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route. D. administer high-flow oxygen, transport, and apply a proximal tourniquet and establish vascular access en route.

Emergency Medical Care of Bleeding and Hemorrhagic Shock, pages 1594-1595 The answer is: apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route.

You are treating a 20-year-old woman with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should: A. control the bleeding by applying pressure to a proximal pressure point, administer high-flow oxygen, and transport. B. administer high-flow oxygen, transport, and apply a proximal tourniquet and establish vascular access en route. C. apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route. D. administer high-flow oxygen, establish vascular access at the scene, transport, and apply a proximal tourniquet en route.

Emergency Medical Care of Bleeding and Hemorrhagic Shock, pages 1594-1595 The answer is: apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route.

You have successfully controlled a large arterial hemorrhage from a 42-year-old man's leg with direct pressure and a pressure dressing. He is conscious, but restless. His blood pressure is 84/58 mm Hg, pulse is 120 beats/min, and respirations are 24 breaths/min. You should: A. administer high-flow oxygen, start two large-bore IV lines at the scene and give a 2- to 3-L fluid bolus, and transport. B. Keep him warm, assist his ventilations, place a hemostatic agent in the wound, transport, and start a large-bore IV en route. C. keep him warm, administer high-flow oxygen, establish one large-bore IV line at the scene, and transport. D. administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route.

Emergency Medical Care of Bleeding and Hemorrhagic Shock, pages 1600-1601 The answer is: administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route.

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should: A. administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give fentanyl for pain. B. apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg. C. administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen. D. apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution.

Emergency Medical Care, page 1181 The answer is: administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should: A. apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg. B. apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution. C. administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give fentanyl for pain. D. administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.

Emergency Medical Care, page 1181 The answer is: administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen.

You have dressed and bandaged a laceration to the arm of a 16-year-old woman and are transporting her to the hospital. En route, the patient complains that her fingers are tingling. You touch her hand and note that it is cool. You should: A. contact the receiving facility and have them place a neurosurgeon on standby. B. elevate her arm, apply an icepack over the bandage, and reassess her hand. C. conclude that the laceration has probably severed a major nerve in her arm. D. readjust the bandage if needed and reassess distal neurovascular function.

Emergency Medical Care, page 1618 The answer is: readjust the bandage if needed and reassess distal neurovascular function.

When applying a dressing and bandage to a scalp wound, you should: A. apply a cervical collar in case the c-spine is injured. B. always use a loose dressing to soak up the blood. C. carefully assess the skull for an underlying fracture. D. remove any foreign particles from the wound first.

Emergency Medical Care, page 1621 The answer is: carefully assess the skull for an underlying fracture.

A patient with orthopnea: A. generally has a slow, shallow respiratory pattern. B. seeks a sitting position when short of breath. C. prefers to lie flat in order to facilitate breathing. D. is awakened from sleep with severe dyspnea.

Emergency Medical Care, page 928 The answer is: seeks a sitting position when short of breath.

A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should: A. apply high-flow oxygen via a nonrebreathing mask. B. assist his ventilations and establish vascular access. C. start an IV of normal saline and administer a steroid. D. assist him with a metered-dose inhaler bronchodilator.

Emergency Medical Care, page 933 The answer is: assist his ventilations and establish vascular access.

The risk of newborn complications is HIGHEST if the amniotic sac: A. contains thin, brown amniotic fluid. B. is still intact at the time of birth. C. encases the baby's face at birth. D. ruptured more than 18 hours before birth.

General Pathophysiology and Assessment, page 2071 The answer is: ruptured more than 18 hours before birth.

A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure, the wound continues to bleed heavily. You should: A. apply supplemental oxygen and keep her warm. B. apply a tourniquet between her elbow and wrist. C. elevate the extremity above the level of her heart. D. locate and apply digital pressure to the brachial artery.

Emergency Medical Care, pages 1618, 1620 The answer is: apply a tourniquet between her elbow and wrist.

A patient with full-thickness burns surrounded by areas of superficial and partial-thickness burns should be treated with all of the following, EXCEPT: A. high-flow oxygen. B. sterile burn pads. C. moist dressings. D. analgesia.

Emergency Medical Care, pages 1654-1655 The answer is: moist dressings.

You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. Her respirations are rapid and shallow and her pulse is rapid and weak. What will maximize this patient's chances of survival? A. Orotracheal intubation, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center B. Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route C. Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route D. Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center

Emergency Medical Care, pages 1831-1832 The answer is: Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A. continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B. decrease the amount of positive-end expiratory pressure that you are delivering and reassess. C. suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. D. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

Emergency Medical Care, pages 933-934 The answer is: remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A. continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B. suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. C. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. D. decrease the amount of positive-end expiratory pressure that you are delivering and reassess.

Emergency Medical Care, pages 933-934 The answer is: remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

A critical step when using a CPAP unit to treat a patient with severe respiratory distress is: A. starting with CPAP levels above 10 to 15 cm of water. B. ensuring an adequate mask seal with minimal leakage. C. holding the mask to the noncompliant patient's face. D. setting the oxygen flow rate to at least 6 L/min.

Emergency Medical Care, pages 934-935 The answer is: ensuring an adequate mask seal with minimal leakage.

You respond to the residence of a 68-year-old man with terminal cancer. As you begin your assessment, the patient's wife tells you that he has an out-of-hospital do not resuscitate order, and hands you a document that appears to be valid. The patient, who is clearly emaciated, is conscious but is in severe pain. Your MOST appropriate action should be to: A. advise the wife that the do not resuscitate order prohibits you from rendering any prehospital care. B. provide supportive care, administer narcotic analgesia as indicated, and transport the patient to the hospital. C. accept the stipulations of the do not resuscitate order, obtain a signed refusal from the wife, and return to service. D. recall that do not resuscitate orders are invalid in the prehospital setting and be prepared to provide full ACLS.

End-of-Life Care, page 2241 The answer is: provide supportive care, administer narcotic analgesia as indicated, and transport the patient to the hospital.

If you receive a medication order from online medical control that seems inappropriate to you, you should: A. refuse to administer the medication. B. look up the dose in your field guide. C. ask the physician to repeat the order. D. administer the drug as ordered and document it.

Ensuring and Safe Medication Administration, pages 687-688 The answer is: ask the physician to repeat the order.

If you make an error when completing a written patient care report, you should: A. not alter the original patient care report and write the information on an addendum. B. leave the error, but write the information in parentheses next to it. C. use different colored ink when drawing a single line through the error. D. circle the error, initial it, and write the information next to it.

Errors and Falsification, page 184 The answer is: use different colored ink when drawing a single line through the error.

According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of: A. 4. B. 5. C. 3. D. 2.

General Pathophysiology and Assessment, page 2075 The answer is: 2.

An infant born with a pink body and blue extremities, a pulse rate of 90 beats/min, a strong cry, and active movement should be assigned an initial Apgar score of: A. 5. B. 6. C. 7. D. 8.

General Pathophysiology and Assessment, page 2075 The answer is: 8.

A neoplasm is MOST accurately defined as a(n): A. damaged cell. B. abnormal growth. C. normal cell. D. cancerous tumor.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1119 The answer is: abnormal growth.

An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called: A. bronchitis. B. emphysema. C. asthma. D. sinusitis.

Factors That Cause Disease, page 457 The answer is: asthma.

An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called: A. emphysema. B. asthma. C. bronchitis. D. sinusitis.

Factors That Cause Disease, page 457 The answer is: asthma.

Allergies are acquired following: A. initial exposure to an allergen. B. indirect exposure to an allergen. C. most bacterial infections. D. repeated exposure to an allergen.

Factors That Cause Disease, page 457 The answer is: initial exposure to an allergen.

Major risk factors for lung cancer include: A. frequent respiratory infections and asthma. B. cigarette smoking and exposure to asbestos. C. chewing tobacco use and a history of allergies. D. female sex and age over 40 years.

Factors That Cause Disease, page 458 The answer is: cigarette smoking and exposure to asbestos.

Hemolytic anemia is a disease characterized by: A. premature death of white blood cells. B. decreased production of red blood cells. C. an overproduction of red blood cells. D. increased destruction of red blood cells.

Factors That Cause Disease, page 460 The answer is: increased destruction of red blood cells.

Patients with type 1 diabetes mellitus: A. experience excessive cellular uptake of glucose. B. are less likely to develop ketoacidosis. C. need exogenous insulin to survive. D. control their disease with dietary modification.

Factors That Cause Disease, page 460 The answer is: need exogenous insulin to survive.

Patients with congenital prolongation of the QT interval are at GREATEST risk for: A. ventricular dysrhythmias. B. sudden asystole. C. acute myocardial infarction. D. coronary artery disease.

Factors That Cause Disease, page 460 The answer is: ventricular dysrhythmias.

Hypertrophic cardiomyopathy is characterized by: A. enlargement or thickening of the heart muscle. B. generalized thinning of the left and right ventricles. C. progressive shrinking of the right side of the heart. D. a significant reduction of blood return to the atria.

Factors That Cause Disease, page 461 The answer is: enlargement or thickening of the heart muscle.

Hypertrophic cardiomyopathy is characterized by: A. generalized thinning of the left and right ventricles. B. progressive shrinking of the right side of the heart. C. a significant reduction of blood return to the atria. D. enlargement or thickening of the heart muscle.

Factors That Cause Disease, page 461 The answer is: enlargement or thickening of the heart muscle.

Common signs and symptoms of ulcerative colitis include all of the following, EXCEPT: A. recurrent abdominal pain. B. pus or blood in the stools. C. bloating after milk ingestion. D. fever, chills, and diarrhea.

Factors That Cause Disease, page 463 The answer is: bloating after milk ingestion.

If signs of brain herniation are present, the paramedic should maintain an ETCO2 of: A. 40 to 45 mm Hg. B. 25 to 30 mm Hg. C. 35 to 40 mm Hg. D. 30 to 35 mm Hg.

General Management of Head Trauma, page 1746 The answer is: 30 to 35 mm Hg.

The middle muscular layer of the heart is called the: A. myocardium. B. pericardium. C. epicardium. D. endocardium.

The Circulatory System, page 338 The answer is: myocardium.

You have just delivered a little boy who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, he remains acrocyanotic and is not crying. You should: A. determine the newborn's Apgar score. B. begin assisting his ventilations at once. C. open his airway and assess respirations. D. resuction his mouth for up to 10 seconds.

General Pathophysiology and Assessment, page 2076 The answer is: open his airway and assess respirations.

If a newborn does not respond to the initial steps of resuscitation, the need for further intervention is based upon: A. respirations, appearance, and muscle tone. B. pulse rate, activity, and appearance. C. appearance, skin color, and muscle tone. D. respiratory effort, pulse rate, and color.

General Pathophysiology and Assessment, page 2076 The answer is: respiratory effort, pulse rate, and color.

To assess a newborn's preductal oxygen saturation, you should place the pulse oximeter probe on the: A. left foot. B. left hand. C. right foot. D. right hand.

General Pathophysiology and Assessment, page 2076 The answer is: right hand.

To assess a newborn's preductal oxygen saturation, you should place the pulse oximeter probe on the: A. left foot. B. right foot. C. left hand. D. right hand.

General Pathophysiology and Assessment, page 2076 The answer is: right hand.

The MOST common etiology for bradycardia in a newborn is: A. severe hypoxia. B. increased vagal tone. C. untreated acidosis. D. occult hypovolemia.

General Pathophysiology and Assessment, page 2077 The answer is: severe hypoxia.

You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn's heart rate remains below 60 beats/min. You should: A. continue bag-mask ventilations and initiate chest compressions. B. cannulate the umbilical vein and give 0.5 mL of epinephrine. C. start a peripheral IV line and give 4 mEq of sodium bicarbonate. D. try tactile stimulation as you continue bag-mask ventilations.

General Pathophysiology and Assessment, page 2083 The answer is: continue bag-mask ventilations and initiate chest compressions.

The initial steps of newborn resuscitation include: A. assessment of pulse rate. B. positive pressure ventilation. C. free-flow oxygen. D. proper positioning.

General Pathophysiology and Assessment, pages 2075-2076 The answer is: proper positioning.

The initial steps of newborn resuscitation include: A. assessment of pulse rate. B. positive pressure ventilation. C. proper positioning. D. free-flow oxygen.

General Pathophysiology and Assessment, pages 2075-2076 The answer is: proper positioning.

Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will MOST likely cause improvement in this newborn's condition? A. Epinephrine B. Dextrose C. Naloxone D. Normal saline

General Pathophysiology and Assessment, pages 2088-2089 The answer is: Normal saline

When a patient's leg is entrapped under a crushing object for a prolonged period of time, toxic metabolic waste products are released into the systemic circulation: A. after the patient's leg is freed from entrapment. B. and result in low serum potassium levels. C. only if the renal system is functioning properly. D. after the leg has been entrapped for 2 hours.

General Pathophysiology: Closed Versus Open Wounds, page 1613 The answer is: after the patient's leg is freed from entrapment.

Failure of the heart's primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in: A. atrioventricular block. B. ventricular ectopy. C. atrial fibrillation. D. junctional rhythms.

Geriatric Anatomy and Physiology, page 2209 The answer is: atrial fibrillation.

A decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to: A. atrial fibrillation. B. heart block. C. tachycardia. D. bradycardia.

Geriatric Anatomy and Physiology, page 2209 The answer is: bradycardia.

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the: A. gallbladder. B. liver. C. intestinal tract. D. spleen.

Geriatric Anatomy and Physiology, page 2212 The answer is: liver.

When assessing an older person, you should remember that it is common for him or her to: A. present with hemiparesis. B. slur his or her words. C. not understand your questions. D. respond slowly to questions.

Geriatric Anatomy and Physiology, pages 2210-2211 The answer is: respond slowly to questions.

Situational depression is: A. often characterized by violent bouts of rage. B. ongoing and does not appear to have a cause. C. a reaction to a stressful event in a patient's life. D. a condition that usually requires inpatient care.

History Taking, page 527 The answer is: a reaction to a stressful event in a patient's life.

Common risks associated with cannulation of the external jugular vein include all of the following, EXCEPT: A. cannulation of the subclavian vein. B. carotid artery puncture. C. an air embolism. D. a rapidly expanding hematoma.

IV Techniques and Administration, page 706 The answer is: cannulation of the subclavian vein.

It would MOST likely be necessary to ask a patient a direct question if: A. he or she is not giving you usable facts about himself or herself. B. there are numerous family members and friends present at the scene. C. he or she is elderly and has more than one medical complaint. D. he or she is having chest pain and a heart attack must be ruled out.

History Taking, page 518 The answer is: he or she is not giving you usable facts about himself or herself.

After determining that the scene is safe, the FIRST step in approaching a patient is to: A. determine the chief complaint. B. ask the patient his or her name. C. introduce yourself to the patient. D. ascertain the age of the patient.

History Taking, page 519 The answer is: introduce yourself to the patient.

An empathetic attitude: A. will put your patient at ease quickly. B. allows you to feel sorry for the patient. C. is often offensive to the patient. D. puts you in your patient's shoes.

History Taking, page 520 The answer is: puts you in your patient's shoes.

Which of the following is an example of a leading question? A. "Does the pain stay in your chest or does it move anywhere else?" B. "On a scale of 1 to 10, what number would you assign your pain?" C. "Has anything like this ever happened to you before today?" D. "Do you think that you are experiencing a cardiac emergency?"

History Taking, page 521 The answer is: "Do you think that you are experiencing a cardiac emergency?"

When assessing a patient who is under the influence of alcohol, it is MOST important to remember that: A. alcohol can mask any number of signs and symptoms. B. suspicions of alcohol intoxication must be documented. C. the amount of alcohol consumed is often overstated. D. the patient often gives a reliable and accurate history.

History Taking, page 522 The answer is: alcohol can mask any number of signs and symptoms.

When assessing a patient who is under the influence of alcohol, it is MOST important to remember that: A. alcohol can mask any number of signs and symptoms. B. the amount of alcohol consumed is often overstated. C. suspicions of alcohol intoxication must be documented. D. the patient often gives a reliable and accurate history.

History Taking, page 522 The answer is: alcohol can mask any number of signs and symptoms.

Paying attention, making eye contact, and repeating key information from the patient's answers are examples of: A. clarification. B. interpretation. C. reflection. D. facilitation.

History Taking, page 522 The answer is: facilitation.

Which of the following findings is LEAST indicative of abuse or domestic violence? A. A husband who towers over his wife and answers your questions for her B. Multiple injuries that are in various stages of healing C. Injuries that are inconsistent with the history that you are given D. A patient who refuses to allow a family member to speak for him or her

History Taking, page 523 The answer is: A patient who refuses to allow a family member to speak for him or her

Which of the following findings is LEAST indicative of abuse or domestic violence? A. A patient who refuses to allow a family member to speak for him or her B. A husband who towers over his wife and answers your questions for her C. Injuries that are inconsistent with the history that you are given D. Multiple injuries that are in various stages of healing

History Taking, page 523 The answer is: A patient who refuses to allow a family member to speak for him or her

When asking a patient if he or she uses illegal drugs, you will MOST likely get accurate information if you: A. question the patient in the presence of a trusted family member. B. tell the patient that withholding such information from you is illegal. C. remain professional and nonjudgmental. D. reassure the patient that you can be trusted and will not tell anyone.

History Taking, page 523 The answer is: remain professional and nonjudgmental.

If your patient becomes seductive or makes sexual advances toward you, you should advise the patient that your relationship with him or her is strictly professional and then: A. threaten the patient with a sexual harassment lawsuit. B. ask your partner to assume care of the patient. C. ensure that a witness is present at all times. D. continue providing care as usual.

History Taking, page 524 The answer is: ensure that a witness is present at all times.

If a patient's family member is hostile and begins shouting at you, you should: A. firmly tell the patient that his or her behavior is unacceptable and childish, and that he or she is worsening the situation. B. tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement. C. remain professional and ignore the family member so that you can provide appropriate patient care. D. have your partner physically remove the family member from the patient care area and continue your assessment.

History Taking, page 527 The answer is: tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement.

When caring for a patient who is mentally challenged: A. you may have to obtain the medical history from a family member. B. it is highly unlikely that you will obtain a reliable medical history. C. you should speak to the patient as though he or she is younger in age. D. your priority should be to transport the patient to a psychiatric facility.

History Taking, page 528 The answer is: you may have to obtain the medical history from a family member.

The focused assessment of a responsive medical patient is guided by: A. the chief complaint. B. baseline vital sign readings. C. SAMPLE history findings. D. the general impression.

History Taking, page 530 The answer is: the chief complaint.

When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine: A. which complaint has a higher priority. B. if the two complaints are related. C. when each of the complaints began. D. the patient's past medical history.

History Taking, page 530 The answer is: which complaint has a higher priority.

Which of the following is an example of a pertinent negative? A. A family member states that the patient has hypertension. B. An agitated patient tells you that he did not request your help. C. A patient tells you that he has developed a plan for suicide. D. A patient with chest discomfort denies shortness of breath.

History Taking, page 536 The answer is: A patient with chest discomfort denies shortness of breath.

Which of the following is an example of a pertinent negative? A. An agitated patient tells you that he did not request your help. B. A family member states that the patient has hypertension. C. A patient tells you that he has developed a plan for suicide. D. A patient with chest discomfort denies shortness of breath.

History Taking, page 536 The answer is: A patient with chest discomfort denies shortness of breath.

A working hypothesis of the nature of a patient's problem is called the: A. field impression. B. differential diagnosis. C. chief complaint. D. history of present illness.

History Taking, page 538 The answer is: differential diagnosis.

How does the body respond to hypoperfusion? A. Catecholamine release and increased systemic vascular resistance B. A compensatory decrease in cardiac output and cardiac oxygen demand C. Decreased preload, stroke volume, and heart rate D. Splenic retention of red blood cells secondary to systemic hypoxia

Hypoperfusion, page 434 The answer is: Catecholamine release and increased systemic vascular resistance

How does the body respond to hypoperfusion? A. Splenic retention of red blood cells secondary to systemic hypoxia B. A compensatory decrease in cardiac output and cardiac oxygen demand C. Catecholamine release and increased systemic vascular resistance D. Decreased preload, stroke volume, and heart rate

Hypoperfusion, page 434 The answer is: Catecholamine release and increased systemic vascular resistance

When oxygen does not reach the cell, the cell reverts to: A. anaerobic metabolism and produces bicarbonate. B. aerobic metabolism and produces carbon dioxide. C. fat metabolism and begins producing ketoacids. D. anaerobic metabolism and produces lactic acid.

Hypoperfusion, page 435 The answer is: anaerobic metabolism and produces lactic acid.

When oxygen does not reach the cell, the cell reverts to: A. fat metabolism and begins producing ketoacids. B. anaerobic metabolism and produces lactic acid. C. aerobic metabolism and produces carbon dioxide. D. anaerobic metabolism and produces bicarbonate.

Hypoperfusion, page 435 The answer is: anaerobic metabolism and produces lactic acid.

You are treating a 29-year-old man who was struck in the abdomen with a steel pipe. He is confused, has absent radial pulses, and has a blood pressure of 78/50 mm Hg. You should administer: A. normal saline fluid boluses until his mental status and radial pulses improve. B. enough isotonic crystalloid to increase his systolic BP to at least 120 mm Hg. C. 1,000 mL of normal saline or lactated Ringer solution and then reassess him. D. 1 mL of isotonic crystalloid for every 3 mL of estimated internal blood loss.

IV Fluid Composition, page 692 The answer is: normal saline fluid boluses until his mental status and radial pulses improve.

A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution: A. has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. B. may cause the cells to expand and rupture due to the increased intracellular osmotic pressure exerted by the solution. C. contains high concentrations of proteins and can result in fluid overloading in patients with impaired cardiac function or renal insufficiency. D. has a lower ionic concentration than serum and pulls fluid and electrolytes from the intravascular compartment into the intracellular and interstitial compartments.

IV Fluid Composition, page 694 The answer is: has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.

When selecting a vein for cannulation, you should avoid areas of the vein that: A. are firm and springy. B. pass over joints. C. are straight. D. appear to be straight.

IV Techniques and Administration, page 698 The answer is: pass over joints.

Which of the following vessels or structures is NOT part of the pulmonary circulation? A. Descending aorta B. Pulmonic valve C. Alveolar capillary D. Pulmonary artery

The Circulatory System, page 332 The answer is: Descending aorta

IO cannulation is contraindicated in all of the following situations, EXCEPT: A. bilateral knee replacements. B. known osteogenesis imperfecta. C. penetrating thoracic trauma. D. the presence of a peripheral IV line.

Intraosseous Infusion, page 720 The answer is: penetrating thoracic trauma.

All of the following are internal regions of the kidney, EXCEPT the: A. hilum. B. cortex. C. pelvis. D. medulla.

Introduction, page 1214 The answer is: hilum.

Which of the following statements contains objective and subjective information? A. "The patient's pulse was rapid and weak and he was diaphoretic." B. "The patient's wife stated that he began feeling ill a few hours ago." C. "The patient appeared confused and stated that he had a headache." D. "The patient's behavior was consistent with alcohol intoxication."

Introduction, page 170 The answer is: "The patient appeared confused and stated that he had a headache."

All of the following are subjective findings, EXCEPT: A. acute and severe nausea. B. a persistent dull headache. C. visible blood in the ear canal. D. a feeling of impending doom.

Introduction, page 170 The answer is: visible blood in the ear canal.

One of the major differences between laws and ethics is that laws: A. have sanctions for violation that are enforceable. B. allow a person to determine right from wrong. C. are usually broken because of an unethical act. D. are reflective of a person's moral responsibilities.

Introduction, page 96 The answer is: have sanctions for violation that are enforceable.

Which of the following vessels or structures is NOT part of the pulmonary circulation? A. Pulmonic valve B. Pulmonary artery C. Alveolar capillary D. Descending aorta

The Circulatory System, page 332 The answer is: Descending aorta

Which of the following factors typically does NOT affect the vital signs of a 65-year-old patient? A. Past medical history B. Overall health C. Medications taken D. Living conditions

Late Adults, page 488 The answer is: Living conditions

In late adults, the size of the airway __________ and the surface area of the alveoli ___________. A. decreases, increases B. increases, increases C. decreases, decreases D. increases, decreases

Late Adults, page 488 The answer is: increases, decreases

Vascular compensation for changes in blood pressure decreases with age due to: A. a marked reduction in renal function with increased sodium reabsorption in the renal tubules. B. reduced elasticity of the peripheral vessels secondary to decreases in elastin and collagen. C. a 60% to 70% decrease in sympathetic nervous system stimulation and catecholamine release. D. left ventricular hypertrophy and the subsequent decrease in cardiac output that it causes.

Late Adults, page 488 The answer is: reduced elasticity of the peripheral vessels secondary to decreases in elastin and collagen.

As the smooth muscles of the lower airway weaken with age: A. beta-agonistic bronchodilators become an ineffective treatment for acute bronchospasm. B. strong inhalation can collapse the walls of the airway, resulting in inspiratory wheezing. C. the alveoli in the lungs expand widely during deep inhalation, causing them to rupture. D. the person is predisposed to aspiration of mucus or other secretions during normal breathing.

Late Adults, page 489 The answer is: strong inhalation can collapse the walls of the airway, resulting in inspiratory wheezing.

As the smooth muscles of the lower airway weaken with age: A. strong inhalation can collapse the walls of the airway, resulting in inspiratory wheezing. B. beta-agonistic bronchodilators become an ineffective treatment for acute bronchospasm. C. the person is predisposed to aspiration of mucus or other secretions during normal breathing. D. the alveoli in the lungs expand widely during deep inhalation, causing them to rupture.

Late Adults, page 489 The answer is: strong inhalation can collapse the walls of the airway, resulting in inspiratory wheezing.

You would MOST likely see an increased end-tidal CO2 reading in an otherwise healthy older adult because: A. many older adults experience idiopathic atrophy of the diaphragm and are unable to breathe in adequate tidal volumes. B. as respiratory muscle mass increases with age, the older adult experiences increasing difficulty with inspiration and expiration. C. the vital capacity in late adulthood amounts to only 20% of the vital capacity noted in young adulthood. D. residual volume increases with age, resulting in stagnant air remaining in the alveoli and hampering gas exchange.

Late Adults, page 490 The answer is: residual volume increases with age, resulting in stagnant air remaining in the alveoli and hampering gas exchange.

When assessing an older adult's pupils and ocular movements, you should recall that: A. it is not uncommon for lens deterioration to cause the pupils to be sluggish to react. B. older adults experience decreased sensitivity to glare and widened peripheral vision. C. the pupils are generally larger in older adults and are commonly asymmetric in size. D. visual impairment is four times more common than loss of hearing in older adults.

Late Adults, page 491 The answer is: it is not uncommon for lens deterioration to cause the pupils to be sluggish to react.

When assessing an older adult's pupils and ocular movements, you should recall that: A. the pupils are generally larger in older adults and are commonly asymmetric in size. B. older adults experience decreased sensitivity to glare and widened peripheral vision. C. it is not uncommon for lens deterioration to cause the pupils to be sluggish to react. D. visual impairment is four times more common than loss of hearing in older adults.

Late Adults, page 491 The answer is: it is not uncommon for lens deterioration to cause the pupils to be sluggish to react.

Which of the following statements regarding certification is ? A. Certification is a process in which a certifying entity attests to the fact that the health care provider has mastered a certain skill set. B. Unlike a licensed health care provider, a certified health care provider is not required to obtain continuing education hours. C. Certification is evidence that an individual has a certain level of credentials based on hours of training and examination. D. A certified health care provider has been granted the authority and privilege to practice medicine in a certain municipality.

Legal Accountability of the Paramedic, page 104 The answer is: Certification is evidence that an individual has a certain level of credentials based on hours of training and examination.

Which of the following is NOT a predisposing risk factor for trauma in the elderly? A. Slower reflexes B. Decreased body water C. Equilibrium disorders D. Overall decrease in agility

Pathophysiology, Assessment, and Management of Geriatric Trauma Emergencies, page 2236 The answer is: Decreased body water

Upon arriving at the scene of a motorcycle crash, you are approached by an EMR. What is the MOST important information the EMR should provide to you? A. The patient's vital signs and the presence of any underlying medical conditions B. His or her perception of the criticality of the patient's condition and suspicion for internal bleeding C. How the crash occurred and approximately when he or she first arrived at the scene D. Initial scene and patient assessment findings and any basic care that was provided to the patient

Levels of Education, page 12 The answer is: Initial scene and patient assessment findings and any basic care that was provided to the patient

While staging at a sniper shooting situation, you hear of a police officer who has been shot in the leg and is bleeding profusely. You should: A. remain where you are and wait for the SWAT team to bring the patient to you for treatment. B. attempt to make verbal contact with the SWAT team and instruct them to apply a tourniquet. C. request at least two armed SWAT team members to accompany you to the patient's side. D. use the concepts of cover and concealment as you carefully make your way to the patient.

Man-Made Disasters, page 2487 The answer is: attempt to make verbal contact with the SWAT team and instruct them to apply a tourniquet.

An endogenous chemical is one that: A. is in one part of the body. B. occurs only in small amounts. C. occurs inside the body. D. occurs outside the body.

Master Tables, page 211 The answer is: occurs inside the body.

You arrive at a convenience store to find a middle-aged male in cardiac arrest. Your protocols provide for standing orders in this type of scenario. This means that you should: A. perform certain interventions prior to contacting medical control. B. contact medical control before providing advanced-level care. C. begin CPR and then contact medical control for further direction. D. pronounce the patient dead if there is no response after 10 minutes.

Medical Direction, page 21 The answer is: perform certain interventions prior to contacting medical control.

You arrive at a convenience store to find a middle-aged male in cardiac arrest. Your protocols provide for standing orders in this type of scenario. This means that you should: A. perform certain interventions prior to contacting medical control. B. pronounce the patient dead if there is no response after 10 minutes. C. begin CPR and then contact medical control for further direction. D. contact medical control before providing advanced-level care.

Medical Direction, page 21 The answer is: perform certain interventions prior to contacting medical control.

If an emergency physician is present at the scene of a mass-casualty incident, he or she would be the LEAST likely to: A. decide which patients require immediate transport. B. provide on-scene medical direction for paramedics. C. make initial and secondary triage decisions. D. assume control over complex rescuer operations.

Medical Incident Command, page 2343 The answer is: assume control over complex rescuer operations.

General criteria for determining a patient's mental competence include all of the following, EXCEPT: A. the absence of a head injury or other trauma. B. an appropriate response to questions. C. the absence of cardiac dysrhythmias. D. blood glucose levels within normal limits.

Paramedic-Patient Relationships, pages 109-111 The answer is: the absence of cardiac dysrhythmias.

Which of the following statements regarding multiple organ dysfunction syndrome (MODS) is ? A. At the cellular level, MODS results in aerobic metabolism, metabolic alkalosis, and impaired cellular function. B. MODS typically develops within 20 to 30 minutes following resuscitation from cardiac arrest. C. Signs and symptoms of MODS include compensatory hypertension, bradycardia, and a fever greater than 105°F. D. MODS occurs when injury or infection triggers a massive systemic immune, inflammatory, and coagulation response.

Multiple Organ Dysfunction Syndrome, page 438 The answer is: MODS occurs when injury or infection triggers a massive systemic immune, inflammatory, and coagulation response.

Signs and symptoms of multiple organ dysfunction syndrome (MODS) include: A. coagulopathy. B. polyuria. C. decreased liver enzymes. D. decreased creatinine.

Multiple Organ Dysfunction Syndrome, page 438 The answer is: coagulopathy.

While providing care to victims following an earthquake, you note that many of them are experiencing respiratory distress. This is MOST likely due to: A. dust suffocation. B. thoracic barotrauma. C. carbon monoxide. D. infectious pneumonia.

Natural Disasters, page 2478 The answer is: dust suffocation.

While providing care to victims following an earthquake, you note that many of them are experiencing respiratory distress. This is MOST likely due to: A. infectious pneumonia. B. thoracic barotrauma. C. carbon monoxide. D. dust suffocation.

Natural Disasters, page 2478 The answer is: dust suffocation.

A paramedic's actions are considered to be grossly negligent if he or she: A. does not consult with online medical control first. B. makes a simple mistake that causes harm to the patient. C. only provides basic life support to a critical patient. D. willfully or wantonly deviates from the standard of care.

Negligence and Protection Against Negligence Claims, page 115 The answer is: willfully or wantonly deviates from the standard of care.

Abandonment occurs when: A. a patient refuses care and subsequently dies of his condition. B. a patient is released and did not require further medical care. C. care of a patient was terminated without his or her consent. D. an emergency nurse takes a verbal report from a paramedic.

Negligence and Protection Against Negligence Claims, page 116 The answer is: care of a patient was terminated without his or her consent.

A woman is in the second stage of labor when: A. she feels a strong urge to move her bowels. B. contractions occur in 5- to 10-minute intervals. C. a gush of amniotic fluid pours from the vagina. D. the cervix is fully effaced and partially dilated.

Normal Childbirth, page 2044 The answer is: she feels a strong urge to move her bowels.

You are assisting in the delivery of a baby. As the infant's head begins to emerge from the vagina, you should support the head as it turns and then: A. gently guide the head upward. B. carefully dry its face. C. thoroughly suction its airway. D. assess for a nuchal cord.

Normal Childbirth, page 2047 The answer is: assess for a nuchal cord.

During the second stage of labor: A. contractions become more intense and more frequent. B. amniotic fluid typically gushes out of the vagina. C. the baby's head begins to bulge through the cervix. D. delivery in a multiparous woman occurs in a few hours.

Normal Childbirth, pages 2043-2044 The answer is: contractions become more intense and more frequent.

Which of the following is NOT a function of the skin? A. Temperature regulation B. Transmission of information to the brain C. Production of antibodies to foreign organisms D. Protection from the environment

Organ Systems, page 262 The answer is: Production of antibodies to foreign organisms

Spina bifida occurs when: A. trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. B. hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord. C. the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed. D. growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.

Other Notable Chronic Medical Conditions, pages 2289-2290 The answer is: the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

Implied consent is based on the premise that a patient: A. would consent to care because of the seriousness of his or her injury. B. will die unless emergency medical treatment is provided immediately. C. would refuse any emergency medical care if he or she were unconscious. D. is of legal age and is able to make rational decisions regarding his or her care.

Paramedic-Patient Relationships, page 109 The answer is: would consent to care because of the seriousness of his or her injury.

Failure to pinch the tubing proximal to the injection port when administering a drug via the IV bolus route will: A. cause the medication to enter the patient's central circulation rapidly. B. cause the medication to flow up the tubing and away from the patient. C. negate the need to follow the IV bolus with a 20-mL normal saline flush. D. result in too much of the medication entering the patient's circulation.

Parenteral Medication Administration, page 742 The answer is: cause the medication to flow up the tubing and away from the patient.

You are treating an unconscious 39-year-old man who overdosed on heroin. You are unable to establish an IV line because his veins are severely sclerosed, and your protocols do not allow for IO cannulation. You should: A. administer naloxone via the mucosal atomizer device. B. assist ventilations and transport immediately. C. intubate the patient and give Narcan via the ET tube. D. use the subcutaneous route to administer Narcan.

Parenteral Medication Administration, page 753 The answer is: administer naloxone via the mucosal atomizer device.

Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because: A. he or she will be a source of important information and assistance. B. caregivers often take their anger out on prehospital professionals. C. doing so will quickly deescalate any hostility that he or she may have. D. the caregiver generally will not accompany the child in the ambulance.

Parents of Ill or Injured Children, page 2125 The answer is: he or she will be a source of important information and assistance.

A healthy adult can tolerate blood loss of up to ____ mL over a period of 15 to 20 minutes without any negative effects. A. 750 B. 500 C. 1,000 D. 1,500

Pathophysiology of Hemorrhage, page 1586 The answer is: 500

All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT: A. acute hyperventilation. B. lactic acidosis. C. anaerobic metabolism. D. increased metabolism.

Pathophysiology of Respiration, page 780 The answer is: acute hyperventilation.

Hypoventilation causes a(n) __________ and leads to __________. A. increased minute volume, hypercapnia B. increased minute volume, hypocapnia C. decreased minute volume, hypocapnia D. decreased minute volume, hypercapnia

Pathophysiology of Respiration, page 780 The answer is: decreased minute volume, hypercapnia

A patient with respiratory splinting: A. is breathing shallowly to alleviate chest pain. B. is holding his or her arm against the chest. C. is often tachypneic with deep breathing. D. has an increased tidal volume due to a chest injury.

Pathophysiology of Respiration, page 780 The answer is: is breathing shallowly to alleviate chest pain.

Intrapulmonary shunting is defined as: A. failure of blood to bypass an obstruction in a pulmonary artery. B. a decrease in the surface area of the alveoli caused by damage. C. the return of unoxygenated blood to the left side of the heart. D. a condition in which too much carbon dioxide is eliminated.

Pathophysiology of Respiration, page 781 The answer is: the return of unoxygenated blood to the left side of the heart.

All of the following factors would increase a person's respiratory rate, EXCEPT: A. narcotic analgesic use. B. increased metabolism. C. a rise in body temperature. D. the use of amphetamines.

Pathophysiology of Respiration, pages 779-780 The answer is: narcotic analgesic use.

A 100-pound violent young woman who requires four large paramedics to subdue and contain her is MOST likely under the influence of: A. ketamine. B. LSD. C. PCP. D. mescaline.

Pathophysiology, Assessment, and Management of Abuse of and Overdose With Specific Substances, page 1417 The answer is: PCP.

Organophosphates exert their effect by: A. agonizing the sympathetic nervous system. B. stimulating the cholinergic nervous system. C. blocking the parasympathetic nervous system. D. destroying the body's acetylcholine.

Pathophysiology, Assessment, and Management of Abuse of and Overdose With Specific Substances, page 1425 The answer is: stimulating the cholinergic nervous system.

A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should: A. start an IV line and give 1 mEq/mg of sodium bicarbonate. B. start an IV line and begin administering a saline fluid bolus. C. assess his blood glucose level and apply a cardiac monitor. D. give him 100 mg of thiamine IM and assess his blood pressure.

Pathophysiology, Assessment, and Management of Abuse of and Overdose With Specific Substances, page 1432 The answer is: assess his blood glucose level and apply a cardiac monitor.

You are dispatched to a residence for a 61-year-old woman with flu-like symptoms. Upon your arrival, the patient greets you at the door. She complains of a headache and nausea, and tells you that she has vomited twice. Her husband, who is lying on the couch in the living room, began experiencing the same symptoms at about the same time. You should: A. suspect that both patients have been exposed to cyanide. B. remove both patients from the residence at once. C. immediately open all of the windows in the house. D. carefully assess the residence for any unusual findings.

Pathophysiology, Assessment, and Management of Abuse of and Overdose With Specific Substances, pages 1425-1426 The answer is: remove both patients from the residence at once.

Common signs and symptoms of acute gastroenteritis include all of the following, EXCEPT: A. abdominal pain. B. fever. C. severe diarrhea. D. chest pain.

Pathophysiology, Assessment, and Management of Acute Infectious Conditions, page 1196 The answer is: chest pain.

Hepatic encephalopathy is a condition in which: A. acute hypoglycemia results from liver failure. B. alcohol progressively destroys the liver tissue. C. liver disease causes reduced brain function. D. the liver is acutely inflamed from a virus.

Pathophysiology, Assessment, and Management of Acute Infectious Conditions, page 1198 The answer is: liver disease causes reduced brain function.

Which of the following is an extrinsic cause of falls in the elderly? A. An uneven sidewalk B. A pathologic fracture C. Postural hypotension D. Dizziness or syncope

Pathophysiology, Assessment, and Management of Geriatric Trauma Emergencies, page 2237 The answer is: An uneven sidewalk

Which of the following statements regarding Grey Turner sign is ? A. Grey Turner sign is characterized by bruising around the umbilicus. B. Grey Turner sign is characterized by flank bruising and indicates internal bleeding. C. Grey Turner sign is the cessation of inspiration during abdominal palpation. D. The presence of Grey Turner sign should make you suspicious for hepatitis.

Pathophysiology, Assessment, and Management of Acute Inflammatory Conditions, page 1193 The answer is: Grey Turner sign is characterized by flank bruising and indicates internal bleeding.

Which of the following statements regarding Grey Turner sign is ? A. Grey Turner sign is characterized by bruising around the umbilicus. B. Grey Turner sign is the cessation of inspiration during abdominal palpation. C. The presence of Grey Turner sign should make you suspicious for hepatitis. D. Grey Turner sign is characterized by flank bruising and indicates internal bleeding.

Pathophysiology, Assessment, and Management of Acute Inflammatory Conditions, page 1193 The answer is: Grey Turner sign is characterized by flank bruising and indicates internal bleeding.

A patient with pancreatitis would MOST likely present with pain that: A. is localized to the epigastric area and may radiate to the back. B. radiates from the flank to the groin and external genitalia. C. improves when the patient is supine with the legs extended. D. originates in the right or left flank and radiates to the chest.

Pathophysiology, Assessment, and Management of Acute Inflammatory Conditions, page 1193 The answer is: is localized to the epigastric area and may radiate to the back.

A paramedic would MOST likely be infected with TB if he or she: A. was exposed to blood-stained vomitus of a patient with active TB. B. received a needlestick from a person suspected of having active TB. C. performed mouth-to-mouth resuscitation on a patient with active untreated TB. D. was close to a coughing patient who had a positive TB skin test.

Pathophysiology, Assessment, and Management of Airborne-Transmitted Diseases, page 1361 The answer is: performed mouth-to-mouth resuscitation on a patient with active untreated TB.

Common signs and symptoms of TB include all of the following, EXCEPT: A. hemoptysis. B. photophobia. C. a persistent cough. D. weight loss.

Pathophysiology, Assessment, and Management of Airborne-Transmitted Diseases, page 1362 The answer is: photophobia.

Abortion is defined as expulsion of the fetus, from any cause, before the ____ week of pregnancy. A. 24th B. 30th C. 18th D. 20th

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, page 2040 The answer is: 20th

Following delivery of a stillborn baby at 16 weeks, the mother presents with fever, abdominal tenderness, and a foul-smelling vaginal discharge. This clinical presentation is consistent with: A. trichomoniasis. B. bacterial vaginosis. C. a septic abortion. D. toxoplasmosis.

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, page 2041 The answer is: a septic abortion.

A 20-year-old female presents with severe lower abdominal pain. She does not believe that she is pregnant, but states that her breasts have been unusually tender and that she has been nauseated. What is the pathophysiology of this patient's suspected condition? A. High levels of estrogen are affecting the gastrointestinal system. B. The placenta has prematurely detached from the uterine wall. C. The normal flow of bile from the liver has been interrupted. D. A fertilized ovum is implanted somewhere other than the uterus.

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, page 2042 The answer is: A fertilized ovum is implanted somewhere other than the uterus.

A 30-year-old woman presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. What should you suspect? A. Threatened abortion B. Abruptio placenta C. Ruptured uterus D. Placenta previa

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, page 2042 The answer is: Abruptio placenta

Abruptio placenta is MOST accurately defined as: A. premature separation of a normally implanted placenta from the uterine wall. B. a placenta that implants low in the uterus and partially or fully covers the cervix. C. a condition in which the placenta progressively detaches from the uterine wall. D. separation of the placenta secondary to blunt maternal abdominal trauma.

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, page 2042 The answer is: premature separation of a normally implanted placenta from the uterine wall.

You are assessing a 36-year-old woman who is in the 33rd week of her pregnancy. The patient complains of bright red vaginal bleeding, but denies abdominal pain or cramping. She tells you that she last felt her baby move about 5 or 10 minutes ago. Fetal heart tones are audible at a rate of 130 beats/min. Gentle palpation of her abdomen reveals that it is soft and nontender. Which of your assessment findings is MOST suggestive of placenta previa? A. Audible fetal heart tones B. Bright red vaginal bleeding C. The age of the patient D. Absence of abdominal pain

Pathophysiology, Assessment, and Management of Bleeding Related to Pregnancy, pages 2042-2043 The answer is: Absence of abdominal pain

Which of the following statements regarding burns in the pediatric patient is ? A. A burn that is characterized by clear demarcation lines is generally suggestive of an unintentional burn. B. A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area. C. Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients. D. A child's larger skin surface-to-body mass ratio increases his or her susceptibility to heat and fluid loss.

Pathophysiology, Assessment, and Management of Burns, page 2192 The answer is: A child's larger skin surface-to-body mass ratio increases his or her susceptibility to heat and fluid loss.

A 19-year-old man presents with a decreased level of consciousness. According to his girlfriend, he has no known medical problems and takes no medications. Initial treatment for this patient involves: A. ensuring airway patency and adequate breathing. B. evaluating his cardiac rhythm with the ECG monitor. C. performing a rapid check of his blood glucose level. D. administering oxygen via nonrebreathing mask.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1109 The answer is: ensuring airway patency and adequate breathing.

Which of the following statements regarding burns in the pediatric patient is ? A. A child's larger skin surface-to-body mass ratio increases his or her susceptibility to heat and fluid loss. B. A burn that is characterized by clear demarcation lines is generally suggestive of an unintentional burn. C. A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area. D. Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients.

Pathophysiology, Assessment, and Management of Burns, page 2192 The answer is: A child's larger skin surface-to-body mass ratio increases his or her susceptibility to heat and fluid loss.

The preferred initial pharmacologic agent for pediatric bradycardia is: A. dobutamine. B. atropine. C. amiodarone. D. epinephrine.

Pathophysiology, Assessment, and Management of Cardiovascular Emergencies, page 2162 The answer is: epinephrine.

A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child's mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child's ventilations with high-flow oxygen, your partner informs you that the child's heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should: A. establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate. B. ask your partner to insert an IO catheter and administer epinephrine 1:10,000. C. attempt immediate transcutaneous pacing while continuing ventilation assistance. D. initiate one-rescuer CPR while your partner attempts to establish vascular access.

Pathophysiology, Assessment, and Management of Cardiovascular Emergencies, pages 2160-2162 The answer is: initiate one-rescuer CPR while your partner attempts to establish vascular access.

A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. You assessment of her chest reveals a segment of obviously fractured ribs that bulges outward during exhalation. Her breathing is labored and shallow and her oxygen saturation is 80%. You should: A. position her on her injured side and monitor her breathing. B. apply oxygen via nasal cannula at 6 L/min and transport. C. assist her ventilations with a bag-mask device and 100% oxygen. D. apply pressure to the segment of ribs as the patient inhales.

Pathophysiology, Assessment, and Management of Chest Wall Injuries, pages 1795-1796 The answer is: assist her ventilations with a bag-mask device and 100% oxygen.

Which of the following interventions would MOST likely be performed on a stroke patient in the prehospital setting? A. Antihypertensive therapy B. Aspirin administration C. Endotracheal intubation D. Fibrinolytic therapy

Pathophysiology, Assessment, and Management of Common Neurologic Disorders, pages 1102-1108 The answer is: Endotracheal intubation

As intracranial pressure rises: A. the brain becomes hypocarbic. B. brainstem herniation may occur. C. mean arterial pressure decreases. D. the heart rate acutely increases.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1101 The answer is: brainstem herniation may occur.

The MOST immediate and significant complication associated with a hemorrhagic stroke is: A. hypertension and bradycardia. B. acute hypovolemic shock. C. mean arterial pressure increase. D. increased intracranial pressure.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1101 The answer is: increased intracranial pressure.

Which of the following would MOST likely cause a sustained increase in intracranial pressure? A. Frequent coughing B. Bearing down C. Projectile vomiting D. Intracranial tumor

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1102 The answer is: Intracranial tumor

Hyperventilating a patient who has increased intracranial pressure (ICP) will: A. increase the carbon dioxide levels in the brain through vasodilation. B. constrict the cerebral vasculature and decrease cerebral perfusion. C. decrease ICP and maintain adequate cerebral perfusion. D. dilate the cerebral vasculature and cause further increases in ICP.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1103 The answer is: constrict the cerebral vasculature and decrease cerebral perfusion.

A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient's medical history from her husband, the MOST important question to ask him is: A. "Is your wife allergic to aspirin or contrast dye?" B. "When did you first notice your wife's symptoms?" C. "Does your wife have a history of diabetes?" D. "When did your wife last see her physician?"

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1108 The answer is: "When did you first notice your wife's symptoms?"

A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient's medical history from her husband, the MOST important question to ask him is: A. "When did you first notice your wife's symptoms?" B. "Does your wife have a history of diabetes?" C. "When did your wife last see her physician?" D. "Is your wife allergic to aspirin or contrast dye?"

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1108 The answer is: "When did you first notice your wife's symptoms?"

A 19-year-old man presents with a decreased level of consciousness. According to his girlfriend, he has no known medical problems and takes no medications. Initial treatment for this patient involves: A. administering oxygen via nonrebreathing mask. B. performing a rapid check of his blood glucose level. C. ensuring airway patency and adequate breathing. D. evaluating his cardiac rhythm with the ECG monitor.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1109 The answer is: ensuring airway patency and adequate breathing.

An idiopathic seizure is one in which: A. a part of the brain is affected. B. the cause is not known. C. a postictal phase is not present. D. the entire brain is affected.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, page 1114 The answer is: the cause is not known.

An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient's wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should: A. start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg. B. suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route. C. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke. D. consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1099-1101 The answer is: rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.

An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient's wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should: A. suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route. B. start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg. C. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke. D. consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1099-1101 The answer is: rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.

Which of the following would have the MOST negative effect on the outcome of a patient with an intracranial hemorrhage? A. Tachycardia B. Slow rise in intracranial pressure C. Hypertension D. Hypotension

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1101-1102 The answer is: Hypotension

Prehospital treatment for a patient with a suspected stroke may include all of the following, EXCEPT: A. diazepam or lorazepam. B. crystalloid fluid boluses. C. up to 325 mg of aspirin. D. 30° elevation of the head.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1102-1103 The answer is: up to 325 mg of aspirin.

You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient's supervisor states that she has a history of seizures and takes Tegretol. The patient's blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes: A. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. B. establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. C. giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. D. administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1113-1116 The answer is: administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient's supervisor states that she has a history of seizures and takes Tegretol. The patient's blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes: A. establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. B. administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. C. giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. D. administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

Pathophysiology, Assessment, and Management of Common Neurologic Emergencies, pages 1113-1116 The answer is: administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.

Women who experience hyperemesis gravidarum: A. develop the condition secondary to increased progesterone and decreased human chorionic gonadotropin levels. B. have been pregnant at least two times and are commonly underweight. C. vomit once or twice a day, usually during the morning hours, and often develop hyperglycemia as a result. D. have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.

Pathophysiology, Assessment, and Management of Complications Related to Pregnancy, page 2038 The answer is: have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.

Women who experience hyperemesis gravidarum: A. have been pregnant at least two times and are commonly underweight. B. develop the condition secondary to increased progesterone and decreased human chorionic gonadotropin levels. C. vomit once or twice a day, usually during the morning hours, and often develop hyperglycemia as a result. D. have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.

Pathophysiology, Assessment, and Management of Complications Related to Pregnancy, page 2038 The answer is: have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.

You are delivering a baby who was in a breech presentation. The baby's body has delivered, and you are attempting to deliver its head by lifting its body upward. After about 3 minutes, the baby's head has not delivered. You should: A. support the baby's body, carefully turn the mother on her left side, and transport expeditiously. B. place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall. C. elevate the mother's hips and apply gentle traction to the baby's body until the head has delivered. D. elevate the mother's hips with pillows, administer high-flow oxygen, and transport immediately.

Pathophysiology, Assessment, and Management of Complications of Delivery, page 2054 The answer is: place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall.

When caring for a prolapsed umbilical cord, you should: A. position the mother in a left lateral recumbent position with her knees flexed into her abdomen. B. instruct the mother to push during each contraction to facilitate passage of the baby past the cord. C. keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital. D. have your partner cover the exposed portion of the umbilical cord with dry, sterile dressings.

Pathophysiology, Assessment, and Management of Complications of Delivery, page 2055 The answer is: keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital.

Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury? A. Transport to an appropriate medical facility B. Pain reduction with cold and analgesia C. Prehospital fracture reduction D. Prevention of gross contamination

Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, page 1863 The answer is: Prehospital fracture reduction

Which of the following is typically the first complaint in a patient who is developing compartment syndrome? A. Disproportionate pain B. Numbness and tingling C. Absent distal pulses D. Pallor to the extremity

Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, page 1864 The answer is: Disproportionate pain

You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She states that her left leg has been painful, red, and swollen. Based on this patient's clinical presentation, you should suspect: A. spontaneous pneumothorax. B. hyperventilation syndrome. C. a pleural effusion. D. acute pulmonary embolism

Pathophysiology, Assessment, and Management of Conditions Outside the Lung Parenchyma, page 949 The answer is: acute pulmonary embolism

An autoimmune disorder in which the body attacks the myelin of the brain and spinal cord is called: A. a dystonic reaction. B. multiple sclerosis. C. Guillain-Barre syndrome. D. muscular dystrophy.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1121 The answer is: multiple sclerosis.

The MOST common sign of an infectious disease of the nervous system is the presence of: A. seizures. B. a headache. C. a fever. D. tachycardia.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1127 The answer is: a fever.

A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include: A. diphenhydramine, 25 mg. B. promethazine, 25 mg. C. ondansetron, 4 mg. D. diazepam, 5 mg.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1127 The answer is: diphenhydramine, 25 mg.

A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include: A. promethazine, 25 mg. B. diazepam, 5 mg. C. ondansetron, 4 mg. D. diphenhydramine, 25 mg.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1127 The answer is: diphenhydramine, 25 mg.

A patient with suspected meningitis involuntarily flexes her knees when her head is flexed toward her chest. This is called: A. Kernig sign. B. Grey Turner sign. C. Brudzinski sign. D. Cullen sign.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1128 The answer is: Brudzinski sign.

Which of the following signs or symptoms are MOST consistent with meningitis in an infant? A. High fever, drooling, and tachycardia B. High-pitched cry and bulging fontanelles C. Low-grade fever and depressed fontanelles D. Kehr sign, vomiting, and poor skin turgor

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1128 The answer is: High-pitched cry and bulging fontanelles

Which of the following signs or symptoms are MOST consistent with meningitis in an infant? A. Low-grade fever and depressed fontanelles B. Kehr sign, vomiting, and poor skin turgor C. High fever, drooling, and tachycardia D. High-pitched cry and bulging fontanelles

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, page 1128 The answer is: High-pitched cry and bulging fontanelles

A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should: A. advise her to take ibuprofen and to follow up with her physician. B. conclude that she has postpolio syndrome and give her fentanyl. C. provide supportive care and safely transport her to the hospital. D. assist her with her prescribed insulin to lower her blood glucose.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, pages 1129-1130 The answer is: provide supportive care and safely transport her to the hospital.

A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should: A. provide supportive care and safely transport her to the hospital. B. assist her with her prescribed insulin to lower her blood glucose. C. advise her to take ibuprofen and to follow up with her physician. D. conclude that she has postpolio syndrome and give her fentanyl.

Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor Neuron Disorders, pages 1129-1130 The answer is: provide supportive care and safely transport her to the hospital.

The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is: A. medication use prior to your arrival. B. a recent medication regimen change. C. a recent emergency department visit. D. prior intubation for the same problem.

Patient Assessment, page 921 The answer is: prior intubation for the same problem.

A 49-year-old woman presents with a severe headache, a temperature of 103.2°F, and photosensitivity. Her blood pressure is 140/76 mm Hg, pulse rate is 120 beats/min and strong, and respiratory rate is 22 breaths/min and regular. While caring for this patient, it is MOST important to: A. apply a cardiac monitor and assess her tachycardia. B. protect yourself from any nasopharyngeal secretions. C. attempt to assist her ventilations with a bag-mask device. D. treat her as though she is experiencing viral meningitis.

Pathophysiology, Assessment, and Management of Droplet-Transmitted Diseases, page 1358 The answer is: protect yourself from any nasopharyngeal secretions.

A 49-year-old woman presents with a severe headache, a temperature of 103.2°F, and photosensitivity. Her blood pressure is 140/76 mm Hg, pulse rate is 120 beats/min and strong, and respiratory rate is 22 breaths/min and regular. While caring for this patient, it is MOST important to: A. protect yourself from any nasopharyngeal secretions. B. attempt to assist her ventilations with a bag-mask device. C. apply a cardiac monitor and assess her tachycardia. D. treat her as though she is experiencing viral meningitis.

Pathophysiology, Assessment, and Management of Droplet-Transmitted Diseases, page 1358 The answer is: protect yourself from any nasopharyngeal secretions.

You are dispatched to a high school where a 16-year-old female was stabbed in the eye with a pencil. The patient is conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient's injury includes: A. irrigating the injured eye with sterile saline, covering both eyes with a protective eye shield, and transporting immediately. B. covering the affected eye with a moist, sterile dressing, applying gently pressure to reduce intraocular pressure, and transporting at once. C. applying an icepack to the affected eye, administering 1 µg/kg of fentanyl IM, elevating the patient's legs, and transporting. D. covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly.

Pathophysiology, Assessment, and Management of Eye Injuries, page 1693 The answer is: covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly.

You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes: A. leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route. B. asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting. C. removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting. D. carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation.

Pathophysiology, Assessment, and Management of Eye Injuries, pages 1694-1696 The answer is: carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation.

Because significant force is required to fracture the mandible: A. most mandibular fractures are associated with a spinal fracture. B. it is often fractured in more than one place and is unstable to palpation. C. patients with a possible mandibular fracture should be intubated routinely. D. a mandibular fracture can be ruled out in cases of minor blunt facial trauma.

Pathophysiology, Assessment, and Management of Face Injuries, page 1684 The answer is: it is often fractured in more than one place and is unstable to palpation.

A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should: A. assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus. B. perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer's boluses to maintain a systolic blood pressure of at least 90 mm Hg. C. suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted. D. turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.

Pathophysiology, Assessment, and Management of Gastrointestinal Bleeding, page 1184 The answer is: turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.

A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should: A. perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer's boluses to maintain a systolic blood pressure of at least 90 mm Hg. B. suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted. C. turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion. D. assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus.

Pathophysiology, Assessment, and Management of Gastrointestinal Bleeding, page 1184 The answer is: turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.

Common signs of bleeding in the upper gastrointestinal tract include all of the following, EXCEPT: A. hematochezia. B. melena. C. dark, tarry stools. D. hematemesis.

Pathophysiology, Assessment, and Management of Gastrointestinal Bleeding, pages 1183-1184 The answer is: hematochezia.

During your assessment of a 79-year-old woman who was involved in a motor vehicle crash, you find that she is responsive to pain only and is breathing with a marked reduction in tidal volume. Your rapid assessment reveals that she has ecchymosis and crepitus over several of her ribs. You should: A. immediately secure her airway with an endotracheal tube because she is at increased risk for aspiration. B. assist her ventilations with a bag-mask device, delivering just enough volume to produce visible chest rise. C. avoid any form of positive pressure ventilation, as this may cause barotrauma and a pneumothorax. D. stabilize her fractured ribs with bulky dressings and administer high-flow oxygen via nonrebreathing mask.

Pathophysiology, Assessment, and Management of Geriatric Trauma Emergencies, page 2238 The answer is: assist her ventilations with a bag-mask device, delivering just enough volume to produce visible chest rise.

Elderly people are more susceptible to intracranial bleeding because of: A. depletion of cerebrospinal fluid. B. a marked increase in brain size. C. enlargement of the subdural space. D. constriction of the cerebral vessels.

Pathophysiology, Assessment, and Management of Geriatric Trauma Emergencies, page 2238 The answer is: enlargement of the subdural space.

Elderly people are more susceptible to intracranial bleeding because of: A. depletion of cerebrospinal fluid. B. constriction of the cerebral vessels. C. enlargement of the subdural space. D. a marked increase in brain size.

Pathophysiology, Assessment, and Management of Geriatric Trauma Emergencies, page 2238 The answer is: enlargement of the subdural space.

Excessive alcohol consumption can lead to low blood glucose levels because: A. alcohol depletes glycogen stores in the liver. B. alcohol blocks the pancreatic release of insulin. C. alcohol destroys any insulin that is produced. D. alcohol antagonizes the pancreatic beta cells.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1267 The answer is: alcohol depletes glycogen stores in the liver.

Excessive alcohol consumption can lead to low blood glucose levels because: A. alcohol destroys any insulin that is produced. B. alcohol blocks the pancreatic release of insulin. C. alcohol depletes glycogen stores in the liver. D. alcohol antagonizes the pancreatic beta cells.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1267 The answer is: alcohol depletes glycogen stores in the liver.

A person with type 1 diabetes: A. is not as likely to experience hypoglycemia as a person with type 2 diabetes. B. can often control his or her diabetes with a proper diet and regular exercise. C. generally does not produce any insulin and requires daily insulin injections. D. is often an older person whose pancreas does not produce adequate insulin.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1267 The answer is: generally does not produce any insulin and requires daily insulin injections.

The tissues of the central nervous system: A. can only survive for about an hour without glucose. B. depend entirely on glucose as their source of energy. C. can metabolize fat and proteins to make energy. D. are able to store glucose and use just what is needed.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1271 The answer is: depend entirely on glucose as their source of energy.

You are dispatched to the residence of a 60-year-old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several "small strokes." In addition to managing her airway, you should: A. perform a field glucose test to rule out hypoglycemia. B. start an IV line and give her 50 mL of 50% dextrose. C. start an IV line and give her a 20-mL/kg fluid bolus. D. avoid giving her glucose because of her small strokes.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1272 The answer is: perform a field glucose test to rule out hypoglycemia.

You are dispatched to the residence of a 60-year-old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several "small strokes." In addition to managing her airway, you should: A. start an IV line and give her a 20-mL/kg fluid bolus. B. start an IV line and give her 50 mL of 50% dextrose. C. perform a field glucose test to rule out hypoglycemia. D. avoid giving her glucose because of her small strokes.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1272 The answer is: perform a field glucose test to rule out hypoglycemia.

Prior to administering 10% dextrose (D10) via IV, it is MOST important to: A. protect the airway with an endotracheal tube. B. ensure that the IV line is patent and freely flowing. C. confirm a blood glucose reading of less than 40 mg/dL. D. draw blood for later analysis in the emergency department.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1273 The answer is: ensure that the IV line is patent and freely flowing.

A patient with diabetic ketoacidosis experiences polydipsia as a result of: A. inefficient nutrient utilization. B. dehydration. C. metabolic acidosis. D. hyperglycemia.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, page 1275 The answer is: dehydration.

Common symptoms of type 2 diabetes include all of the following, EXCEPT: A. thirst. B. blurred vision. C. dysuria. D. fatigue.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1268-1269 The answer is: dysuria.

A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will MOST likely find that the patient is: A. breathing deeply. B. hyperglycemic. C. tachypneic. D. dehydrated.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1270-1274 The answer is: tachypneic.

A 16-year-old boy collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to: A. attach the ECG leads and be prepared to defibrillate. B. start an IV line and administer an antiarrhythmic drug. C. rapidly assess the chest for signs of a sternal fracture. D. perform intubation to secure the patient's airway.

Pathophysiology, Assessment, and Management of Myocardial Injuries, page 1809 The answer is: attach the ECG leads and be prepared to defibrillate.

You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being "drunk." Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient's ventilations, you start an IV and administer 125ml dextrose 10%. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should: A. conclude that he will require immediate definitive care and begin transport. B. administer a second dose of dextrose and prepare for immediate transport. C. intubate his trachea to prevent aspiration and transport him immediately. D. give him 1 mg of glucagon IM and reassess his blood glucose.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1273-1274 The answer is: administer a second dose of dextrose and prepare for immediate transport.

You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being "drunk." Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient's ventilations, you start an IV and administer 125ml dextrose 10%. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should: A. intubate his trachea to prevent aspiration and transport him immediately. B. conclude that he will require immediate definitive care and begin transport. C. administer a second dose of dextrose and prepare for immediate transport. D. give him 1 mg of glucagon IM and reassess his blood glucose.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1273-1274 The answer is: administer a second dose of dextrose and prepare for immediate transport.

A 30-year-old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm Hg, her pulse is 110 beats/min and full, and her respirations are rapid and deep. On the basis of this patient's clinical presentation, she will MOST likely require: A. 25 g of 50% dextrose. B. crystalloid fluid hydration. C. 0.5 to 1 mg of glucagon. D. in-hospital antibiotics.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1274-1277 The answer is: crystalloid fluid hydration.

A 30-year-old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm Hg, her pulse is 110 beats/min and full, and her respirations are rapid and deep. On the basis of this patient's clinical presentation, she will MOST likely require: A. crystalloid fluid hydration. B. 25 g of 50% dextrose. C. in-hospital antibiotics. D. 0.5 to 1 mg of glucagon.

Pathophysiology, Assessment, and Management of Glucose Metabolic Derangements, pages 1274-1277 The answer is: crystalloid fluid hydration.

Open fractures of the cranial vault: A. are uncommonly associated with multisystem trauma. B. cause death due to increased intracranial pressure. C. are associated with a high risk of bacterial meningitis. D. typically cause lethal atrial cardiac dysrhythmias.

Pathophysiology, Assessment, and Management of Head Injuries, page 1734 The answer is: are associated with a high risk of bacterial meningitis.

Which of the following signs of a basilar skull fracture would MOST likely be observed in the prehospital setting? A. Battle's sign B. Bruising over the mastoid process C. Ecchymosis around the eyes D. Cerebrospinal fluid drainage from the ear

Pathophysiology, Assessment, and Management of Head Injuries, page 1735 The answer is: Cerebrospinal fluid drainage from the ear

A 12-year-old child with a history of hemophilia presents with a headache and slurred speech. What should you suspect? A. Bacterial meningitis B. Cerebral thrombus C. Hemorrhagic shock D. Intracranial bleeding

Pathophysiology, Assessment, and Management of Hematologic, Oncologic, and Immunologic Emergencies, page 2178 The answer is: Intracranial bleeding

You are transporting a conscious middle-aged woman with anterior neck trauma. She is on high-flow oxygen, has spinal precautions in place, and has a large-bore IV line of normal saline in place. When you reassess her vital signs, you note that her blood pressure is 90/64 mm Hg, her pulse rate is 120 beats/min, and her respirations are 22 breaths/min with adequate depth. You should: A. begin assisting her ventilations with a bag-mask device, rapidly infuse 2 L of IV fluid, and reassess. B. keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. C. elevate her legs, apply a blanket, and administer IV fluid boluses until her heart rate is within a normal range. D. start a second IV line and administer crystalloid IV fluids until her systolic blood pressure is at least 100 mm Hg.

Pathophysiology, Assessment, and Management of Injuries to the Anterior Part of the Neck, page 1703 The answer is: keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion.

Immediate treatment for an open pneumothorax involves: A. assisting ventilations with a bag-mask device. B. converting the pneumothorax to a closed injury. C. covering the open wound with a porous dressing. D. administering oxygen via nonrebreathing mask.

Pathophysiology, Assessment, and Management of Lung Injuries, page 1799 The answer is: converting the pneumothorax to a closed injury.

Which of the following is an appropriate site for performing a needle thoracentesis? A. Just below the second rib into the intercostal space at the midaxillary line B. Inferior to the third rib into the intercostal space at the midclavicular line C. Superior to the third rib into the intercostal space at the midclavicular line D. Just above the sixth rib into the intercostal space at the midaxillary line

Pathophysiology, Assessment, and Management of Lung Injuries, page 1802 The answer is: Superior to the third rib into the intercostal space at the midclavicular line

Unlike a tension pneumothorax, a massive hemothorax would MOST likely present with: A. severe respiratory distress. B. signs of shock. C. collapsed jugular veins. D. tracheal deviation.

Pathophysiology, Assessment, and Management of Lung Injuries, page 1805 The answer is: collapsed jugular veins.

Definitive treatment for a patient with end-stage renal disease involves: A. inotropic drugs. B. crystalloid fluids. C. diuretic therapy. D. kidney transplant.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1226 The answer is: kidney transplant.

COPD is characterized by: A. changes in pulmonary structure and function that are progressive and irreversible. B. widespread alveolar collapse due to increased pressure during the exhalation phase. C. narrowing of the smaller airways that is often reversible with prompt treatment. D. small airway spasms during the inhalation phase, resulting in progressive hypoxia.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 939 The answer is: changes in pulmonary structure and function that are progressive and irreversible.

COPD is characterized by: A. narrowing of the smaller airways that is often reversible with prompt treatment. B. widespread alveolar collapse due to increased pressure during the exhalation phase. C. small airway spasms during the inhalation phase, resulting in progressive hypoxia. D. changes in pulmonary structure and function that are progressive and irreversible.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 939 The answer is: changes in pulmonary structure and function that are progressive and irreversible.

The primary treatment of bronchospasm is: A. assisted ventilation. B. corticosteroid therapy. C. bronchodilator therapy. D. humidified oxygen.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 941 The answer is: bronchodilator therapy.

You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing: A. COPD exacerbation. B. end-stage COPD. C. bronchitis. D. pneumonia.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 942 The answer is: pneumonia.

Patients with decompensated asthma or COPD who require positive-pressure ventilation: A. should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide. B. may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. C. should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease. D. should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 944 The answer is: may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.

Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A. a pulmonary embolism. B. a pneumothorax. C. bronchospasm. D. pneumonia.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, page 944 The answer is: pneumonia.

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: A. administer a sedative and a paralytic and then intubate his trachea. B. begin assisting his ventilations with a bag-mask device and 100% oxygen. C. remove the nonrebreathing mask and apply a nasal cannula. D. insert a nasal airway, apply a CPAP unit, and notify medical control.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, pages 943-944 The answer is: begin assisting his ventilations with a bag-mask device and 100% oxygen.

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: A. insert a nasal airway, apply a CPAP unit, and notify medical control. B. administer a sedative and a paralytic and then intubate his trachea. C. remove the nonrebreathing mask and apply a nasal cannula. D. begin assisting his ventilations with a bag-mask device and 100% oxygen.

Pathophysiology, Assessment, and Management of Obstructive Lower Airway Diseases, pages 943-944 The answer is: begin assisting his ventilations with a bag-mask device and 100% oxygen.

During an explosion, a 42-year-old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you should be MOST concerned with: A. applying a bulky dressing to the laceration and securing it firmly with a bandage. B. carefully examining his ear to determine if his tympanic membrane is ruptured. C. administering high-flow oxygen via nonrebreathing mask as soon as possible. D. covering the laceration with an occlusive dressing and controlling the bleeding.

Pathophysiology, Assessment, and Management of Oral and Dental Injuries, pages 1700-1701 The answer is: covering the laceration with an occlusive dressing and controlling the bleeding.

An infant or small child who falls from a significant height would MOST likely experience: A. lateral thoracic trauma. B. lumbar spine fractures. C. bilateral femur fractures. D. a traumatic brain injury.

Pathophysiology, Assessment, and Management of Pediatric Trauma Emergencies, page 2187 The answer is: a traumatic brain injury.

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary survey reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid exam of her body does not reveal any gross injuries or bleeding. You should: A. manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min. B. open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device. C. suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask. D. insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea.

Pathophysiology, Assessment, and Management of Pediatric Trauma Emergencies, pages 2187-2188 The answer is: open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.

A 29-year-old woman complains of abdominal cramping and vaginal bleeding. The patient is 22 weeks pregnant and tells you that she passed several large clots of blood while using the toilet. Your partner confirms that she can clearly recognize a small fetus in the toilet. The patient is conscious and alert, but her skin is diaphoretic. Her blood pressure is 92/56 mm Hg, pulse rate is 114 beats/min and regular, and respirations are 24 breaths/min. The MOST appropriate treatment for this patient involves: A. oxygen by face mask at 8 L/min, placing her in a left lateral recumbent position, a sanitary pad over her vagina, emotional support, and transport to the hospital. B. supplemental oxygen, careful packing of the vagina to control the bleeding, an IV line set to keep the vein open, emotional support as needed, and transport. C. high-flow oxygen, a sanitary pad over her vagina, a large-bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport. D. oxygen via nasal cannula at 2 L/min, two large-bore IV lines, a 20-mL/kg normal saline bolus, emotional support, and rapid transport to the hospital.

Pathophysiology, Assessment, and Management of Postpartum Complications, page 2056 The answer is: high-flow oxygen, a sanitary pad over her vagina, a large-bore IV, crystalloid boluses as needed to maintain adequate perfusion, emotional support, and prompt transport.

Uterine inversion occurs when: A. the placenta fails to detach properly and adheres to the uterine wall when it is expelled. B. postpartum bleeding is improperly managed with inadequate massage of the uterine fundus. C. excessive postpartum hemorrhage causes uterine ischemia and subsequent expulsion from the vagina. D. the musculature of the uterine fundus is inherently weak, causing the uterus to prolapse.

Pathophysiology, Assessment, and Management of Postpartum Complications, page 2056 The answer is: the placenta fails to detach properly and adheres to the uterine wall when it is expelled.

After 50 years of age, there is an increase in urinary tract infections in men because: A. diabetes is most common after 50 years of age. B. renal function markedly declines after 50 years of age. C. normal bacterial flora enter the urethra. D. the urethra is obstructed by the prostate.

Pathophysiology, Assessment, and Management of Renal Conditions, page 2229 The answer is: the urethra is obstructed by the prostate.

You are dispatched to a daycare center for a 5-year-old girl with trouble breathing. Upon arriving at the scene, you assess the child and note that she is responsive to pain only, has weak intercostal retractions, and is breathing at a slow rate with shallow depth. You should: A. begin assisting her ventilations with a bag-mask device and assess her pulse rate. B. deliver two effective rescue breaths and assess her pulse for at least 5 seconds. C. administer high-flow oxygen, assess her cardiac rhythm, and establish IO access. D. apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, page 2137 The answer is: begin assisting her ventilations with a bag-mask device and assess her pulse rate.

A typical finding for a foreign body aspiration is: A. a child with recent flu-like symptoms who presents with acute stridor. B. a temperature less than 102°F with sudden drooling, crowing, and dyspnea. C. an otherwise healthy child with a progressive increase in work of breathing. D. an afebrile child with a sudden onset of coughing or gagging while playing.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, page 2138 The answer is: an afebrile child with a sudden onset of coughing or gagging while playing.

A typical finding for a foreign body aspiration is: A. a temperature less than 102°F with sudden drooling, crowing, and dyspnea. B. an otherwise healthy child with a progressive increase in work of breathing. C. a child with recent flu-like symptoms who presents with acute stridor. D. an afebrile child with a sudden onset of coughing or gagging while playing.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, page 2138 The answer is: an afebrile child with a sudden onset of coughing or gagging while playing.

A 9-year-old, 55-pound girl presents with generalized hives, marked facial swelling, and loud inspiratory stridor. She is conscious but appears sleepy. You can MOST rapidly improve this child's condition by: A. administering a nebulized bronchodilator. B. administering epinephrine IM. C. starting an epinephrine infusion. D. administering diphendydramine.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, page 2140 The answer is: administering epinephrine IM.

You are providing high-flow oxygen to a 3-year-old boy with severe respiratory distress. When you reassess him, you note that he is pale and his respiratory rate has decreased from 30 breaths/min to 12 breaths/min. You should: A. begin treatment with a beta-2 agonist medication. B. secure his airway with an endotracheal tube. C. assist his ventilations with a bag-mask device. D. auscultate his lung sounds and reassess his SpO2.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, pages 2137-2138 The answer is: assist his ventilations with a bag-mask device.

You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mother's lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should: A. establish vascular access, give an appropriate dose of methylprednisolone, and transport. B. administer high-flow oxygen via pediatric nonrebreathing mask, keep him calm, and transport. C. allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital. D. administer 0.5 mL of racemic epinephrine via nebulizer, apply the cardiac monitor, and transport.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, pages 2140-2141 The answer is: allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital.

Appropriate bag-mask ventilation for an apneic 3-year-old child involves: A. hyperextending the head to ensure an adequate mask-to-face seal. B. ensuring a consistently delivered tidal volume of 400 mL. C. providing hyperventilation to ensure carbon dioxide elimination. D. delivering each breath over 1 second until the chest rises visibly.

Pathophysiology, Assessment, and Management of Respiratory Emergencies, pages 2148-2149 The answer is: delivering each breath over 1 second until the chest rises visibly.

You are dispatched to an apartment complex for a 20-year-old woman who is sick. When you arrive at the scene and begin assessing the patient, she tells you that she has been experiencing a purulent vaginal discharge, but denies vaginal bleeding or a fever. Her blood pressure is 104/64 mm Hg, pulse rate is 88 beats/min and strong, and respirations are 14 breaths/min and regular. What should you suspect? A. Chlamydia B. Gonorrhea C. Syphilis D. Pelvic inflammatory disease

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1365 The answer is: Gonorrhea

You are dispatched to an apartment complex for a 20-year-old woman who is sick. When you arrive at the scene and begin assessing the patient, she tells you that she has been experiencing a purulent vaginal discharge, but denies vaginal bleeding or a fever. Her blood pressure is 104/64 mm Hg, pulse rate is 88 beats/min and strong, and respirations are 14 breaths/min and regular. What should you suspect? A. Syphilis B. Chlamydia C. Gonorrhea D. Pelvic inflammatory disease

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1365 The answer is: Gonorrhea

Which of the following statements regarding genital herpes is ? A. Acyclovir is used to reduce a herpetic outbreak, but there is no cure. B. The incubation period for genital herpes often lasts up to 3 weeks. C. In females, genital herpes presents as a single vesicle on the vulva. D. The lesions of genital herpes remain infectious for 12 to 24 days.

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1366 The answer is: Acyclovir is used to reduce a herpetic outbreak, but there is no cure.

The primary infection with syphilis produces: A. dysuria and a purulent discharge in the urine. B. low-grade fever and pain in the genital area. C. numerous small pustules on the genitalia. D. an ulcerative chancre at the site of infection.

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1366 The answer is: an ulcerative chancre at the site of infection.

Nocturnal itching and the presence of a rash involving the hands are indicative of: A. herpes. B. scabies. C. shingles. D. lice.

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1367 The answer is: scabies.

A 70-year-old homeless man presents with a rash to his hands, wrists, and ankles. He denies any known allergies and states that the rash itches severely at night. His vital signs are stable, and he is breathing without difficulty. You should: A. be highly suspicious that he has body lice and use a high-level disinfectant when cleaning the ambulance. B. administer 25 mg of diphenhydramine IM and transport him to an appropriate medical facility. C. transport him to the hospital and thoroughly wash your hands after patient care has been completed. D. establish vascular access in case he begins to experience signs and symptoms of a severe allergic reaction.

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1367 The answer is: transport him to the hospital and thoroughly wash your hands after patient care has been completed.

A 70-year-old homeless man presents with a rash to his hands, wrists, and ankles. He denies any known allergies and states that the rash itches severely at night. His vital signs are stable, and he is breathing without difficulty. You should: A. be highly suspicious that he has body lice and use a high-level disinfectant when cleaning the ambulance. B. establish vascular access in case he begins to experience signs and symptoms of a severe allergic reaction. C. transport him to the hospital and thoroughly wash your hands after patient care has been completed. D. administer 25 mg of diphenhydramine IM and transport him to an appropriate medical facility.

Pathophysiology, Assessment, and Management of Sexually Transmitted Diseases, page 1367 The answer is: transport him to the hospital and thoroughly wash your hands after patient care has been completed.

You receive a call for a "sick child." When you arrive at the scene, the child's mother tells you that her 5-year-old son has had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his heart rate is 150 beats/min. The MOST appropriate treatment for this child involves: A. establishing IV access and administering a 20-mL/kg normal saline bolus, applying high-flow oxygen, administering 25% dextrose, and transporting. B. administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route. C. applying high-flow oxygen via pediatric nonrebreathing mask, assessing his blood glucose level, elevating his legs 12 inches, and transporting at once. D. administering supplemental oxygen, starting an IV line, assessing his blood glucose level, delivering at least two 20-mL/kg normal saline boluses, and transporting.

Pathophysiology, Assessment, and Management of Shock, page 2156 The answer is: administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route.

A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should suspect: A. tetanus. B. meningitis. C. a viral infection. D. a staph infection.

Pathophysiology, Assessment, and Management of Soft-Tissue Injuries to Specific Anatomic Sites, page 1630 The answer is: tetanus.

Hypotension during an episode of dehydration indicates that the body is: A. no longer capable of effectively pulling fluid from the interstitial space and the cellular area. B. shifting water from inside the cells to the interstitial space in an attempt to maintain perfusion. C. decompensating due to an excessive loss of blood as well as water and key electrolytes. D. compensating by releasing epinephrine and norepinephrine from the sympathetic nervous system.

Pathophysiology, Assessment, and Management of Specific Abdominal and Gastrointestinal Emergencies, page 1182 The answer is: no longer capable of effectively pulling fluid from the interstitial space and the cellular area.

Hypotension during an episode of dehydration indicates that the body is: A. shifting water from inside the cells to the interstitial space in an attempt to maintain perfusion. B. no longer capable of effectively pulling fluid from the interstitial space and the cellular area. C. decompensating due to an excessive loss of blood as well as water and key electrolytes. D. compensating by releasing epinephrine and norepinephrine from the sympathetic nervous system.

Pathophysiology, Assessment, and Management of Specific Abdominal and Gastrointestinal Emergencies, page 1182 The answer is: no longer capable of effectively pulling fluid from the interstitial space and the cellular area.

You respond to an industrial plant for a 42-year-old man with a chemical burn. Upon arrival at the scene, you find the patient to be ambulatory. He tells you that he was moving some bags of dry lime when one of the bags broke and spilled lime all over him. After donning the appropriate personal protective equipment, you should: A. remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water. B. remove all of his clothing, apply baking powder to neutralize the lime, and begin flushing his body with copious amounts of sterile saline. C. remove his clothing, carefully brush the lime away from his skin, but avoid flushing with water, as doing so will likely increase burn severity. D. avoid brushing any of the lime from his skin, as doing so may cause additional injury, and flush his entire body with water for 30 minutes.

Pathophysiology, Assessment, and Management of Specific Burns, page 1657 The answer is: remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water.

Unlike chemical burns, radiation burns: A. generally extend into the dermal layer. B. are typically confined to the epidermis. C. may appear hours or days after exposure. D. are immediately apparent after exposure.

Pathophysiology, Assessment, and Management of Specific Burns, page 1665 The answer is: may appear hours or days after exposure.

You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to: A. administer at least 2 L of normal saline solution to prevent renal failure. B. thoroughly assess and clean the entry and exit wounds to prevent an infection. C. remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. D. reassess his vital signs every 15 minutes and treat any fractures or dislocations.

Pathophysiology, Assessment, and Management of Specific Burns, pages 1662 The answer is: remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate.

A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves: A. continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary. B. instructing your partner to resume one-rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes. C. performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes. D. continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20 to 24 breaths per minute.

Pathophysiology, Assessment, and Management of Specific Burns, pages 1663-1664 The answer is: continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

Infarctions of the inferior myocardial wall are MOST often caused by: A. acute spasm of the circumflex artery. B. a blocked left anterior descending artery. C. blockage of the left coronary artery. D. occlusion of the right coronary artery.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1041 The answer is: occlusion of the right coronary artery.

Infarctions of the inferior myocardial wall are MOST often caused by: A. blockage of the left coronary artery. B. a blocked left anterior descending artery. C. acute spasm of the circumflex artery. D. occlusion of the right coronary artery.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1041 The answer is: occlusion of the right coronary artery.

Nitroglycerin is contraindicated for patients: A. with suspected right ventricular infarction. B. with suspected left circumflex artery occlusion. C. with a systolic BP less than 110 mm Hg. D. who are also taking beta-blocker medication.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1047 The answer is: with suspected right ventricular infarction.

A patient with right ventricular failure would most likely present with: A. collapsed jugular veins. B. rhonchi in the lungs. C. pulmonary edema. D. an enlarged liver.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1051 The answer is: an enlarged liver.

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm: A. is maximal from the onset. B. gradually becomes severe. C. is preceded by other symptoms. D. often waxes and wanes.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1063 The answer is: is maximal from the onset.

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm: A. often waxes and wanes. B. gradually becomes severe. C. is maximal from the onset. D. is preceded by other symptoms.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, page 1063 The answer is: is maximal from the onset.

A 56-year-old man presents with an acute onset chest pressure, shortness of breath, and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should: A. acquire a 12-lead ECG tracing. B. establish vascular access. C. obtain baseline vital signs. D. administer supplemental oxygen.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1044-1045 The answer is: administer supplemental oxygen.

A 56-year-old man presents with an acute onset chest pressure, shortness of breath, and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should: A. establish vascular access. B. acquire a 12-lead ECG tracing. C. obtain baseline vital signs. D. administer supplemental oxygen.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1044-1045 The answer is: administer supplemental oxygen.

A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she: A. was previously intubated for his or her condition. B. takes a bronchodilator and a corticosteroid. C. was recently evaluated in an emergency department. D. has used his or her inhaler twice in the previous week.

Patient Assessment, page 921 The answer is: was previously intubated for his or her condition.

You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should: A. give her a 250-mL saline bolus. B. reassess her blood pressure. C. administer 2 to 4 mg of morphine. D. repeat the nitroglycerin.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1045, 1047-1048 The answer is: reassess her blood pressure.

You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should: A. reassess her blood pressure. B. administer 2 to 4 mg of morphine. C. repeat the nitroglycerin. D. give her a 250-mL saline bolus.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1045, 1047-1048 The answer is: reassess her blood pressure.

Patients experiencing a right ventricular infarction: A. may present with hypotension. B. should not be given baby aspirin. C. often require higher doses of morphine. D. usually have anterior myocardial damage.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1047-1048 The answer is: may present with hypotension.

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of "breathing problem," for which he uses a prescribed inhaler and takes a "heart pill." You should suspect: A. right ventricular failure. B. acute COPD exacerbation. C. reactive airway disease. D. left ventricular failure.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1050-1053 The answer is: left ventricular failure.

Common signs of left ventricular failure include all of the following, EXCEPT: A. hypotension. B. confusion. C. hypertension. D. tachycardia.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1051-1053 The answer is: hypotension.

A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should: A. elevate the patient's legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure. B. place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure. C. start an IV line, administer 5 mg of midazolam, intubate the patient's trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital. D. keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.

Pathophysiology, Assessment, and Management of Specific Cardiovascular Conditions, pages 1056-1057 The answer is: keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.

Epinephrine is indicated during newborn resuscitation if: A. the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions. B. the heart rate does not increase above 80 beats/min after 30 to 60 seconds of effective positive pressure ventilation. C. profound central cyanosis persists despite 30 seconds of effective positive pressure ventilation with 100% supplemental oxygen. D. the newborn is bradycardic and thick secretions are hindering your ability to provide effective positive pressure ventilations.

Pathophysiology, Assessment, and Management of Specific Conditions, page 2087 The answer is: the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions.

A newborn is at GREATEST risk for meconium aspiration if he or she: A. requires positive pressure ventilations. B. is born at more than 42 weeks' gestation. C. is large for his or her gestational age. D. has respiratory depression at the time of birth.

Pathophysiology, Assessment, and Management of Specific Conditions, page 2088 The answer is: is born at more than 42 weeks' gestation.

In which of the following situations would a newborn MOST likely experience a seizure? A. Hyperglycemia B. 33 weeks' gestation C. Maternal aspirin use D. Post-term gestation

Pathophysiology, Assessment, and Management of Specific Conditions, page 2091 The answer is: 33 weeks' gestation

Newborn hypoglycemia is defined as a blood glucose of ___ mg/dL or lower. A. 60 B. 50 C. 45 D. 55

Pathophysiology, Assessment, and Management of Specific Conditions, page 2093 The answer is: 45

Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT: A. gross hematuria. B. painful urination. C. localized pain in the pelvis. D. increased urinary frequency.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1221 The answer is: gross hematuria.

Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT: A. localized pain in the pelvis. B. gross hematuria. C. painful urination. D. increased urinary frequency.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1221 The answer is: gross hematuria.

Urine output of less than 500 mL per day is called: A. anuria. B. dysuria. C. polyuria. D. oliguria.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1223 The answer is: oliguria.

A protein of the immune system that recognizes foreign substances is called a(n): A. antibody. B. bilirubin. C. pathogen. D. antigen.

The Circulatory System, page 333 The answer is: antibody.

You are dispatched to a residence for a 34-year-old woman who is "sick." Upon your arrival, the patient greets you at the door. She tells you that she began experiencing a dull aching pain in the left lower quadrant of her abdomen. She further states that she recently had her menstrual period, which was accompanied by more pain than usual. Her vital signs are stable, she is conscious and alert, and she denies vaginal bleeding or fever. This patient MOST likely has: A. a ruptured ovarian cyst. B. pelvic inflammatory disease. C. a tubo-ovarian abscess. D. an ectopic pregnancy.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1244 The answer is: a ruptured ovarian cyst.

A ruptured ovarian cyst typically presents with: A. chronic waxing and waning abdominal cramping between menstrual periods. B. dull or aching epigastric pain that radiates to the shoulders or lower back. C. a sudden onset of upper abdominal pain and nausea without vomiting. D. a sudden onset of abdominal pain that can be related to the menstrual cycle.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1244 The answer is: a sudden onset of abdominal pain that can be related to the menstrual cycle.

An obese 30-year-old female had two children within an 18-month time span. She presents with a feeling of "heaviness" in her pelvis and lower back pain. She states that the symptoms resolve slightly when she lies down. What should you suspect? A. Endometriosis B. Ectopic pregnancy C. Uterine prolapse D. Endometritis

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1245 The answer is: Uterine prolapse

Within a few days after having a miscarriage, a 33-year-old woman presents with malaise, fever, constipation, and pelvic pain. Her blood pressure is 124/84 mm Hg, pulse rate is 104 beats/min and strong, and respirations are 22 breaths/min and regular. You should be MOST suspicious for: A. a ruptured ovarian cyst. B. endometritis. C. pelvic inflammatory disease. D. acute cystitis.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1245 The answer is: endometritis.

Within a few days after having a miscarriage, a 33-year-old woman presents with malaise, fever, constipation, and pelvic pain. Her blood pressure is 124/84 mm Hg, pulse rate is 104 beats/min and strong, and respirations are 22 breaths/min and regular. You should be MOST suspicious for: A. endometritis. B. a ruptured ovarian cyst. C. acute cystitis. D. pelvic inflammatory disease.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1245 The answer is: endometritis.

How should you transport a patient who has a beer bottle stuck in her vagina? A. Left lateral recumbent position B. Knees flexed, legs together C. Supine with legs elevated D. Right lateral recumbent position

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1250 The answer is: Knees flexed, legs together

Which of the following statements regarding sickle cell disease is ? A. Patients with sickle cell disease are at a lower risk for thrombotic diseases because their blood contains fewer platelets. B. Sickle cell disease is an acquired blood disorder that exclusively affects the African American population. C. Patients with sickle cell disease become hypoxic because their misshapen red blood cells are poor carriers of oxygen. D. When the defective HbA gene is inherited from both parents, the patient will not develop the sickle cell trait.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1301 The answer is: Patients with sickle cell disease become hypoxic because their misshapen red blood cells are poor carriers of oxygen.

Anemia would result from all of the following conditions, EXCEPT: A. chronic hemorrhage. B. acute blood loss. C. erythrocyte hemolysis. D. an increase in iron.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1303 The answer is: an increase in iron.

Anemia resulting from an autoimmune disorder occurs when: A. hemoglobin becomes desaturated due to a massive infection. B. red blood cells are destroyed by the body's own antibodies. C. a patient receives blood of a type different than his or her own. D. the body's red blood cells destroy certain white blood cells.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1303 The answer is: red blood cells are destroyed by the body's own antibodies.

A painless, progressive enlargement of the lymphoid glands that most commonly affects the spleen and lymph nodes is called: A. sarcoma. B. Hodgkin lymphoma. C. non-Hodgkin lymphoma. D. adenocarcinoma.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1305 The answer is: Hodgkin lymphoma.

You are transferring a 60-year-old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of a prior stroke, and hypertension. The patient tells you that he feels a fluttering sensation in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190 beats/min. The patient's blood pressure is 116/70 mm Hg and he remains conscious and alert. You should: A. ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm. B. place the patient supine, elevate his legs 6 to 12 inches, and administer 150 mg of amiodarone over 10 minutes. C. administer 5 mg of midazolam, perform synchronized cardioversion with 50 joules, and reassess his cardiac rhythm. D. carefully auscultate his lung sounds and then administer a 500-mL bolus of normal saline solution.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1306 The answer is: ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.

A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should: A. transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure. B. start an IV line with normal saline and infuse 200 mL of normal saline per hour. C. monitor her cardiac rhythm, transport, and start an IV line en route to the hospital. D. recognize that she probably received an overaggressive dialysis treatment.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1228-1229 The answer is: monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

You receive a call to a residence for a patient who is "sick." Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should: A. ask her to sign a refusal of EMS transport form, have a neighbor sit with her until her husband gets home, and then return to service. B. tell her that her condition is critical and that you are legally required to transport her to the closest appropriate medical facility. C. notify her husband, explain the situation to him, and advise him that you will be transporting his wife to the hospital. D. advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1307 The answer is: advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

You receive a call to a residence for a patient who is "sick." Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should: A. tell her that her condition is critical and that you are legally required to transport her to the closest appropriate medical facility. B. ask her to sign a refusal of EMS transport form, have a neighbor sit with her until her husband gets home, and then return to service. C. advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death. D. notify her husband, explain the situation to him, and advise him that you will be transporting his wife to the hospital.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1307 The answer is: advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

Common central nervous system manifestations of anaphylactic shock include all of the following, EXCEPT: A. confusion. B. combativeness. C. anxiety. D. headache.

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1328 The answer is: combativeness.

Which of the following is considered the major contributing factor to fatalities in anaphylactic shock? A. Failure to administer an antihistamine B. Inadequate delivery of IV fluids C. Failure to recognize signs of shock D. Delayed epinephrine administration

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1329 The answer is: Delayed epinephrine administration

A middle-aged male who received a kidney transplant called EMS because he was not feeling well. Which of the following assessment findings is MOST suggestive of organ rejection? A. Fever with swelling and tenderness over the implanted kidney B. Excessive urine output, shortness of breath, and a diffuse rash C. Bilateral flank pain that radiates to both shoulders and scapulae D. Blood in the urine, diffuse abdominal pain, and hypothermia

Pathophysiology, Assessment, and Management of Specific Emergencies, page 1334 The answer is: Fever with swelling and tenderness over the implanted kidney

A young woman presents with left-sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. You should suspect: A. kidney stones. B. pyelonephritis. C. a renal calculus. D. renal failure.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1220-1221 The answer is: pyelonephritis.

A young woman presents with left-sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. You should suspect: A. pyelonephritis. B. a renal calculus. C. kidney stones. D. renal failure.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1220-1221 The answer is: pyelonephritis.

A renal calculus that has become lodged in a lower ureter would likely produce all of the following signs and symptoms, EXCEPT: A. urinary urgency. B. fever. C. hematuria. D. painful urination.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1221-1222 The answer is: fever.

A renal calculus that has become lodged in a lower ureter would likely produce all of the following signs and symptoms, EXCEPT: A. urinary urgency. B. fever. C. painful urination. D. hematuria.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1221-1222 The answer is: fever.

A 59-year-old woman with chronic kidney disease presents with an acute onset of dyspnea while undergoing a hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm Hg. Based on this patient's medical history and clinical presentation, which of the following interventions is likely NOT indicated? A. Left lateral recumbent position B. Rapid transport to the hospital C. Ventilation assistance as needed D. IV crystalloid fluid boluses

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1228-1229 The answer is: IV crystalloid fluid boluses

A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should: A. recognize that she probably received an overaggressive dialysis treatment. B. transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure. C. start an IV line with normal saline and infuse 200 mL of normal saline per hour. D. monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1228-1229 The answer is: monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

A 30-year-old woman complains of an "achy" pain to both lower abdominal quadrants, which she states is made worse by walking. She further tells you that she recently finished her menstrual period. She has a fever of 101.9°F. Her blood pressure is 122/62 mm Hg, pulse rate is 84 beats/min and strong, and respirations are 14 breaths/min and unlabored. After gathering the rest of her medical history, you should: A. visually inspect her vagina for bleeding or discharge, start an IV line and set it to keep the vein open, and transport. B. provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital. C. advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock. D. establish vascular access and give her a 250-mL normal saline bolus, consider analgesia for her pain, and transport.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1242-1243 The answer is: provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital.

Which of the following statements regarding ectopic pregnancy is MOST ? A. Most ectopic pregnancies present with symptoms during the second trimester. B. Ectopic pregnancy occurs when a fertilized egg implants in a fallopian tube. C. In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus. D. Use of an intrauterine device is the most common cause of an ectopic pregnancy.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1246-1247 The answer is: In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus.

You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her last menstrual period was 2 months ago, but she adamantly denies being pregnant. Her blood pressure is 86/50 mm Hg, pulse rate is 120 beats/min and weak, and respirations are 24 breaths/min and regular. Which of the following interventions is NOT appropriate for this patient? A. Cardiac monitoring B. Narcotic analgesia C. Thermal management D. IV fluid boluses

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1246-1248 The answer is: Narcotic analgesia

You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her last menstrual period was 2 months ago, but she adamantly denies being pregnant. Her blood pressure is 86/50 mm Hg, pulse rate is 120 beats/min and weak, and respirations are 24 breaths/min and regular. Which of the following interventions is NOT appropriate for this patient? A. Narcotic analgesia B. IV fluid boluses C. Thermal management D. Cardiac monitoring

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1246-1248 The answer is: Narcotic analgesia

Law enforcement requests that you respond to a local apartment complex for a young woman who was sexually assaulted. When you arrive at the scene, you find the patient sitting on her couch, clearly upset. You see a small amount of blood on her shorts, near the groin area. What is your initial priority in the care of this patient? A. Not allowing her to shower or use the restroom B. Asking her if she recognized the perpetrator C. Quickly assessing her blood pressure and pulse D. Identifying and treating immediate life threats

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1248-1249 The answer is: Identifying and treating immediate life threats

While caring for an unresponsive young woman who was apparently sexually assaulted, you note that her respirations are slow and shallow, her pulse is slow and weak, and her blood pressure is low. There is a small amount of dried blood on her thigh, but no grossly active bleeding. Immediate care for this patient involves: A. visualizing her vaginal area to assess for external bleeding. B. establishing an IV line and administering 0.5 mg of atropine. C. elevating her lower extremities to improve her blood pressure. D. maintaining her airway and providing ventilatory assistance.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1248-1249 The answer is: maintaining her airway and providing ventilatory assistance.

Early clinical manifestations of an allergic reaction include all of the following, EXCEPT: A. pruritus. B. edema. C. urticaria. D. stridor.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1327-1328 The answer is: stridor.

You have administered the appropriate dose of epinephrine to a patient with a severe allergic reaction. Reassessment reveals that the patient's condition has improved markedly. The patient, who has a history of coronary artery disease, is receiving high-flow oxygen and is on a cardiac monitor. You should next: A. transport immediately, monitor airway and breathing en route, and administer Benadryl IV or IM. B. start an epinephrine infusion, administer Benadryl IV or IM, and transport without delay. C. administer a half dose of epinephrine, begin transport, and give the patient Solu-Medrol en route. D. transport immediately, monitor the patient's blood pressure en route, and give IV fluid boluses if symptoms recur.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1328-1330 The answer is: transport immediately, monitor airway and breathing en route, and administer Benadryl IV or IM.

A 20-year-old woman complains of difficulty breathing and the feeling of a lump in her throat approximately 10 minutes after being stung by a wasp. Your assessment reveals that she is anxious, is in obvious respiratory distress, and has hives covering her arms and legs. Further assessment reveals diffuse wheezing, a blood pressure of 80/50 mm Hg, and a heart rate of 120 beats/min. You should: A. administer high-flow oxygen, start a large-bore IV, infuse up to 2 liters of normal saline, and administer epinephrine SQ. B. apply high-flow oxygen via nonrebreathing mask, administer epinephrine via the IM route, and establish vascular access. C. administer albuterol via an inline nebulizer attached to a bag-mask device, assist ventilations, and consider administering epinephrine. D. immediately sedate and intubate her to protect her airway, administer Benadryl IM, and consider an epinephrine infusion.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1329-1330 The answer is: apply high-flow oxygen via nonrebreathing mask, administer epinephrine via the IM route, and establish vascular access.

A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she: A. was previously intubated for his or her condition. B. was recently evaluated in an emergency department. C. has used his or her inhaler twice in the previous week. D. takes a bronchodilator and a corticosteroid.

Patient Assessment, page 921 The answer is: was previously intubated for his or her condition.

A 20-year-old woman complains of difficulty breathing and the feeling of a lump in her throat approximately 10 minutes after being stung by a wasp. Your assessment reveals that she is anxious, is in obvious respiratory distress, and has hives covering her arms and legs. Further assessment reveals diffuse wheezing, a blood pressure of 80/50 mm Hg, and a heart rate of 120 beats/min. You should: A. apply high-flow oxygen via nonrebreathing mask, administer epinephrine via the IM route, and establish vascular access. B. administer high-flow oxygen, start a large-bore IV, infuse up to 2 liters of normal saline, and administer epinephrine SQ. C. immediately sedate and intubate her to protect her airway, administer Benadryl IM, and consider an epinephrine infusion. D. administer albuterol via an inline nebulizer attached to a bag-mask device, assist ventilations, and consider administering epinephrine.

Pathophysiology, Assessment, and Management of Specific Emergencies, pages 1329-1330 The answer is: apply high-flow oxygen via nonrebreathing mask, administer epinephrine via the IM route, and establish vascular access.

Referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect injury to the: A. diaphragm. B. intestines. C. spleen. D. stomach.

Pathophysiology, Assessment, and Management of Specific Injuries, page 1833 The answer is: spleen.

Flexion injuries to the spine would MOST likely result from: A. rapid acceleration forces. B. a rear-end motor vehicle crash. C. rapid deceleration forces. D. a direct blow to the frontal lobe.

Pathophysiology, Assessment, and Management of Spinal Injuries, page 1748 The answer is: rapid deceleration forces.

You have just completed spinal immobilization of a hemodynamically stable patient with a possible spinal injury. Prior to moving the patient to the ambulance, it is MOST important to: A. start an IV of normal saline in case the patient deteriorates. B. perform a detailed secondary assessment to detect other injuries. C. apply a cardiac monitor and obtain a full set of vital signs. D. reassess pulse, motor, and sensory functions in all extremities.

Pathophysiology, Assessment, and Management of Spinal Injuries, pages 1759-1762 The answer is: reassess pulse, motor, and sensory functions in all extremities.

Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should: A. rapidly extricate the driver so you can gain quick access to the child in the backseat. B. carefully assess the driver for occult injuries before removing her from the vehicle. C. apply a vest-type extrication device to the driver and quickly remove her from the car. D. ask the driver to step out of the vehicle so you can access the backseat passenger.

Pathophysiology, Assessment, and Management of Spinal Injuries, pages 1766-1767 The answer is: rapidly extricate the driver so you can gain quick access to the child in the backseat.

The management for any potentially toxic exposure in children begins by: A. identifying the toxin. B. ensuring a patent airway. C. providing an antidote. D. assessing respiratory effort.

Pathophysiology, Assessment, and Management of Toxicologic Emergencies, page 2180 The answer is: ensuring a patent airway.

A person who is "speedballing" is: A. packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location. B. highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria. C. using heroin to withdraw or detoxify himself or herself from cocaine by gradually increasing the amounts of heroin taken while decreasing the amounts of cocaine used. D. using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.

Pathophysiology, page 1403 The answer is: using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.

You would NOT expect a person using methamphetamine to present with: A. hypertension. B. bradypnea. C. insomnia. D. restlessness.

Pathophysiology, page 1404 The answer is: bradypnea.

A middle-aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of: A. drug abuse. B. physical dependence. C. tolerance. D. habituation.

Pathophysiology, page 1404 The answer is: tolerance.

A dislocation is considered an urgent injury because of its potential to cause: A. neurovascular compromise. B. significant internal bleeding. C. severe hemodynamic instability. D. proximal sensory and motor loss.

Pathophysiology, page 1851 The answer is: neurovascular compromise.

The peripheral area surrounding the zone of coagulation, which has decreased blood flow and inflammation, is called the zone of: A. coagulation. B. liquefaction. C. stasis. D. hyperemia.

Pathophysiology, pages 1642-1643 The answer is: stasis.

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include: A. manually stabilizing his head and opening his airway with the jaw-thrust maneuver. B. rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds. C. applying a cervical collar and assisting his ventilations with a bag-mask device. D. performing a tongue-jaw lift and looking in his mouth for any obvious obstructions.

Patient Assessment of Head and Spinal Injuries, page 1721 The answer is: manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by: A. both arms moving downward more than 3 inches in 30 seconds when the patient's eyes are open. B. one arm drifting downward and turning away from the body when the patient's eyes are closed. C. one arm drifting downward and turning toward the body when the patient's eyes are closed. D. one arm drifting downward and turning away from the body when the patient's eyes are open.

Patient Assessment, page 1095 The answer is: one arm drifting downward and turning toward the body when the patient's eyes are closed.

A male patient with a closed head injury opens his eyes in response to pain, makes incomprehensible sounds, and responds to pain with flexion of his arms. His Glasgow Coma Scale score is ___, and the MOST appropriate treatment for him involves: A. 7; intubation, ventilations performed at a rate of 12 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 90%. B. 8; ventilation assistance with a bag-mask device, a 2-L bolus of normal saline or lactated Ringer solution, elevating his head 12 inches, and hyperventilating him if his heart rate falls below 60 beats/min. C. 6; intubation, hyperventilation at a rate of 20 breaths/min, two large-bore IV lines running wide open, keeping him warm, and maintaining his oxygen saturation at greater than 90%. D. 9; high-flow oxygen via nonrebreathing mask, IV fluids as needed to maintain a systolic blood pressure of at least 100 mm Hg, monitoring his oxygen saturation, and administering 1.5 mg/kg of lidocaine to decrease intracranial pressure.

Patient Assessment of Head and Spine Injuries, pages 1721-1723 The answer is: 7; intubation, ventilations performed at a rate of 12 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 90%.

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, heart rate of 56 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves: A. hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center. B. intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. C. preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. D. applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital.

Patient Assessment of Head and Spine Injuries, pages 1721-1723 The answer is: intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

When assessing a patient's response to pain, you place your thumb in the notch above the eye and near the bridge of the nose. This region is called the: A. foramen magnum B. supraorbital foramen. C. vertebral foramen. D. foramen of Monroe.

Patient Assessment, page 1086 The answer is: supraorbital foramen.

When assessing a patient's response to pain, you place your thumb in the notch above the eye and near the bridge of the nose. This region is called the: A. foramen of Monroe. B. supraorbital foramen. C. vertebral foramen. D. foramen magnum

Patient Assessment, page 1086 The answer is: supraorbital foramen.

All of the following cranial nerves are responsible for airway control, EXCEPT the: A. glossopharyngeal. B. abducens. C. hypoglossal. D. trigeminal.

Patient Assessment, page 1087 The answer is: abducens.

A patient with a head injury is found lying supine. The patient's feet are extended with the toes pointed, and the arms extended with the hands pronated. This indicates: A. low intracranial pressure. B. decorticate posturing. C. brainstem injury. D. spinal cord injury.

Patient Assessment, page 1087 The answer is: brainstem injury.

Decerebrate posturing: A. is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem. B. is characterized by abnormal flexion of the arms and extension of the lower extremities. C. is considered less severe than decorticate posturing, because it indicates that the brainstem is intact. D. is an early clinical finding, because it occurs with minimal increases in intracranial pressure.

Patient Assessment, page 1087 The answer is: is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem.

Decerebrate posturing: A. is considered less severe than decorticate posturing, because it indicates that the brainstem is intact. B. is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem. C. is an early clinical finding, because it occurs with minimal increases in intracranial pressure. D. is characterized by abnormal flexion of the arms and extension of the lower extremities.

Patient Assessment, page 1087 The answer is: is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem.

Apneustic breathing is characterized by: A. a gradual increase and decrease in breathing with periods of apnea. B. extreme tachypnea and hyperpnea with a fruity or acetone breath odor. C. an irregular respiratory pattern with unpredictable periods of apnea. D. a prolonged inspiratory phase with a shortened expiratory phase and bradypnea.

Patient Assessment, page 1088 The answer is: a prolonged inspiratory phase with a shortened expiratory phase and bradypnea.

In contrast to patients in shock, patients with increased intracranial pressure MOST often experience: A. a widened pulse pressure. B. an increased diastolic blood pressure. C. systolic hypotension. D. tachycardia and tachypnea.

Patient Assessment, page 1088 The answer is: a widened pulse pressure.

Which of the following is an example of receptive aphasia? A. A patient with slurred speech is able to tell you his or her name. B. You hand a patient a pencil and he or she tries to cut paper with it. C. A patient responds with "no" when asked if he or she has hypertension. D. You ask a patient who the president is and he or she says, "January."

Patient Assessment, page 1093-1094 The answer is: You ask a patient who the president is and he or she says, "January."

__________ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking. A. Bradykinesia B. Ataxia C. Decussation D. Myoclonus

Patient Assessment, page 1095 The answer is: Ataxia

When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by: A. one arm drifting downward and turning toward the body when the patient's eyes are closed. B. both arms moving downward more than 3 inches in 30 seconds when the patient's eyes are open. C. one arm drifting downward and turning away from the body when the patient's eyes are closed. D. one arm drifting downward and turning away from the body when the patient's eyes are open.

Patient Assessment, page 1095 The answer is: one arm drifting downward and turning toward the body when the patient's eyes are closed.

A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called __________ activity. A. clonic B. myoclonic C. hypertonic D. tonic

Patient Assessment, page 1096 The answer is: clonic

Blood that has been digested by stomach acids manifests as: A. bright red vomitus. B. hematochezia. C. gray-colored stool. D. coffee grounds emesis.

Patient Assessment, page 1177 The answer is: coffee grounds emesis.

Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT: A. epinephrine administration. B. assessment of lung sounds. C. a secondary assessment. D. aggressive airway control.

Patient Assessment, page 1324 The answer is: a secondary assessment.

You are dispatched to a residence for a man who cut his hand with a chainsaw. Upon arriving at the scene, your FIRST action should be to: A. immediately gain access to the patient. B. determine if air medical transport is available. C. carefully assess the scene for safety hazards. D. apply gloves, a gown, and facial protection.

Patient Assessment, page 1616 The answer is: carefully assess the scene for safety hazards.

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should: A. suction his oropharynx for 30 seconds and then perform endotracheal intubation. B. suction the blood from his mouth and assist ventilations with a bag-mask device. C. insert a nasal airway, apply oxygen via nonrebreathing mask, and transport. D. apply direct pressure to his facial wounds and promptly intubate him.

Patient Assessment, page 1616 The answer is: suction the blood from his mouth and assist ventilations with a bag-mask device.

You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned? A. 27% B. 18% C. 36% D. 45%

Patient Assessment, page 1648 The answer is: 36%

Periumbilical ecchymosis is: A. referred to as Cullen sign and may take several hours to develop following abdominal trauma. B. also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma. C. commonly observed in the prehospital setting following blunt force trauma to the abdomen. D. usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen.

Patient Assessment, page 1830 The answer is: referred to as Cullen sign and may take several hours to develop following abdominal trauma.

During your assessment of a patient with a femur fracture, you discover a rapidly expanding hematoma on the medial aspect of his thigh. What should you suspect? A. Venous thrombus B. Compartment syndrome C. Arterial injury D. Fasciitis

Patient Assessment, page 1855 The answer is: Arterial injury

A primigravida woman: A. has had one abortion. B. is pregnant for the first time. C. will deliver her second baby. D. has delivered one baby.

Patient Assessment, page 2032 The answer is: is pregnant for the first time.

Which of the following conditions would LEAST likely present with a rapid onset of dyspnea? A. Pneumothorax B. Anaphylaxis C. Pneumonia D. Pulmonary embolism

Patient Assessment, page 911 The answer is: Pneumonia

If a patient's initial presentation makes you suspicious about a particular respiratory condition, you must: A. begin immediate treatment based on your suspicion. B. make your field impression based on the presentation. C. immediately perform a focused physical examination. D. confirm your suspicions with a thorough assessment.

Patient Assessment, page 912 The answer is: confirm your suspicions with a thorough assessment.

Retractions of the sternum or ribs during inhalation: A. are common in patients with emphysema. B. are signs of acute respiratory failure in adults. C. are especially common in infants and small children. D. occur when soft tissue is pulled in around the bones.

Patient Assessment, page 913 The answer is: are especially common in infants and small children.

Retractions of the sternum or ribs during inhalation: A. are signs of acute respiratory failure in adults. B. occur when soft tissue is pulled in around the bones. C. are common in patients with emphysema. D. are especially common in infants and small children.

Patient Assessment, page 913 The answer is: are especially common in infants and small children.

A patent airway: A. should be prophylactically suctioned. B. is characterized by adequate tidal volume. C. does not equate to adequate ventilation. D. is evidenced by visible chest rise.

Patient Assessment, page 913 The answer is: does not equate to adequate ventilation.

A patient with quiet tachypnea suggests: A. airway swelling. B. asthma. C. alkalosis. D. shock.

Patient Assessment, page 917 The answer is: shock.

The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates: A. right-sided congestive heart failure. B. isolated consolidation of secretions. C. thick secretions in the large airways. D. air being forced through narrowed airways.

Patient Assessment, page 917 The answer is: thick secretions in the large airways.

Frothy sputum that has a pink tinge to it is MOST suggestive of: A. congestive heart failure. B. antihistamine use. C. chronic bronchitis. D. tuberculosis.

Patient Assessment, page 918 The answer is: congestive heart failure.

In which situation would Cheyne-Stokes respirations be considered an ominous finding? A. Obstructive sleep apnea B. Apneic periods less than 5 seconds C. Traumatic brain injury D. Alcohol intoxication

Patient Assessment, page 919 The answer is: Traumatic brain injury

While assessing the airway of a 3-year-old girl who is unresponsive, you hear a snoring sound during each of her slow, shallow breaths. You should: A. manually maneuver her head and reassess her breathing status. B. provide free-flow oxygen as you nasotracheally intubate her. C. insert an oropharyngeal airway and apply high-flow oxygen. D. begin bag-mask ventilations to improve her low tidal volume.

Pediatric Patient Assessment, pages 2127-2128 The answer is: manually maneuver her head and reassess her breathing status.

The concept of apneic oxygenation is based on the fact that: A. in the apneic patient, approximately 200 mL/min of carbon dioxide moves in the alveoli. B. oxygen uptake by the alveoli will continue, even when the diaphragm is not moving. C. the average healthy adult patient will not desaturate for 15 to 20 minutes. D. supplemental oxygen after chemical paralysis will not reduce a hypoxic event.

Pharmacological Adjuncts to Airway Management and Ventilation, page 866 The answer is: oxygen uptake by the alveoli will continue, even when the diaphragm is not moving.

Damage to nerves, tendons, or ligaments would MOST likely occur during venipuncture if: A. the selected IV site is near a joint. B. a small vein in the hand is cannulated. C. the patient has diabetes. D. the patient moves suddenly.

Potential Complications of IV Therapy, page 710 The answer is: the selected IV site is near a joint.

A vasovagal reaction is the result of: A. sudden hypertension. B. dilation of the vasculature. C. massive vasoconstriction. D. acute bradycardia.

Potential Complications of IV Therapy, page 711 The answer is: dilation of the vasculature.

Signs and symptoms of circulatory overload include: A. diarrhea. B. hypertension. C. collapsed jugular veins. D. headache.

Potential Complications of IV Therapy, page 711 The answer is: hypertension.

Which of the following is NOT an example of a passive injury prevention intervention? A. Installing sprinkler systems in commercial buildings B. The use of softer materials for playground surfaces C. The manufacture of child-resistant bottles D. Providing public education on the use of AEDs

Prevention, page 79 The answer is: Providing public education on the use of AEDs

Air bags installed in an automobile are more likely to reduce injuries than educating people to wear their seat belts because: A. automobile manufacturers are required to install air bags. B. air bags do not require conscious effort on a person's part. C. air bags are more effective than seat belts during a crash. D. failure to wear a seat belt is not punishable by law.

Prevention, page 79 The answer is: air bags do not require conscious effort on a person's part.

Sonorous respirations are MOST likely caused by: A. secretions or blood in the airway. B. severe inflammation of the epiglottis. C. an anatomic airway obstruction. D. swelling of upper airway structures.

Primary Survey, page 511 The answer is: an anatomic airway obstruction.

A patient who does not respond to verbal or tactile stimuli is: A. disoriented. B. semiconscious. C. lethargic. D. unresponsive.

Primary Survey, page 511 The answer is: unresponsive.

A patient who does not respond to verbal or tactile stimuli is: A. unresponsive. B. disoriented. C. semiconscious. D. lethargic.

Primary Survey, page 511 The answer is: unresponsive.

A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is: A. irregular. B. rapid. C. thready. D. bounding.

Primary Survey, page 512 The answer is: bounding.

A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is: A. thready. B. bounding. C. rapid. D. irregular.

Primary Survey, page 512 The answer is: bounding.

An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would MOST likely have ________ skin. A. cyanotic B. flushed C. pale D. mottled

Primary Survey, page 513 The answer is: cyanotic

An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would MOST likely have ________ skin. A. pale B. cyanotic C. flushed D. mottled

Primary Survey, page 513 The answer is: cyanotic

Stimulation of the sympathetic nervous system causes: A. bradycardia. B. warm, moist skin. C. vasodilation. D. diaphoresis.

Primary Survey, page 513 The answer is: diaphoresis.

What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? A. 13 B. 11 C. 12 D. 10

Primary Survey, page 515 The answer is: 12

Prior to transporting a 66-year-old woman with chest pain to the hospital, she expresses the need to retrieve her Bible and say a prayer. You should: A. leave the room if your religious beliefs are not consistent with hers. B. tactfully explain to the patient that her condition will not allow it. C. advise the patient that a minister will talk with her at the hospital. D. be respectful of the patient's wishes and give her the time she needs.

Professionalism, page 17-18 The answer is: be respectful of the patient's wishes and give her the time she needs.

Personal protective equipment: A. is a standardized set of equipment that is used with every patient contact. B. is required by the CDC when a paramedic draws blood or gives an injection. C. serves as a secondary protective barrier beyond what your body provides. D. is the most effective means of preventing the spread of an infectious disease.

Protecting Health Care Providers, page 1348 The answer is: serves as a secondary protective barrier beyond what your body provides.

Personal protective equipment: A. is the most effective means of preventing the spread of an infectious disease. B. is a standardized set of equipment that is used with every patient contact. C. is required by the CDC when a paramedic draws blood or gives an injection. D. serves as a secondary protective barrier beyond what your body provides.

Protecting Health Care Providers, page 1348 The answer is: serves as a secondary protective barrier beyond what your body provides.

Which of the following statements regarding unintentional injuries and death is ? A. They occur without the intent to cause harm. B. Few motor vehicle deaths are unintentional. C. Their incidence cannot be reduced. D. Unintentional falls are the leading cause of death.

Public Health Threats, page 72 The answer is: They occur without the intent to cause harm.

Children are at higher risk for serious injury than adults because of: A. a proportionately larger head. B. a shorter body stature. C. inadequate parental guidance. D. a lack of personal responsibility.

Public Health Threats, page 73 The answer is: a proportionately larger head.

Factors that can influence injury patterns in a child include all of the following, EXCEPT: A. the child's age. B. number of relatives. C. developmental stage. D. the gender of the child.

Public Health Threats, page 73 The answer is: number of relatives.

In 2016, the leading cause of death by unintentional injury was: A. drowning. B. choking. C. poisoning. D. falls.

Public Health Threats, page 73 The answer is: poisoning.

Which of the following is the MOST common cause of injuries that occur at school? A. Sports-related incidents B. Drug-related incidents C. School bus crashes D. Gang fights

Public Health Threats, page 74 The answer is: Sports-related incidents

Pulse oximetry is used to measure the: A. percentage of carbon dioxide that is eliminated from the body. B. amount of oxygen dissolved in the plasma portion of the blood. C. exchange of oxygen and carbon dioxide at the cellular level. D. percentage of hemoglobin that is saturated with oxygen.

Quantifying Ventilation and Oxygenation, page 787 The answer is: percentage of hemoglobin that is saturated with oxygen.

If the ET tube is placed in the trachea properly, the colorimetric paper inside the CO2 detector should: A. turn yellow during exhalation. B. not change colors. C. remain purple during ventilations. D. turn yellow during inhalation.

Quantifying Ventilation and Oxygenation, page 790 The answer is: turn yellow during exhalation.

If return of spontaneous circulation (ROSC) occurs, which of the following ETCO2 findings would you expect to encounter? A. Complete loss of a capnographic waveform B. Capnographic waveforms that get smaller C. A progressive decrease in the ETCO2 reading D. An abrupt and sustained increase in ETCO2

Quantifying Ventilation and Oxygenation, page 791, 794 The answer is: An abrupt and sustained increase in ETCO2

Assessment of a spontaneously perfusing patient's ETCO2 reveals small capnographic waveforms and a reading of 22 mm Hg. Which of the following does this indicate? A. Respiratory acidosis B. Hyperventilation C. Bradypnea D. Metabolic alkalosis

Quantifying Ventilation and Oxygenation, page 792 The answer is: Hyperventilation

While ventilating an intubated patient, you note a complete loss of capnographic waveform and numeric value, yet the patient's chest rises with ventilations and you are able to hear bilateral breath sounds. What should you do? A. Decrease the rate of ventilation. B. Replace the ETCO2 inline adaptor. C. Extubate and ventilate with a bag-mask. D. Increase the rate of ventilation.

Quantifying Ventilation and Oxygenation, page 792 The answer is: Replace the ETCO2 inline adaptor.

The use of capnography in patients with prolonged cardiac arrest may be limited because: A. of acidosis and minimal carbon dioxide elimination. B. of an excess buildup of nitrogen in the blood. C. the paramedic often ventilates the patient too slowly. D. metabolic alkalosis damages the colorimetric paper.

Quantifying Ventilation and Oxygenation, page 792 The answer is: of acidosis and minimal carbon dioxide elimination.

You are transporting an intubated patient and note that his ETCO2 reading has fallen below 30 mm Hg. You should: A. take immediate measures to confirm proper placement of the ET tube. B. promptly extubate the patient and ventilate with a bag-mask device. C. hyperventilate the patient to see if the ETCO2 reading increases. D. slow your ventilation rate to see if the ETCO2 reading decreases.

Quantifying Ventilation and Oxygenation, pages The answer is: slow your ventilation rate to see if the ETCO2 reading decreases.

Capnography is a reliable method for confirming proper ET tube placement because: A. capnographers measure the amount of exhaled oxygen. B. capnographers measure the amount of carbon dioxide in inhaled air. C. it is a reliable indicator of the patient's PaO2 level. D. carbon dioxide is not present in the esophagus.

Quantifying Ventilation and Oxygenation, pages 790-792 The answer is: carbon dioxide is not present in the esophagus.

You are at the scene of an explosion at an office complex. There are a total of 15 casualties, including 2 deaths. In addition to injuries experienced by the explosion, most of the victims are complaining of nausea, vomiting, and diarrhea. When caring for any of these victims, you must: A. wear a lead shield or apron to protect yourself adequately. B. immediately treat those with injuries that are life threatening. C. ensure that they have been properly decontaminated first. D. recall that a dirty bomb does not cause radiation contamination.

Radiologic or Nuclear Devices, page 2456 The answer is: ensure that they have been properly decontaminated first.

During a 20-minute transport of a critical patient, you should make a concerted effort to reassess the patient ___ times. A. three B. two C. one D. four

Reassessment, page 593 The answer is: four

Which of the following reassessment findings is MOST significant in a patient with penetrating chest trauma? A. Loud heart tones to auscultation B. Blood pressure of 90/76 mm Hg C. Heart rate of 78 beats per minute D. Symmetrical chest rise and fall

Reassessment, pages 593-594 The answer is: Blood pressure of 90/76 mm Hg

Which of the following situations does NOT depict a technical rescue? A. Retrieving a woman whose car was swept off the road by swift water B. Moving a 180-pound man from his living room to the ambulance C. Gaining access to an unresponsive man who is trapped in a grain silo D. Disentangling a young woman from her badly damaged vehicle

Rescue Training, page 2361 The answer is: Moving a 180-pound man from his living room to the ambulance

All of the following are formed components of the blood, EXCEPT: A. platelets. B. red blood cells. C. white blood cells. D. plasma.

The Circulatory System, page 333 The answer is: plasma.

The upper airway of an adult consists of all the structures above the: A. glottis. B. cricoid ring. C. carina. D. bronchus.

Review of Airway Anatomy, page 776 The answer is: glottis.

Anatomically, the ________ is directly anterior to the glottic opening. A. thyroid cartilage B. vallecular space C. thyroid gland D. cricoid cartilage

Review of Airway Anatomy, page 776 The answer is: thyroid cartilage

When responding to an emergency scene, it is MOST important to: A. use your siren to move heavy traffic out of the way. B. moderately exceed the speed limit when possible. C. proceed in a manner that is timely and safe. D. stay at least 10' behind any cars in front of you.

Roles and Responsibilities, page 19 The answer is: proceed in a manner that is timely and safe.

When returning your unit to service following a call, the responsibility of ensuring that the unit is restocked and ready for another call rests with: A. the paramedic in charge. B. the shift captain or supervisor. C. the medic who was driving. D. everyone on the EMS team.

Roles and Responsibilities, pages 19-20 The answer is: everyone on the EMS team.

When deciding which medical facility is most appropriate for your patient's needs, it is MOST important to: A. be knowledgeable of the major streets and highways. B. consider the distance from the scene to the hospital. C. know the capabilities of all the hospitals in your area. D. ask the patient where his or her physician is located.

Roles and Responsibilities, pages 19-20 The answer is: know the capabilities of all the hospitals in your area.

When deciding which medical facility is most appropriate for your patient's needs, it is MOST important to: A. consider the distance from the scene to the hospital. B. ask the patient where his or her physician is located. C. know the capabilities of all the hospitals in your area. D. be knowledgeable of the major streets and highways.

Roles and Responsibilities, pages 19-20 The answer is: know the capabilities of all the hospitals in your area.

You are about to assess a patient who complains of fever, chills, and coughing up blood. In addition to donning gloves and eye protection, you should: A. wear a properly fitted HEPA or N-95 mask. B. place a tight-fitting mask on the patient. C. immediately notify the health department. D. ask the patient if he or she is HIV-positive.

Scene Size-up, page 508 The answer is: wear a properly fitted HEPA or N-95 mask.

Which white blood cell is formed in the thymus and works to rid the body of viruses and bacteria by direction invasion? A. B lymphocyte B. Basophil C. T lymphocyte D. Neutrophil

The Circulatory System, page 335 The answer is: T lymphocyte

Which of the following would be of LEAST value when trying to determine the type of hazardous material a commercial tanker truck is carrying? A. Bill of lading B. Emergency Response Guidebook C. CHEMTREC D. Waybill

Scene Size-up, page 2403 The answer is: Waybill

Which of the following would be of LEAST value when trying to determine the type of hazardous material a commercial tanker truck is carrying? A. Waybill B. Bill of lading C. Emergency Response Guidebook D. CHEMTREC

Scene Size-up, page 2403 The answer is: Waybill

You are about to assess a patient who complains of fever, chills, and coughing up blood. In addition to donning gloves and eye protection, you should: A. ask the patient if he or she is HIV-positive. B. wear a properly fitted HEPA or N-95 mask. C. place a tight-fitting mask on the patient. D. immediately notify the health department.

Scene Size-up, page 508 The answer is: wear a properly fitted HEPA or N-95 mask.

What type of pain has its origin in a particular location but is described by the patient as pain in a different location? A. Referred pain B. Radiating pain C. Visceral pain D. Somatic pain

Secondary Assessment, page 570 The answer is: Referred pain

Upon arriving at the scene of an overturned tanker truck or train derailment, you should be MOST suspicious that a hazardous material is involved if: A. a visible cloud or dark smoke is escaping from the tanker or railroad car. B. multiple patients are unconscious or are experiencing respiratory distress. C. any type of fluid is leaking from the overturned tanker or railroad car. D. the truck driver or train conductor is unconscious and still in the vehicle.

Scene Size-up, pages 2400-2401 The answer is: multiple patients are unconscious or are experiencing respiratory distress.

At 3:00 a.m. you receive a call for a "man down." While en route to the scene, you ask the dispatcher to provide additional information, but the dispatcher advises you the caller was abrupt on the phone and then hung up. You should: A. assume the caller was panicked because the patient is critically ill. B. ask the dispatcher if law enforcement is en route to the scene. C. advise the dispatcher to send a second paramedic crew to the scene. D. stage in a safe area until contact with the caller can be reestablished.

Scene Size-up, pages 504-507 The answer is: ask the dispatcher if law enforcement is en route to the scene.

Upon completing your rapid full-body exam of an unresponsive trauma patient's head and neck, you should next: A. assess the integrity of the 12 cranial nerves. B. log roll the patient onto a long backboard. C. apply a properly sized rigid cervical collar. D. ventilate the patient at 12 to 20 breaths/min.

Secondary Assessment, page 541 The answer is: apply a properly sized rigid cervical collar.

Upon completing your rapid full-body exam of an unresponsive trauma patient's head and neck, you should next: A. ventilate the patient at 12 to 20 breaths/min. B. apply a properly sized rigid cervical collar. C. log roll the patient onto a long backboard. D. assess the integrity of the 12 cranial nerves.

Secondary Assessment, page 541 The answer is: apply a properly sized rigid cervical collar.

Other than overall patient appearance, the patient's __________ is/are the MOST objective data for determining his or her status. A. medications B. vital signs C. chief complaint D. medical history

Secondary Assessment, page 542 The answer is: vital signs

Other than overall patient appearance, the patient's __________ is/are the MOST objective data for determining his or her status. A. medications B. vital signs C. medical history D. chief complaint

Secondary Assessment, page 542 The answer is: vital signs

What does pulse oximetry measure? A. The percentage of hemoglobin saturation B. The percentage of red blood cells in the blood C. The percentage of ratio of red blood cells to plasma D. The percentage of oxygen that reaches the cells

Secondary Assessment, page 546 The answer is: The percentage of hemoglobin saturation

What does pulse oximetry measure? A. The percentage of red blood cells in the blood B. The percentage of hemoglobin saturation C. The percentage of ratio of red blood cells to plasma D. The percentage of oxygen that reaches the cells

Secondary Assessment, page 546 The answer is: The percentage of hemoglobin saturation

Poor skin turgor in an infant or child is MOST indicative of: A. shock. B. dehydration. C. hypoxemia. D. elastin deficiency.

Secondary Assessment, page 554 The answer is: dehydration.

Poor skin turgor in an infant or child is MOST indicative of: A. shock. B. hypoxemia. C. dehydration. D. elastin deficiency.

Secondary Assessment, page 554 The answer is: dehydration.

Flushed skin is commonly seen as a result of all the following, EXCEPT: A. heat exposure. B. vasoconstriction. C. superficial burns. D. fever.

Secondary Assessment, page 554 The answer is: vasoconstriction.

Examination of the head is MOST important when assessing a patient who: A. presents with hemiparesis. B. complains of nausea. C. has an altered mental status. D. has shortness of breath.

Secondary Assessment, page 555 The answer is: has an altered mental status.

Asymmetry of the face could indicate: A. facial nerve palsy. B. a spinal cord injury. C. oculomotor nerve injury. D. severe hyperglycemia.

Secondary Assessment, page 556 The answer is: facial nerve palsy.

Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): A. ruptured tympanic membrane. B. basilar skull fracture. C. orbital blowout fracture. D. fracture of the cribriform plate.

Secondary Assessment, page 559 The answer is: basilar skull fracture.

The presence of rhonchi during auscultation of the lungs is MOST suggestive of: A. pneumonia. B. toxic inhalation. C. pneumothorax. D. asthma.

Secondary Assessment, page 565 The answer is: pneumonia.

A bruit indicates _________ blood flow and is MOST significant in the _________ arteries. A. laminar, carotid B. turbulent, femoral C. laminar, brachial D. turbulent, carotid

Secondary Assessment, page 568 The answer is: turbulent, carotid

Which of the following statements regarding ascites is ? A. The abdomen of a patient with ascites has a sunken appearance. B. Percussion of the abdomen will often yield hyperresonance. C. The most common cause of ascites is an acute splenic injury. D. Ascites is a collection of fluid within the peritoneal cavity.

Secondary Assessment, page 570 The answer is: Ascites is a collection of fluid within the peritoneal cavity.

A patient is generally considered to have orthostatic vital signs when: A. the systolic BP increases and the diastolic BP decreases when going from a lying to a sitting position. B. the heart rate increases by 20 beats/min or more when going from a supine to a standing position. C. the respiratory rate becomes fast and the depth becomes shallow when he or she suddenly stands up. D. he or she experiences chest pain and a rapid, irregular heart rate when going from a seated to a standing position.

Secondary Assessment, page 570 The answer is: the heart rate increases by 20 beats/min or more when going from a supine to a standing position.

Which assessment technique usually yields the MOST significant diagnostic information during the abdominal exam? A. Percussion B. Inspection C. Auscultation D. Palpation

Secondary Assessment, page 571 The answer is: Palpation

Bruising in the periumbilical area is indicative of: A. a leaking aortic aneurysm. B. a ruptured urinary bladder. C. intraperitoneal hemorrhage. D. ruptured ectopic pregnancy.

Secondary Assessment, page 571 The answer is: intraperitoneal hemorrhage.

Abdominal guarding is MOST commonly encountered in patients with: A. chronic liver inflammation. B. peritoneal irritation. C. acute renal failure. D. intra-abdominal bleeding.

Secondary Assessment, page 572 The answer is: peritoneal irritation.

Assessment of the female genitalia: A. should be limited to inspection only. B. is not performed by the paramedic. C. is only necessary in pregnant patients. D. is a routine part of the physical exam.

Secondary Assessment, page 573 The answer is: should be limited to inspection only.

A pathologic fracture occurs when: A. abnormal forces are applied to abnormal bone structures. B. abnormal forces are applied to normal bone structures. C. normal forces are applied to normal bone structures. D. normal forces are applied to abnormal bone structures.

Secondary Assessment, page 574 The answer is: normal forces are applied to abnormal bone structures.

Structural integrity of the pelvis should be assessed by: A. gently pushing in and down on the iliac crests. B. carefully rocking the pelvis back and forth. C. placing the patient on his or her side to elicit pain. D. applying firm upward pressure to the pelvic wings.

Secondary Assessment, page 576 The answer is: gently pushing in and down on the iliac crests.

Lower extremity shortening and/or internal or external rotation are findings often associated with: A. mid-shaft femur fractures. B. pathologic fractures of the hip. C. pelvic fractures. D. proximal lower extremity injury.

Secondary Assessment, page 577 The answer is: proximal lower extremity injury.

You would MOST likely encounter bilateral dependent edema in a patient with: A. arterial occlusion. B. diabetes mellitus. C. heart failure. D. deep vein occlusion.

Secondary Assessment, page 580 The answer is: heart failure.

You would MOST likely encounter bilateral dependent edema in a patient with: A. deep vein occlusion. B. heart failure. C. diabetes mellitus. D. arterial occlusion.

Secondary Assessment, page 580 The answer is: heart failure.

The MOST clinically significant indicator(s) of ischemia in a limb is/are: A. parasthesias. B. poikilothermia. C. pulselessness. D. pain and pallor.

Secondary Assessment, page 580 The answer is: pulselessness.

All of the following are adventitious breath sounds, EXCEPT: A. rhonchi. B. wheezes. C. vesicular sounds. D. rales.

Secondary Assessment, pages 562, 564 The answer is: vesicular sounds.

The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT: A. bronchospasm. B. heart failure. C. toxic inhalation. D. pulmonary edema.

Secondary Assessment, pages 564-565 The answer is: bronchospasm.

Visceral abdominal pain is: A. often less localized on palpation and is poorly described by the patient. B. highly suggestive of a ruptured hollow abdominal organ. C. characterized by a localized area of abdominal tenderness or pain. D. commonly encountered in patients with cholecystitis or pancreatitis.

Secondary Assessment, pages 570, 572 The answer is: often less localized on palpation and is poorly described by the patient.

A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary survey, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should: A. insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions. B. quickly place her on the stretcher, obtain a 12-lead ECG tracing, and perform a detailed physical exam. C. apply supplemental oxygen via nonrebreathing mask, place her in a lateral recumbent position, and transport. D. apply a rigid cervical collar, start an IV of normal saline, and perform immediate endotracheal intubation.

Secondary Assessment, pages 587-588 The answer is: insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions.

Which of the following injuries or mechanisms would MOST likely lead to nonhemorrhagic shock? A. Severe burns B. Fractures C. Blunt trauma D. Hemothorax

Shock, page 1587 The answer is: Severe burns

In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with: A. polyuria and weak pulses. B. restlessness and pale cool skin. C. bounding radial pulses. D. mottled skin and dilated pupils.

Shock, page 1589 The answer is: mottled skin and dilated pupils.

In which of the following situations would the documentation on a patient care report MOST likely be limited? A. Cardiac arrest B. Injury to a paramedic C. Mass-casualty incident D. Physical abuse

Situations Requiring Additional Documentation, page 175 The answer is: Mass-casualty incident

For purposes of refusing medical care, a patient's mental status may be considered impaired if he or she: A. makes nonsensical statements. B. is notably frightened. C. makes a derogatory comment. D. is not sure of the exact time.

Situations Requiring Additional Documentation, page 175 The answer is: makes nonsensical statements.

When caring for a trauma patient with multiple injuries, it is MOST important for the paramedic to: A. perform a secondary assessment immediately after the primary assessment. B. ensure he or she does not overlook anything that can be treated in the field. C. first determine which problem will be the least likely to result in death. D. definitively rule out conditions that can result in rapid deterioration.

Taking It to the Streets, page 613 The answer is: ensure he or she does not overlook anything that can be treated in the field.

Which of the following is NOT a typical element to evaluate when reading the scene of a motor vehicle crash? A. Overall safety of the situation B. Environmental conditions C. The person at fault D. Access and exit routes

Taking It to the Streets, pages 611-612 The answer is: The person at fault

Which of the following is NOT a typical element to evaluate when reading the scene of a motor vehicle crash? A. The person at fault B. Access and exit routes C. Overall safety of the situation D. Environmental conditions

Taking It to the Streets, pages 611-612 The answer is: The person at fault

The chief white blood cell of the immune response is the: A. lymphocyte. B. eosinophil. C. neutrophil. D. monocyte.

The Body's Self-Defense Mechanisms, page 439 The answer is: lymphocyte.

Cells that mature in the bone marrow where they differentiate into memory cells or immunoglobulin-secreting (antibody) cells are called: A. T lymphocytes. B. B lymphocytes. C. plasma cells. D. memory B cells.

The Body's Self-Defense Mechanisms, page 440 The answer is: B lymphocytes.

Cells that mature in the bone marrow where they differentiate into memory cells or immunoglobulin-secreting (antibody) cells are called: A. memory B cells. B. T lymphocytes. C. plasma cells. D. B lymphocytes.

The Body's Self-Defense Mechanisms, page 440 The answer is: B lymphocytes.

The secondary (amnestic) immune response occurs when: A. the body is reexposed to a foreign substance. B. an antibody binds to a specific antigen and destroys it. C. the body is initially exposed to a foreign substance. D. biologic mediators release histamine and other chemicals.

The Body's Self-Defense Mechanisms, page 441 The answer is: the body is reexposed to a foreign substance.

The two MOST common causes of inflammation are: A. infection and injury. B. hypercarbia and hypoxemia. C. immunosuppression and fever. D. fever and phagocytosis.

The Body's Self-Defense Mechanisms, page 446 The answer is: infection and injury.

The two MOST common causes of inflammation are: A. infection and injury. B. immunosuppression and fever. C. hypercarbia and hypoxemia. D. fever and phagocytosis.

The Body's Self-Defense Mechanisms, page 446 The answer is: infection and injury.

During the acute inflammatory response: A. chemical mediators, which are primarily produced by monocytes, cause localized constriction of the vessels adjacent to the affected site. B. transient arteriolar constriction is followed by arteriolar dilation, which allows an influx of blood under increased pressure. C. increased vessel wall permeability forces fluid out of the interstitial spaces, resulting in cell shrinkage and eventual death. D. active hyperemia causes the blood vessels to constrict, which diverts blood flow away from the affected site.

The Body's Self-Defense Mechanisms, page 446 The answer is: transient arteriolar constriction is followed by arteriolar dilation, which allows an influx of blood under increased pressure.

Aspirin and NSAIDs reduce inflammation and pain by: A. promoting mast cell synthesis of prostaglandins. B. inhibiting prostaglandin synthesis. C. thinning the blood and reducing platelets. D. decreasing circulating pyrogen levels.

The Body's Self-Defense Mechanisms, page 447 The answer is: inhibiting prostaglandin synthesis.

In general, a child's immune system is not fully developed until he or she is between: A. 1 and 2 years of age. B. 2 and 3 years of age. C. 3 and 4 years of age. D. 4 and 5 years of age.

The Body's Self-Defense Mechanisms, page 450 The answer is: 2 and 3 years of age.

Wounds that heal by primary intention: A. heal without the formation of a scab. B. have a more pronounced and prolonged inflammatory phase. C. do not utilize fibrin or fibronectin. D. are generally clean wounds with opposed margins.

The Body's Self-Defense Mechanisms, page 450 The answer is: are generally clean wounds with opposed margins.

When nerve cells and cardiac myocytes are injured: A. a slow influx of blood flow causes progressive repair. B. scar tissue forms because these cells cannot be replaced. C. their cells divide completely and thus heal completely. D. they are replaced by regeneration from remaining cells.

The Body's Self-Defense Mechanisms, page 450 The answer is: scar tissue forms because these cells cannot be replaced.

When nerve cells and cardiac myocytes are injured: A. their cells divide completely and thus heal completely. B. they are replaced by regeneration from remaining cells. C. scar tissue forms because these cells cannot be replaced. D. a slow influx of blood flow causes progressive repair.

The Body's Self-Defense Mechanisms, page 450 The answer is: scar tissue forms because these cells cannot be replaced.

A type I hypersensitivity reaction is: A. an allergic response that occurs within hours of antigen exposure. B. an acute reaction that occurs in response to a stimulus. C. a cytotoxic reaction and destroys many of the body's healthy cells. D. a local reaction that primarily involves IgG antibodies.

The Body's Self-Defense Mechanisms, page 451 The answer is: an acute reaction that occurs in response to a stimulus.

All of the following diseases are autoimmune diseases, EXCEPT: A. myasthenia gravis. B. HIV infection. C. Graves disease. D. type 1 diabetes.

The Body's Self-Defense Mechanisms, page 453 The answer is: HIV infection.

If the cause of a disease is unknown, it is said to be: A. idiopathic. B. organic. C. pathologic. D. functional.

The Body's Self-Defense Mechanisms, page 453 The answer is: idiopathic.

Angiogenesis is defined as: A. rerouting of intact blood vessels. B. the growth of new blood vessels. C. regrowth of damaged blood vessels. D. the destruction of blood vessels.

The Body's Self-Defense Mechanisms, pages 450-451 The answer is: the growth of new blood vessels.

At a very large incident, the operations section is responsible for: A. locating food, shelter, and health care for you and the other responders present at the incident. B. managing the tactical operations job usually handled by the incident commander on routine EMS calls. C. ensuring that there is ample lighting and functional communications equipment during the incident. D. obtaining data regarding problems that may arise at the incident and revising the plan to solve the problem.

The Incident Command System, page 2337 The answer is: managing the tactical operations job usually handled by the incident commander on routine EMS calls.

You are caring for a patient with non-life-threatening injuries in the treatment section of a multiple-casualty incident when you are approached by several TV reporters who are seeking details regarding the incident. You should: A. direct the reporters to the public information officer. B. firmly tell the reporters to leave the scene immediately. C. provide a brief overview of the current situation. D. ignore the reporters' questions and continue patient care.

The Incident Command System, page 2339 The answer is: direct the reporters to the public information officer.

The ______________ has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. A. rescue officer B. triage officer C. logistics chief D. safety officer

The Incident Command System, page 2339 The answer is: safety officer

The integumentary system includes all of the following structures, EXCEPT: A. the epidermis. B. sweat glands. C. blood vessels. D. hair follicles.

The Integumentary System, page 262 The answer is: blood vessels.

Which of the following general statements regarding medical law is ? A. A medical liability lawsuit will only be successful if the patient's outcome was unfavorable. B. Medical providers with fewer than 5 years of experience are at highest risk of being sued. C. The patient or survivor must prove all elements of negligence before a lawsuit will be successful. D. A poor patient outcome typically means that the medical provider was grossly negligent.

The Legal System in the United States, page 100 The answer is: The patient or survivor must prove all elements of negligence before a lawsuit will be successful.

Transporting a competent adult patient without his or her consent would MOST likely result in allegations of: A. criminal trespassing. B. assault. C. false imprisonment. D. battery.

The Legal System in the United States, page 101 The answer is: false imprisonment.

Which type of nerve cells conduct electrical impulses toward the cell body? A. Dendrites B. Neurocytes C. Neurons D. Axons

The Nervous System, page 293 The answer is: Dendrites

The gap that lies between each nerve cell is called the: A. synapse. B. cleft. C. vesicle. D. terminal.

The Nervous System, page 294 The answer is: synapse.

Beginning with the outermost layer, the three meningeal layers of the central nervous system are the: A. dura mater, pia mater, and arachnoid. B. pia mater, dura mater, and arachnoid. C. arachnoid, pia mater, and dura mater. D. dura mater, arachnoid, and pia mater.

The Nervous System, page 296 The answer is: dura mater, arachnoid, and pia mater.

Cerebrospinal fluid is manufactured in the: A. posterior pituitary gland. B. ventricles of the brain. C. subarachnoid space. D. anterior pituitary gland.

The Nervous System, page 296 The answer is: ventricles of the brain.

The _______________ is a deep ridge of nerve fibers, which is separated by a layer of dura mater and connects the two cerebral hemispheres. A. coroid plexus B. corpus collosum C. presynaptic terminal D. cerebral cortex

The Nervous System, page 299 The answer is: corpus collosum

Any cell that ingests microorganisms or other cells is called a(n): A. endocyte. B. phagocyte. C. pinocyte. D. exocyte.

The Nervous System, page 301-302 The answer is: phagocyte.

The midbrain, pons, and medulla oblongata collectively form the: A. cerebellum. B. diencephalon. C. cerebral cortex. D. brainstem.

The Nervous System, page 302 The answer is: brainstem.

The midbrain, pons, and medulla oblongata collectively form the: A. diencephalon. B. cerebellum. C. cerebral cortex. D. brainstem.

The Nervous System, page 302 The answer is: brainstem.

The limbic system, a portion of the cerebrum and diencephalon, contains structures that: A. regulate a person's level of consciousness. B. control heart rate and blood pressure. C. regulate sleeping and breathing. D. influence emotions and mood.

The Nervous System, page 302 The answer is: influence emotions and mood.

Of the 12 pairs of cranial nerves, which two do NOT exit from the brainstem? A. Trochlear and abducens B. Phrenic and vagus C. Hypoglossal and oculomotor D. Olfactory and optic

The Nervous System, page 308 The answer is: Olfactory and optic

Stimulation of alpha-1 receptors of the sympathetic nervous system results in: A. bronchodilation. B. peripheral vasoconstriction. C. peripheral vasodilation. D. tachycardia.

The Nervous System, page 313 The answer is: peripheral vasoconstriction.

Stimulation of alpha-1 receptors of the sympathetic nervous system results in: A. peripheral vasoconstriction. B. bronchodilation. C. peripheral vasodilation. D. tachycardia.

The Nervous System, page 313 The answer is: peripheral vasoconstriction.

The term inotropy refers to the: A. rate of cardiac contraction. B. control of electrical conduction. C. strength of myocardial contraction. D. degree of ventricular irritability.

The Nervous System, page 313 The answer is: strength of myocardial contraction.

The catecholamine epinephrine (adrenaline) has an affinity for: A. alpha and beta receptors. B. alpha-1 receptors only. C. beta-1 receptors only. D. alpha-1 and beta-2 receptors.

The Nervous System, page 315 The answer is: alpha and beta receptors.

The catecholamine epinephrine (adrenaline) has an affinity for: A. alpha and beta receptors. B. beta-1 receptors only. C. alpha-1 receptors only. D. alpha-1 and beta-2 receptors.

The Nervous System, page 315 The answer is: alpha and beta receptors.

A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient? A. 12-Lead ECG B. Aspirin C. Adenosine D. IV access

The answer is: Adenosine

A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next? A. Administer 300 mg of amiodarone via rapid IV push B. Give amiodarone followed by 1.5 mg/kg of lidocaine C. Rapidly infuse 2 liters of normal saline solution D. Give 40 units of vasopressin followed by defibrillation

The answer is: Administer 300 mg of amiodarone via rapid IV push

Which of the following signs would you MOST likely observe in a patient with compensated shock? A. Dilation of the pupils B. Anxiety or agitation C. Response to painful stimuli D. Absent peripheral pulses

The answer is: Anxiety or agitation

__________ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking. A. Ataxia B. Myoclonus C. Decussation D. Bradykinesia

The answer is: Ataxia

Which of the following cardiac dysrhythmias is associated with the highest risk of stroke? A. Junctional rhythm B. Atrial fibrillation C. Sinus tachycardia D. AV heart block

The answer is: Atrial fibrillation

A motorcycle rider struck a parked car and was catapulted over the handlebars of his bike. Your assessment reveals that he is tachypneic, diaphoretic, and tachycardic. There is no gross external bleeding present. What is the MOST likely cause of this patient's clinical presentation? A. Sympathetic nervous system failure B. Closed head injury C. Bilateral femur fractures D. Proximal upper extremity fractures

The answer is: Bilateral femur fractures

Which of the following is LEAST characteristic of an apparent life-threatening event in an infant? A. Pallor or cyanosis B. Brief loss of a pulse C. Loss of muscle tone D. A period of apnea

The answer is: Brief loss of a pulse

_______________ binds to red blood cells and prevents them from transporting oxygen to all parts of the body. A. Nitrogen dioxide B. Carbon monoxide C. Cyanide D. Ammonium nitrate

The answer is: Carbon monoxide

Which of the following injuries or conditions would cause obstructive shock? A. Cardiac tamponade B. Pelvic fracture C. Massive sepsis D. Severe burns

The answer is: Cardiac tamponade

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac care? A. Chest compressions B. Tracheal intubation C. Artificial ventilation D. Defibrillation

The answer is: Chest compressions

Which of the following medical conditions would MOST likely cause changes in sensation in a patient with an extremity injury? A. Renal insufficiency B. Rheumatoid arthritis C. Diabetes D. Hypertension

The answer is: Diabetes

A 55-year-old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain? A. ST-segment depression on the 12-lead ECG tracing B. Difference in blood pressure between the two arms C. Bruits to both carotid arteries during auscultation D. Disappearance of radial pulses during inspiration

The answer is: Difference in blood pressure between the two arms

While attempting to ventilate an unresponsive, apneic drowning victim, you notice poor lung compliance. Which of the following would be the MOST likely cause of this? A. Acute pneumonitis B. Water within the pleural space C. Excess pulmonary surfactant D. Diffuse alveolar collapse

The answer is: Diffuse alveolar collapse

Considering the physiologic changes that occur with age, which of the following interventions would pose the GREATEST potential for further harm when caring for an elderly patient with a severe burn that is complicated by a spinal injury? A. Intubation B. Fluid replacement C. Thermal management D. Spinal immobilization

The answer is: Fluid replacement

In which of the following situations would endotracheal intubation MOST likely be indicated? A. Following return of spontaneous circulation, the patient remains comatose. B. The patient has an end-tidal CO2 reading of 36 mm Hg with a King LT airway in place. C. Bag-mask ventilation is adequate, but the patient has undergone more than 2 minutes of cardiac arrest. D. The patient is experiencing a ventricular fibrillation that is refractory to defibrillation and epinephrine.

The answer is: Following return of spontaneous circulation, the patient remains comatose.

Which of the following statements regarding frostbite is ? A. Frostbite is an ischemic injury that is classified as superficial or deep. B. Frostbite most commonly affects the trunk and lower extremities. C. Increased blood flow to an extremity exacerbates deep frostbite. D. Frostbite can only occur if the ambient temperature is below 40°F.

The answer is: Frostbite is an ischemic injury that is classified as superficial or deep.

Which of the following factors decreases the body's ability to eliminate excess heat through evaporation? A. Wet clothing B. High humidity C. Hyperventilation D. Low wind chill

The answer is: High humidity

You are dispatched to a residence for an injured person. The scene has been secured by law. The patient, a young female, tells you that her boyfriend kicked her in the chest yesterday during an argument. Your assessment reveals that the patient is in significant pain, is dyspneic, has a strong heart rate of 98 beats/min, and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient? A. Cardiac monitoring B. Titrated IV analgesics C. IV fluid boluses D. End-tidal CO2 monitoring

The answer is: IV fluid boluses

A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves: A. conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls. B. administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations. C. assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin. D. recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation.

The answer is: administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations.

When performing the standing takedown technique to immobilize a patient's spine, the patient is secured to the long backboard with straps: A. while still in the standing position. B. after the board is placed on the stretcher. C. after he or she is lowered to the ground. D. after a cervical collar has been applied.

The answer is: after he or she is lowered to the ground. CommentsComment:

The unified command system: A. can deplete the resources of multiple jurisdictions and agencies and should only be used during large disasters. B. mandates that a single person will maintain command authority, even if multiple jurisdictions respond. C. is a type of incident response in which command is established and maintained by the first agency on the scene. D. allows representatives from multiple jurisdictions and agencies to share command authority and responsibility.

The answer is: allows representatives from multiple jurisdictions and agencies to share command authority and responsibility.

The diagnosis of heatstroke is usually made when a patient has a high core body temperature and: A. an altered mental status. B. a heart rate above 140 beats/min. C. an absence of sweating. D. a history of heat exposure.

The answer is: an altered mental status.

A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of: A. an injury to the spleen. B. retroperitoneal bleeding. C. a lacerated liver. D. acute peritonitis.

The answer is: an injury to the spleen.

When viewing leads V3 and V4, you are looking at the _________ wall of the _________. A. inferior, right ventricle. B. septal, heart. C. lateral, left ventricle. D. anterior, left ventricle.

The answer is: anterior, left ventricle.

A 63-year-old diabetic woman presents with an open wound to her forearm that she experienced when she fell a week ago. She tells you that the wound has been draining purulent fluid, but has not been bleeding. The wound itself is red, inflamed, and warm to the touch. You should: A. apply a moist, sterile dressing and transport to the hospital. B. apply a dry, sterile dressing and transport her to the hospital. C. apply a light coat of antibiotic ointment and cover the wound. D. carefully irrigate the wound with sterile water for 5 minutes.

The answer is: apply a dry, sterile dressing and transport her to the hospital.

A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower-extremity injuries, it is MOST important that you: A. apply spinal motion restriction precautions. B. administer high-flow supplemental oxygen. C. try to determine why he jumped from the balcony. D. start a large-bore IV line of an isotonic crystalloid.

The answer is: apply spinal motion restriction precautions.

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should: A. preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea. B. assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status. C. suction his oropharynx, perform intubation, and then administer naloxone via slow IV push. D. apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations.

The answer is: assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

A 39-year-old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should: A. insert an oral airway, provide ventilatory assistance, cover the exposed bowel with aluminum foil, begin transport, and start two large-bore IV lines with normal saline en route. B. assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route. C. administer oxygen via nonrebreathing mask; cover the exposed bowel with dry, sterile dressings; start an IV and give a 500-mL fluid bolus; and transport to a trauma center. D. consider intubation to protect his airway; cover the exposed bowel with moist, sterile dressings; start an IV and give analgesia; and transport to a trauma center with fluid boluses en route.

The answer is: assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.

A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to: A. rapidly assess the chest for signs of a sternal fracture. B. perform intubation to secure the patient's airway. C. start an IV line and administer an antiarrhythmic drug. D. attach the ECG leads and be prepared to defibrillate.

The answer is: attach the ECG leads and be prepared to defibrillate.

Frothy sputum that has a pink tinge to it is MOST suggestive of: A. congestive heart failure. B. chronic bronchitis. C. antihistamine use. D. tuberculosis.

The answer is: congestive heart failure.

Strength of a person's peripheral pulses is related to: A. cardiac output and heart rate. B. heart rate and preload. C. stroke volume and pulse pressure. D. physical size and blood pressure.

Types of Shock, page 438 The answer is: stroke volume and pulse pressure.

A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient's son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to: A. auscultate his breath sounds before administering IV fluids. B. obtain a 12-lead ECG to assess for signs of cardiac ischemia. C. avoid narcotic analgesics because of his medical history. D. apply cold, moist dressings to his burns to provide pain relief.

The answer is: auscultate his breath sounds before administering IV fluids.

You are dispatched to a daycare center for a 5-year-old girl with trouble breathing. Upon arriving at the scene, you assess the child and note that she is responsive to pain only, has weak intercostal retractions, and is breathing at a slow rate with shallow depth. You should: A. deliver two effective rescue breaths and assess her pulse for at least 5 seconds. B. apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter. C. begin assisting her ventilations with a bag-mask device and assess her pulse rate. D. administer high-flow oxygen, assess her cardiac rhythm, and establish IO access.

The answer is: begin assisting her ventilations with a bag-mask device and assess her pulse rate.

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should: A. begin assisting his ventilations with a bag-mask and 100% oxygen. B. administer a sedative and a paralytic and then intubate his trachea. C. insert a nasal airway, apply a CPAP unit, and notify medical control. D. remove the nonrebreathing mask and apply a nasal cannula.

The answer is: begin assisting his ventilations with a bag-mask and 100% oxygen.

Most patients with an aortic injury will complain of pain: A. while taking a shallow breath. B. behind the sternum or in the scapula. C. in the region of the posterior pharynx. D. that radiates from the chest to the flank.

The answer is: behind the sternum or in the scapula.

An adult patient presents with a blood pressure of 78/60 mm Hg, a pulse rate of 120 beats/min and irregular, and labored breathing. Further assessment reveals pale, cool, moist skin and diffuse crackles in all lung fields. You should suspect: A. neurogenic shock. B. hypovolemic shock. C. cardiogenic shock. D. septic shock.

The answer is: cardiogenic shock.

The primary function of the tactical paramedic is to provide: A. armed cover for SWAT teams who enter the scene of a mass shooting. B. emergency medical treatment to hostages or those who are barricaded. C. care for law enforcement teams who make entry into violent situations. D. care for assailants who have been shot, stabbed, or otherwise injured.

The answer is: care for law enforcement teams who make entry into violent situations.

You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes: A. carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation. B. removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting. C. leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route. D. asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting.

The answer is: carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation.

Defibrillation of a patient who is in asystole is detrimental to the patient because it: A. makes ruling out underlying causes impossible. B. has been shown to render epinephrine ineffective. C. stops the cardiac cells from spontaneously depolarizing. D. causes an unnecessary interruption in chest compressions.

The answer is: causes an unnecessary interruption in chest compressions.

Depolarization, the process by which muscle fibers are stimulated to contract, occurs when: A. potassium ions escape from the cell through specialized channels. B. cell wall permeability changes and sodium rushes into the cell. C. cardiac muscle relaxes in response to a cellular influx of calcium. D. calcium ions rapidly enter the cell, facilitating contraction.

The answer is: cell wall permeability changes and sodium rushes into the cell.

As intracranial pressure rises: A. the brain becomes hypocarbic. B. the heart rate acutely increases. C. mean arterial pressure decreases. D. cerebral herniation may occur.

The answer is: cerebral herniation may occur.

COPD is characterized by: A. widespread alveolar collapse due to increased pressure during the exhalation phase. B. small airway spasms during the inhalation phase, resulting in progressive hypoxia. C. changes in pulmonary structure and function that are progressive and irreversible. D. narrowing of the smaller airways that is often reversible with prompt treatment.

The answer is: changes in pulmonary structure and function that are progressive and irreversible.

Nerve agents block _______________, an essential enzyme of the nervous system. A. cholinesterase B. epinephrine C. norepinephrine D. acetylcholine

The answer is: cholinesterase

Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT: A. chronic hyperthyroidism. B. atherosclerotic vessels. C. impaired circulation. D. decreased sweat production.

The answer is: chronic hyperthyroidism.

A police officer was shot when he attempted to serve a warrant to a known criminal. The shooter is still inside the residence, which is surrounded by SWAT team members. You have provided initial treatment, have loaded the officer into the ambulance, and are ready to depart. Your next action should be to: A. choose a different route than the one used to enter the scene. B. immediately turn your lights and siren on to announce your exit. C. confirm with the incident commander that it is safe to exit. D. wait for the shooter to be neutralized before departing.

The answer is: confirm with the incident commander that it is safe to exit.

You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn's heart rate remains below 60 beats/min. You should: A. continue bag-mask ventilations and initiate chest compressions. B. try tactile stimulation as you continue bag-mask ventilations. C. start a peripheral IV line and give 4 mEq of sodium bicarbonate. D. cannulate the umbilical vein and give 0.5 mL of epinephrine.

The answer is: continue bag-mask ventilations and initiate chest compressions.

A decreased wind chill factor increases heat loss through: A. conduction. B. radiation. C. convection. D. evaporation.

The answer is: convection.

A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are distended and his breath sounds are bilaterally diminished but equal. The MOST appropriate treatment for this patient involves: A. performing bilateral needle thoracenteses, intubating the patient and ventilating at 10 to 12 breaths/min, and transporting him to a trauma center. B. assisting his ventilations, initiating transport, starting a large-bore IV line en route, and administering fluids to maintain a systolic blood pressure of 100 mm Hg. C. covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route. D. administering oxygen via nonrebreathing mask, transporting at once, and placing an occlusive dressing over the stab wound if his oxygen saturation is low.

The answer is: covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route. CommentsComment:

Your primary assessment of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should: A. continue high-quality CPR and reassess in 2 minutes. B. defibrillate and immediately resume CPR. C. start an IV and administer 0.2 mg of epinephrine 1:10,000. D. charge the defibrillator to 80 joules while CPR is ongoing.

The answer is: defibrillate and immediately resume CPR.

You are caring for a patient with non-life-threatening injuries in the treatment section of a multiple-casualty incident when you are approached by several TV reporters who are seeking details regarding the incident. You should: A. ignore the reporters' questions and continue patient care. B. direct the reporters to the public information officer. C. firmly tell the reporters to leave the scene immediately. D. provide a brief overview of the current situation.

The answer is: direct the reporters to the public information officer.

The killing of pathogenic agents by directly applying a chemical made for that purpose is called: A. disinfection. B. sterilization. C. cleaning. D. high-level disinfection.

The answer is: disinfection.

In contrast to the right side of the heart, the left side of the heart: A. drives blood out of the heart against the relatively low resistance of the pulmonary circulation. B. is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs. C. is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta. D. drives blood out of the heart against the relatively high resistance of the systemic circulation.

The answer is: drives blood out of the heart against the relatively high resistance of the systemic circulation.

While providing care to victims following an earthquake, you note that many of them are experiencing respiratory distress. This is MOST likely due to: A. dust suffocation. B. carbon monoxide. C. thoracic barotrauma. D. infectious pneumonia.

The answer is: dust suffocation.

A second-degree heart block, Mobitz type I, occurs when: A. more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles. B. every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles. C. each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. D. the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex.

The answer is: each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles.

Common signs and symptoms of preeclampsia include: A. edema, hypertension, and headache. B. facial swelling, dysuria, and chest pain. C. ketones in the urine and rapid weight gain. D. weight loss, blurred vision, and diarrhea.

The answer is: edema, hypertension, and headache.

A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads. A. depression, 2, one B. depression, 1, two C. elevation, 2, one D. elevation, 1, two

The answer is: elevation, 1, two

The primary treatment for hypotension secondary to anaphylaxis is: A. a dopamine infusion. B. diphenhydramine. C. isotonic crystalloid. D. epinephrine.

The answer is: epinephrine.

Respiratory alkalosis is the result of: A. increased hydrogen ion production. B. carbon dioxide retention. C. slow and shallow respirations. D. excess carbon dioxide elimination.

The answer is: excess carbon dioxide elimination.

In contrast to adults, young children are more prone to liver and spleen injuries because the organs: A. are more mobile and less supported. B. are relatively smaller and less protected. C. extend well below the rib cage. D. are both highly vascular.

The answer is: extend well below the rib cage.

Fertilization of an egg usually occurs in the: A. fallopian tube. B. uterus. C. ovary. D. infundibulum.

The answer is: fallopian tube.

When delivering multiple babies, you should clamp and cut the umbilical cord: A. after all the babies have delivered. B. after the placenta has delivered. C. following delivery of each baby. D. only after the first baby delivers.

The answer is: following delivery of each baby.

A patient would MOST likely become trapped between the driver's seat and steering wheel following a: A. rollover crash. B. frontal crash. C. lateral collision. D. T-bone collision.

The answer is: frontal crash.

Level A personal protective equipment: A. fully encapsulates the hazardous materials technician, including his or her self-contained breathing apparatus. B. provides the same degree of protection as a fire fighter's turnout gear, and is typically worn in the cold zone. C. is designed to protect the rescuer against a known agent and is worn with an air-purifying respirator. D. is required when a technician needs protection from splashes and inhaled toxins but does not need to be fully encapsulated.

The answer is: fully encapsulates the hazardous materials technician, including his or her self-contained breathing apparatus.

Muscular dystrophy can be defined as a(n): A. nonprogressive neuromuscular disorder caused by fetal brain hypoxia. B. autoimmune disease in which the skeletal muscles are rapidly destroyed. C. genetic disease that causes a slow, progressive degeneration of muscle fibers. D. birth defect caused by improper development of the fetal neural tube.

The answer is: genetic disease that causes a slow, progressive degeneration of muscle fibers.

You are dispatched to the city park on a hot summer day for a 39-year-old man who fainted. When you arrive, you find the patient sitting under a tree. According to his wife, he had been playing softball all day and has consumed a significant amount of alcohol. She further confirms that he did faint and was "out" for about 2 minutes. The patient is conscious and tells you that he does not remember what happened. His skin is cool, moist, and pale, and his pulse is weak and rapid. You should: A. initiate immediate and aggressive cooling measures, begin transport, start two large-bore IV lines en route, and closely monitor his cardiac rhythm. B. administer oxygen, apply a cervical collar in case he injured himself when he fainted, start an IV with normal saline, give a 20-mL/kg fluid bolus, and transport. C. give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm. D. give oxygen via nasal cannula, start an IV of normal saline at a keep-vein-open rate, administer 50% dextrose IV, and transport with passive cooling en route.

The answer is: give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm.

When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced: A. serum glucose levels will fall and brain damage may occur. B. glucose levels in the blood and urine will be elevated. C. the cells will metabolize oxygen and function normally. D. the body will stop making glucose as a protective mechanism.

The answer is: glucose levels in the blood and urine will be elevated.

It is MOST important to consider a clandestine drug lab to be a(n): A. illegal operation. B. hazardous materials scene. C. unsafe environment for children. D. crime scene.

The answer is: hazardous materials scene.

ly splinting an injured extremity: A. typically provides complete pain relief without the need to administer narcotic analgesia. B. effectively reduces swelling and inflammation by shunting blood away from the injured area. C. eliminates the need to elevate the extremity because immobilization causes blood stasis. D. helps to control internal bleeding by allowing clots to form where vessels are damaged.

The answer is: helps to control internal bleeding by allowing clots to form where vessels are damaged.

You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on: A. heroin. B. LSD. C. ibuprofen. D. Prozac.

The answer is: heroin.

Fall-related fractures in the elderly occur MOST often to the _______, usually in patients with underlying _______. A. pelvis, osteoarthritis B. humerus, arthritis C. elbow, osteoporosis D. hip, osteoporosis

The answer is: hip, osteoporosis

You receive a call to a residence for a 44-year-old man who is "ill." The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient's vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is: A. hyperkalemic. B. having an acute myocardial infarction. C. hypernatremic. D. hypocalcemic.

The answer is: hyperkalemic.

In a cold environment, the body produces and conserves heat through all of the following mechanisms, EXCEPT: A. shivering. B. vasoconstriction. C. thermogenesis. D. hyperventilation.

The answer is: hyperventilation.

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by: A. increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia. B. maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. C. delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase. D. improving patency of the lower airway through the use of positive-end expiratory pressure.

The answer is: improving patency of the lower airway through the use of positive-end expiratory pressure.

Triage and emergency medical treatment should be performed: A. in the warm zone. B. at least 100 feet from the incident. C. in the hot zone. D. in the cold zone.

The answer is: in the cold zone.

Systemic effects of epinephrine include: A. decreased preload. B. increased afterload. C. diffuse vasodilation. D. bronchoconstriction.

The answer is: increased afterload.

Anaerobic metabolism is the process in which: A. the adrenal glands fail to release catecholamines. B. adequate amounts of oxygen reach the cell level. C. the cells produce carbon dioxide and water. D. inefficient cellular metabolism produces lactic acid.

The answer is: inefficient cellular metabolism produces lactic acid.

The treatment for sinus tachycardia should focus on: A. ing the underlying cause. B. administering IV fluid boluses. C. relieving pain and anxiety. D. decreasing the heart rate.

The answer is: ing the underlying cause.

Accumulating acids and other waste products in the blood: A. act as potent vasoconstrictors, which worsens ischemia. B. cause a left shift in the oxyhemoglobin dissociation curve. C. cause a marked increase in the production of red blood cells. D. inhibit hemoglobin from binding with and carrying oxygen.

The answer is: inhibit hemoglobin from binding with and carrying oxygen.

You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient's wife tells you that he collapsed about 10 minutes ago. You should: A. initiate CPR as your partner applies the defibrillator pads. B. apply the defibrillator pads and assess his cardiac rhythm. C. ask the patient's wife if her husband has a living will. D. begin CPR with a compression to ventilation ratio of 15:2.

The answer is: initiate CPR as your partner applies the defibrillator pads.

If a cardiac arrest patient's airway is maintained with an oral airway and ventilation with a bag-mask device is producing adequate chest rise, then: A. a King LT or Combitube is preferred over tracheal intubation. B. insertion of an advanced airway device is not a high priority. C. there should be no pause in chest compressions to deliver a breath. D. the paramedic should deliver one breath every 5 to 6 seconds.

The answer is: insertion of an advanced airway device is not a high priority.

As you are administering 40 units of vasopressin to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should: A. deliver a monophasic defibrillation with 200 joules and resume CPR. B. advise your team to stop CPR as you prepare to deliver another shock. C. administer 300 mg of amiodarone while CPR remains uninterrupted. D. instruct your team to continue CPR as the defibrillator is charging.

The answer is: instruct your team to continue CPR as the defibrillator is charging.

Impaired vasodilation: A. increases heat absorption. B. interferes with heat dissipation. C. decreases internal heat production. D. is caused by beta blocker medications.

The answer is: interferes with heat dissipation.

Cyanide is a chemical asphyxiant, which means that it: A. binds to hemoglobin and prevents oxygen transport to the cells. B. impairs pulmonary respiration by causing pulmonary edema. C. destroys red blood cells and prevents red blood cell production. D. interferes with the utilization of oxygen at the cellular level.

The answer is: interferes with the utilization of oxygen at the cellular level.

A partial-thickness burn is considered to be critical if it: A. is rated as at least a 5 on a pain scale of 0 to 10. B. is located to the proximal aspect of an extremity. C. involves more than 30% of the body surface area. D. occurs in any patient over the age of 45 years.

The answer is: involves more than 30% of the body surface area.

Unlike an opioid, an opiate: A. is a synthetic, non-opium-derived narcotic. B. is a natural product derived from opium. C. is not reversed by naloxone administration. D. produces a distinctly different toxidrome.

The answer is: is a natural product derived from opium.

A deeply frostbitten extremity: A. is typically bright red and painful. B. requires amputation due to gangrene. C. is cold, hard, and without sensation. D. usually heals well with rewarming.

The answer is: is cold, hard, and without sensation.

A closed, or contained, multiple-casualty incident is a situation that: A. does not require mutual aid assistance from other agencies. B. involves no more than 10 patients who are critically injured. C. does not have the potential to grow in size or complexity. D. is not expected to produce more patients than initially present.

The answer is: is not expected to produce more patients than initially present.

The toxicity of carbon monoxide arises primarily from: A. its affinity for hemoglobin in red blood cells. B. its ability to markedly decrease the metabolic rate. C. the fact that carbon monoxide destroys hemoglobin molecules. D. its destructive properties on ferric ions.

The answer is: its affinity for hemoglobin in red blood cells.

When sarin is on clothing, it has the effect of off-gassing, which means that: A. the chemical soaks through clothing and penetrates the skin. B. contamination of the patient is limited to a short period. C. it rapidly transforms from a vapor to a liquid. D. its vapors are continuously released over a period of time.

The answer is: its vapors are continuously released over a period of time.

When caring for a prolapsed umbilical cord, you should: A. have your partner cover the exposed portion of the umbilical cord with dry, sterile dressings. B. instruct the mother to push during each contraction to facilitate passage of the baby past the cord. C. keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital. D. position the mother in a left lateral recumbent position with her knees flexed into her abdomen.

The answer is: keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital.

A hiker was bitten on the left lower leg by a rattlesnake. He is conscious and alert, but complains of nausea and generalized weakness. The affected area, which has two distinct puncture wounds, is swollen markedly. The patient's blood pressure is 114/66 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min and regular. The MOST appropriate treatment for this patient involves: A. administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity. B. applying venous tourniquets proximal and distal to the affected site, elevating the limb no more than 12 inches, applying a splint, and establishing vascular access. C. keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access. D. placing him in a supine position, elevating the affected extremity and applying ice to reduce the swelling, establishing vascular access, and administering fentanyl for pain.

The answer is: keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of "breathing problem," for which he uses a prescribed inhaler and takes a "heart pill." You should suspect: A. left-sided heart failure. B. right ventricular failure. C. acute COPD exacerbation. D. reactive airway disease.

The answer is: left-sided heart failure.

Strength of a person's peripheral pulses is related to: A. cardiac output and heart rate. B. physical size and blood pressure. C. heart rate and preload. D. stroke volume and pulse pressure.

Types of Shock, page 438 The answer is: stroke volume and pulse pressure.

If a trauma patient cannot be assessed properly in his or her vehicle, you should: A. grasp the patient behind the shoulders, cradle his or her head in your arms to protect the spine, and rapidly extricate him or her from the car. B. apply a rigid cervical collar, perform a rapid assessment only, and then remove the patient with the two-person lift technique. C. apply a vest-type extrication device and then rapidly remove him or her from the vehicle using at least three people. D. maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

The answer is: maintain manual stabilization of the head, apply a cervical collar, and move the patient from the vehicle onto a long backboard.

If you discover minor external bleeding during your primary assessment of a patient, you should: A. make note of it and continue your assessment. B. stop your assessment and take the patient's blood pressure. C. establish a large-bore IV line immediately. D. stop your assessment and control the bleeding.

The answer is: make note of it and continue your assessment.

You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: A. remove his helmet and apply a cervical collar. B. carefully straighten his legs and assess distal pulses. C. manually stabilize his head and assess his airway. D. immediately stabilize both lower extremities.

The answer is: manually stabilize his head and assess his airway.

A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semiconscious, has shallow breathing, and has blood draining from the corner of his mouth. Initial management for this patient involves: A. applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a bag-mask device. B. manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen. C. fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him with a bag-mask device at a rate of 20 breaths/min. D. inserting an oropharyngeal airway, preoxygenating him with a bag-mask device for 2 minutes, and then intubating his trachea.

The answer is: manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

A wandering atrial pacemaker: A. has consistent P-wave shapes. B. may have variable PR intervals. C. is generally treated with atropine. D. is generally faster than 100 beats/min.

The answer is: may have variable PR intervals.

An acute dystonic reaction is characterized by: A. dry mouth, blurred vision, and cardiac dysrhythmias following treatment with a neuroleptic drug. B. muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug. C. a sudden catatonic state that results from oversedation with drugs such as Zyprexa and Mellaril. D. intermittent explosive behavior after a person suddenly stops taking medications for schizophrenia.

The answer is: muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug.

The MOST common cause of cardiogenic shock is: A. myocardial infarction. B. a sudden dysrhythmia. C. papillary muscle rupture. D. ventricular aneurysm.

The answer is: myocardial infarction.

A spontaneous abortion: A. is most often the result of a congenital abnormality of the placenta. B. is generally performed by a physician to prevent maternal death. C. occurs naturally and may or may not have an identifiable cause. D. affects one out of every three pregnancies and is typically idiopathic.

The answer is: occurs naturally and may or may not have an identifiable cause.

Nitrogen causes decompression sickness: A. on descent because of a progressive increase in atmospheric absolute. B. on descent because of the bubbles that form on reduction of pressure. C. on ascent because of a progressive increase in atmospheric absolute. D. on ascent because of the bubbles that form on reduction of pressure.

The answer is: on ascent because of the bubbles that form on reduction of pressure.

One aspect of the technique of contact and cover involves: A. one paramedic trying to defuse the situation with a calm voice while the second paramedic discreetly returns to the ambulance to summon law enforcement personnel to the scene. B. one paramedic making contact with the patient to provide care while the second paramedic obtains patient information from another person while gauging his or her level of tension. C. both paramedics providing emergency care to the patient while a law enforcement officer gathers information from another person and prevents the situation from escalating. D. one paramedic assessing and providing care to the patient while the other paramedic physically blocks the view of the patient from an angry spouse to avoid escalating the potential for violence.

The answer is: one paramedic making contact with the patient to provide care while the second paramedic obtains patient information from another person while gauging his or her level of tension.

You respond to a residence for an unknown emergency involving an 83-year-old man. When you arrive, you find the patient, who is conscious and alert, sitting on his couch with his head held over a bowl. He tells you that his nose started bleeding about 20 minutes ago and he cannot get it to stop. As your partner assists the patient in controlling the bleeding, you inquire about his medical history. He tells you that he has chronic atrial fibrillation, has high blood pressure, and is occasionally depressed. When you ask him about compliance with his medications, he tells you, "I take my medicine every day, but the writing on the bottles is so small." The patient's blood pressure is 112/58 mm Hg, pulse rate is 88 beats/min and irregular, and respirations are 18 and unlabored. This patient has MOST likely inadvertently: A. underdosed on his Toprol. B. overdosed on his Xanax. C. overdosed on his warfarin. D. underdosed on his digoxin.

The answer is: overdosed on his warfarin.

The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to: A. peptic ulcer disease. B. constipation. C. mesenteric ischemia. D. cholelithiasis.

The answer is: peptic ulcer disease.

If you have reason to believe that an unresponsive child has a foreign body airway obstruction, you should: A. try to remove it by performing a finger sweep of the mouth. B. perform 30 chest compressions and then look in the mouth. C. administer abdominal thrusts until the object is expelled. D. assess for a pulse and then begin chest compressions.

The answer is: perform 30 chest compressions and then look in the mouth.

While triaging patients at a multiple-casualty incident, you rapidly assess a patient and determine that he is conscious and alert, but cannot feel or move anything below his umbilicus. You should: A. categorize him as an immediate patient and continue triage. B. place a yellow tag on him and move on to the next patient. C. conduct a more in-depth neurologic exam of the patient. D. apply full spinal motion restriction precautions at once.

The answer is: place a yellow tag on him and move on to the next patient.

To ensure that an infant's head is in a neutral position during spinal immobilization, you should: A. provide slight extension of his or her head. B. place padding under the infant's shoulders. C. place a towel roll behind the infant's neck. D. use towel rolls for lateral head stabilization.

The answer is: place padding under the infant's shoulders.

The key to any disaster response is: A. recovery. B. planning. C. triage. D. execution.

The answer is: planning.

The leading cause of death from infection in Americans older than 65 years of age is: A. pneumonia. B. encephalitis. C. meningitis. D. nephritis.

The answer is: pneumonia.

You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing: A. bronchitis. B. COPD exacerbation. C. end-stage COPD. D. pneumonia.

The answer is: pneumonia.

An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n): A. wandering atrial pacemaker. B. premature atrial complex. C. junctional escape complex. D. atrial escape complex.

The answer is: premature atrial complex.

Compartment syndrome occurs when: A. metabolic waste products accumulate within a large hematoma that develops near a fracture site. B. pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death. C. blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue. D. yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling.

The answer is: pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.

When caring for an unresponsive patient with a toxicologic emergency, you should: A. administer high-flow oxygen, perform a detailed secondary assessment, obtain vital signs, and transport to the closest hospital. B. intubate at once, obtain baseline vital signs, transport immediately, and perform all other interventions en route to the hospital. C. try to neutralize any ingested toxins, secure a definitive airway, obtain baseline vital signs, start an IV line, and transport as soon as possible. D. protect the airway, perform a rapid assessment, obtain vital signs, try to gather a medical history from the family, and transport promptly.

The answer is: protect the airway, perform a rapid assessment, obtain vital signs, try to gather a medical history from the family, and transport promptly.

Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT: A. pleuritic chest pain. B. tachycardia and tachypnea. C. pulmonary edema. D. right-sided heart failure.

The answer is: pulmonary edema.

Upon arriving at the scene of a woman with chest pain, you enter the residence and begin to assess the patient. The patient's husband, who is angry because of your response time, is standing in the corner clenching his fists. You should: A. return to the ambulance and leave the scene at once. B. quickly scan the area for the quickest escape route. C. allow the patient to try to calm her husband down. D. tell the man that his behavior will not be tolerated.

The answer is: quickly scan the area for the quickest escape route.

Hypotension during anaphylactic shock is caused primarily by: A. relative hypovolemia. B. vascular damage. C. capillary leakage. D. cardiac muscle injury.

The answer is: relative hypovolemia.

Wheezing is resolved with medications that: A. relax the smooth muscle of the bronchioles. B. cause bronchoconstriction and improved airflow. C. dry up secretions in the lower airway. D. reduce soft tissue swelling in the larynx.

The answer is: relax the smooth muscle of the bronchioles.

You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to: A. administer at least 2 L of normal saline solution to prevent renal failure. B. thoroughly assess and clean the entry and exit wounds to prevent an infection. C. remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. D. reassess his vital signs every 15 minutes and treat any fractures or dislocations.

The answer is: remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate.

When removing a vehicle's roof, you must FIRST: A. remove all glass to prevent it from falling on the patient. B. cut the vehicle posts farthest away from the patient. C. remove at least one door so patient assessment can begin. D. break the safety glass of the window closest to the patient.

The answer is: remove all glass to prevent it from falling on the patient.

The preferred site for performing a needle thoracentesis is: A. just below the second rib into the intercostal space at the midaxillary line. B. superior to the third rib into the intercostal space at the midclavicular line. C. just above to the fifth rib into the intercostal space at the midaxillary line. D. inferior to the third rib into the intercostal space at the midclavicular line.

The answer is: superior to the third rib into the intercostal space at the midclavicular line.

A positive Babinski reflex is observed when the: A. patient's reflexes are hyperactive in response to an external stimulus. B. patient responds to pain by flexing the arms and extending the legs. C. toes curve or move downward when the sole of the foot is touched. D. toes move upward in response to stimulation of the sole of the foot.

The answer is: toes move upward in response to stimulation of the sole of the foot.

Law enforcement requests your assistance for a 40-year-old man whom they found in an alley. According to one police officer, the patient is "probably drunk." The outside temperature is 37°F with a light wind and drizzle. The patient, who is conscious but confused, is shivering and has slurred speech. His skin is cold and pale, his heart rate is 68 beats/min and regular, and his respirations are 24 breaths/min and regular. After moving the patient into the warmed ambulance, you should: A. remove his wet clothing, apply chemical heat packs directly to the groin, assess his blood glucose level and treat with dextrose if it is less than 80 mg/dL, and administer high-flow oxygen. B. assess his blood pressure, apply chemical heat packs to his neck, groin, and axillae, infuse 250 to 500 mL of warm normal saline, and administer one or two tubes of oral glucose. C. apply warm layered blankets, administer 100 mg of thiamine IM, administer oxygen via nasal cannula, start an IV line with lactated Ringer's solution, and administer 25 grams of 50% dextrose. D. remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.

The answer is: remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.

While applying the defibrillator pads, you note that the patient has a transdermal nitroglycerin patch on the right anterior chest. You should: A. move the patch to the left anterior chest. B. place the pads at least 1 inch from the patch. C. place the second pad in between the scapulae. D. remove the patch and wipe away any residue.

The answer is: remove the patch and wipe away any residue.

In contrast to alpha radiation, beta radiation: A. travels slowly and is less penetrating. B. requires a layer of clothing to stop it. C. can easily penetrate the human body. D. is easily stopped by a piece of paper.

The answer is: requires a layer of clothing to stop it.

Cardiac arrest following a narcotic overdose is usually the result of: A. seizures. B. respiratory arrest. C. renal failure. D. a cardiac dysrhythmia.

The answer is: respiratory arrest.

In contrast to adults, cardiac arrest in children is usually caused by: A. respiratory failure. B. a toxic ingestion. C. congenital anomalies. D. a dysrhythmia.

The answer is: respiratory failure.

The ______________ has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. A. safety officer B. triage officer C. rescue officer D. logistics chief

The answer is: safety officer

Proper treatment for an open wound to the neck includes: A. prompt transportation to a hyperbaric chamber. B. sealing the wound with an occlusive dressing. C. administering 2 L of IV crystalloid solution. D. applying a circumferential pressure dressing.

The answer is: sealing the wound with an occlusive dressing.

The MOST common etiology for bradycardia in a newborn is: A. occult hypovolemia. B. increased vagal tone. C. severe hypoxia. D. untreated acidosis.

The answer is: severe hypoxia.

If a woman is gravida 3 and para 2: A. she has been pregnant five times. B. she has delivered three babies. C. she has delivered two babies. D. she has been pregnant two times.

The answer is: she has delivered two babies.

On the ECG strip, a third-degree AV block usually appears as a: A. slow, wide QRS complex rhythm with inconsistent PR intervals. B. slow, narrow QRS complex rhythm with irregular P-P intervals. C. narrow QRS complex rhythm with a rate less than 60 beats/min. D. wide QRS complex rhythm with a rate between 50 and 70 beats/min.

The answer is: slow, wide QRS complex rhythm with inconsistent PR intervals.

The MOST practical method of splinting multiple fractures in a critically injured patient is to: A. splint the axial skeleton using a long backboard. B. apply vacuum splints en route to the hospital. C. sedate the patient before applying any splints. D. use air splints so you can visualize the injuries.

The answer is: splint the axial skeleton using a long backboard.

A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should: A. splint the elbow in the position found and reassess distal circulation. B. apply a sling and swathe to immobilize the injury and then apply heat. C. carefully straighten the arm to facilitate placement of a vacuum splint. D. administer fentanyl for pain relief and then carefully straighten the arm.

The answer is: splint the elbow in the position found and reassess distal circulation.

If your only protection from gunfire in a residence is behind a frame wall, you should: A. attempt to locate a stud behind the wall and remain as close to that area as you possibly can. B. recall that most walls have an interior frame that is metal and will afford you adequate protection. C. crouch down at the base of the wall, with your hands protecting your head, and remain still. D. stand near the door or window frame, which usually contain more wood than other areas of the wall.

The answer is: stand near the door or window frame, which usually contain more wood than other areas of the wall.

The terrorism carried out by groups that have close ties with a national government is referred to as: A. foreign-funded terrorism. B. intercontinental terrorism. C. international terrorism. D. state-sponsored terrorism.

The answer is: state-sponsored terrorism.

The MOST significant immediate danger resulting from an earthquake is: A. natural gas leaks. B. power failure. C. building explosions. D. structural collapse.

The answer is: structural collapse.

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should: A. suction his oropharynx for 30 seconds and then perform endotracheal intubation. B. apply direct pressure to his facial wounds and promptly intubate him. C. suction the blood from his mouth and assist ventilations with a bag-mask device. D. insert a nasal airway, apply oxygen via nonrebreathing mask, and transport.

The answer is: suction the blood from his mouth and assist ventilations with a bag-mask device.

A 71-year-old man slipped on wet grass and landed on his left side. He denies losing consciousness before or after the fall and is presently conscious and alert. He complains of pain to his left hip and in his neck. Your assessment reveals a hematoma to the left side of his head and an external rotation and shortening of his left leg. His vital signs are stable. The MOST appropriate treatment for this patient includes: A. supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, morphine if needed, and transport. B. spinal motion restriction precautions, stabilization of his hip with a traction splint, an IV of normal saline, 5 mg/kg of morpine, and transport. C. supplemental oxygen, application and inflation of the PASG to stabilize his hip, an IV line of normal saline and midazolam 1-2 mg to relieve his pain, and transport. D. placing him on a scoop stretcher and stabilizing his hip with pillows, applying a cervical collar, starting an IV line set to keep the vein open, and transport.

The answer is: supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, morphine if needed, and transport.

You are one of the paramedics staffing the rehabilitation section at a hazardous materials incident when a hazardous materials technician brings you one of his coworkers, whose mental status is altered. According to the technician, his coworker was appropriately decontaminated in the warm zone. The patient's skin is hot and moist, and he is confused and nauseated. You should: A. first contact the incident commander and confirm that the patient has indeed been decontaminated. B. administer oxygen, start an IV line, administer 2 L of cold normal saline rapidly, and prepare for transport. C. suspect that he is suffering from heatstroke, administer high-flow oxygen, and begin rapid cooling measures. D. administer oxygen via nasal cannula, take his blood pressure, and offer him cold water to drink.

The answer is: suspect that he is suffering from heatstroke, administer high-flow oxygen, and begin rapid cooling measures.

An idiopathic seizure is one in which: A. a part of the brain is affected. B. a postictal phase is not present. C. the cause is not known. D. the entire brain is affected.

The answer is: the cause is not known.

Spina bifida occurs when: A. trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. B. the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed. C. growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected. D. hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord.

The answer is: the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed.

Administering a drug that possesses a positive chronotropic effect will have a direct effect on: A. the heart rate. B. blood pressure. C. cardiac output. D. stroke volume.

The answer is: the heart rate.

The basal metabolic rate is MOST accurately defined as: A. the expenditure of heat energy during strenuous exertion or exercise. B. a constant fluctuation in core body temperature to maintain homeostasis. C. the balance between heat production and heat elimination from the body. D. the heat energy produced at rest from normal body metabolic reactions.

The answer is: the heat energy produced at rest from normal body metabolic reactions.

Supraglottic damage following a burn is MOST often caused by: A. the inhalation of superheated gases. B. the inhalation of hot particulate steam. C. direct flame exposure to the oropharynx. D. exposure to carbon monoxide or cyanide.

The answer is: the inhalation of superheated gases.

A motorcycle or football helmet should be removed if: A. you are properly trained in the technique, even if you are by yourself. B. you are going to transport the patient to a medical treatment facility. C. the patient complains of severe neck pain and the helmet fits snugly. D. the patient is breathing shallowly and access to the airway is difficult.

The answer is: the patient is breathing shallowly and access to the airway is difficult.

The only time a patient should be moved prior to completion of initial care, assessment, stabilization, and treatment is when: A. your primary assessment reveals no life-threatening injuries. B. the patient is in severe pain and is extremely anxious. C. the patient's or responder's life is in immediate danger. D. more than one noncritical patient is involved.

The answer is: the patient's or responder's life is in immediate danger.

A 19-year-old diabetic woman who is 22 weeks pregnant presents with an occipital headache, blurred vision, and edema to her hands and feet. Her blood pressure is 152/94 mm Hg, pulse rate is 108 beats/min, and respirations are 20 breaths/min. The patient is conscious and alert, and states that she is "retaining a lot of water." Your MOST immediate concern should be: A. her current blood sugar level. B. the possibility of a seizure. C. lowering her blood pressure. D. the risk of fetal compromise.

The answer is: the possibility of a seizure.

Polypharmacy is MOST accurately defined as: A. the prescribing of multiple drugs to treat multiple conditions. B. unnecessarily prescribing numerous drugs to prevent a disease. C. a harmful interaction when several drugs are taken together. D. the unintentional ingestion of multiple doses of the same drug.

The answer is: the prescribing of multiple drugs to treat multiple conditions.

It is MOST important to park your ambulance upwind and uphill from a hazardous materials incident scene because: A. hazardous chemicals that turn to gas rarely have a vapor density that is heavier than the air, regardless of the amount of chemical. B. the risk of being contaminated is minimal if the chemical travels, and you will have greater visibility of the entire incident scene. C. the vapor density of many chemicals is less than that of the air, causing the vapor to rise and dissipate as it travels with the wind. D. if the chemical ignites and explodes, the fallout from the blast will most likely sink into valleys and ditches instead of rising.

The answer is: the vapor density of many chemicals is less than that of the air, causing the vapor to rise and dissipate as it travels with the wind.

The use of wet dressings in the field is limited because: A. they provide a medium for pathogens to grow. B. they are of no value in providing pain relief. C. their use may result in severe hypothermia. D. their sterility cannot be maintained in the field.

The answer is: they provide a medium for pathogens to grow.

If the wife of a critically ill man asks you if her husband is going to die, the MOST appropriate response should be: A. "It is possible, and you should prepare yourself for the worst." B. "He is very sick, but we are doing everything we can to help him." C. "The situation appears grim, but you should not lose all hope." D. "That question is best answered by the physician at the hospital."

Therapeutic Communication, page 154 The answer is: "He is very sick, but we are doing everything we can to help him."

If a patient asks for your advice regarding a treatment decision that his or her physician made, you should: A. obtain specific information about the physician's decision. B. advise the patient to consult with his or her physician. C. only give advice if you disagree with the physician. D. give your opinion, but state that you are not a physician.

Therapeutic Communication, page 154 The answer is: advise the patient to consult with his or her physician.

When attempting to interview a potentially violent patient, you should: A. ensure that you are positioned between the patient and the door. B. use closed-ended questions to obtain his or her medical history. C. avoid eye contact with the patient, as this may agitate him or her. D. set "ground rules" regarding what you expect from him or her.

Therapeutic Communication, page 155 The answer is: ensure that you are positioned between the patient and the door.

If the paramedic is unable to defuse a hostile patient's anger, the paramedic should: A. obtain a signed refusal and depart the scene. B. administer Valium or Haldol for sedation. C. restrain the patient and transport at once. D. request law enforcement personnel at the scene.

Therapeutic Communication, page 155 The answer is: request law enforcement personnel at the scene.

What type of tissue covers and lines internal organs? A. Epithelial B. Connective C. Striated D. Muscle

Tissue Level, page 253 The answer is: Epithelial

During an allergic reaction, mast cells release histamines and heparin. What respective roles do these chemicals play? A. Reduce inflammation and inhibit blood clotting. B. Reduce tissue inflammation and inhibit blood clotting. C. Increase tissue inflammation and inhibit blood clotting. D. Reduce inflammation and facilitate blood clotting.

Tissue Level, page 256 The answer is: Increase tissue inflammation and inhibit blood clotting.

All of the following are voluntary muscles, EXCEPT: A. skeletal muscle. B. smooth muscle. C. striated muscle. D. somatic muscle.

Tissue Level, pages 258-259 The answer is: smooth muscle.

Basic language mastery typically occurs by what age? A. 18 months B. 48 months C. 36 months D. 24 months

Toddlers and Preschoolers, page 483 The answer is: 36 months

All of the following physical changes occur in school-age children, EXCEPT: A. they develop permanent teeth. B. their weight, on average, increases 3 kg per year. C. their vital signs become the same as adults'. D. their height, on average, increases 2 inches per year.

Toddlers and Preschoolers, page 484 The answer is: their vital signs become the same as adults'.

A 25-year-old woman was involved in a motor vehicle accident in which she struck the rear end of another car at a low speed. When you arrive at the scene and exit the ambulance, you immediately hear the patient screaming, "My baby, my baby!" After calming the patient down, she tells you that she is 10 weeks pregnant and that she is afraid that the car accident injured her child. She confirms that she was properly restrained at the time of impact. She is conscious and alert, denies abdominal pain, and has stable vital signs. She refuses spinal motion restriction precautions but does consent to EMS transport. You should: A. administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital. B. be concerned that the traumatic injury may have caused an abruptio placenta, administer high-flow oxygen, establish a large-bore IV, and transport her to a trauma center. C. provide emotional support, administer diazepam to prevent her from becoming frantic, administer oxygen via nasal cannula at 6 L/min, and transport her to a minor emergency clinic. D. reassure her that her baby was not injured, offer her oxygen via nasal cannula, defer IV therapy, and transport her to the closest hospital with continuous emotional support en route.

Trauma and Pregnancy, page 2059 The answer is: administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.

A 25-year-old woman was involved in a motor vehicle accident in which she struck the rear end of another car at a low speed. When you arrive at the scene and exit the ambulance, you immediately hear the patient screaming, "My baby, my baby!" After calming the patient down, she tells you that she is 10 weeks pregnant and that she is afraid that the car accident injured her child. She confirms that she was properly restrained at the time of impact. She is conscious and alert, denies abdominal pain, and has stable vital signs. She refuses spinal motion restriction precautions but does consent to EMS transport. You should: A. administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital. B. provide emotional support, administer diazepam to prevent her from becoming frantic, administer oxygen via nasal cannula at 6 L/min, and transport her to a minor emergency clinic. C. reassure her that her baby was not injured, offer her oxygen via nasal cannula, defer IV therapy, and transport her to the closest hospital with continuous emotional support en route. D. be concerned that the traumatic injury may have caused an abruptio placenta, administer high-flow oxygen, establish a large-bore IV, and transport her to a trauma center.

Trauma and Pregnancy, page 2059 The answer is: administer supplemental oxygen, establish a large-bore IV line and set the rate to keep the vein open, provide emotional support, and transport her to an appropriate hospital.

While triaging patients at a multiple-casualty incident, you rapidly assess a patient and determine that she is conscious and alert, but cannot feel or move anything below her umbilicus. You should: A. place a yellow tag on her and move on to the next patient. B. apply full spinal motion restriction precautions at once. C. conduct a more in-depth neurologic exam of the patient. D. categorize her as an immediate patient and continue triage.

Triage, pages 2346-2347 The answer is: place a yellow tag on her and move on to the next patient.

Upon arriving at the scene of a multiple vehicle crash, you call for additional resources and begin triaging patients using the START triage system. The first patient you assess is a young male who is unconscious and apneic. After manually opening his airway, you note that he starts breathing shallowly. You should: A. categorize him as an immediate patient. B. secure his airway with an ET tube. C. assess the rate and quality of his radial pulse. D. place a yellow tag on him and continue triage.

Triage, pages 2348-2349 The answer is: categorize him as an immediate patient.

What type of shock occurs when blood flow becomes blocked in the heart or great vessels? A. Distributive B. Cardiogenic C. Peripheral D. Obstructive

Types of Shock, page 435 The answer is: Obstructive

Distributive shock occurs when: A. blood pools in expanded vascular beds and tissue perfusion decreases. B. microorganisms attack the blood vessels, resulting in vasodilation. C. a significant decrease in cardiac contractility causes decreased perfusion. D. central vasoconstriction forces blood from the core of the body.

Types of Shock, page 437 The answer is: blood pools in expanded vascular beds and tissue perfusion decreases.

A loss of normal sympathetic nervous system tone causes: A. neurogenic shock. B. obstructive shock. C. profound vasoconstriction. D. a reduced absolute blood volume.

Types of Shock, page 437 The answer is: neurogenic shock.

Anaphylactic shock is characterized by: A. wheezing and widespread vasodilation. B. a deficiency of circulating histamines. C. intracellular hypovolemia and hives. D. labored breathing and hypertension.

Types of Shock, page 437 The answer is: wheezing and widespread vasodilation.

Which of the following is an early sign of shock? A. Absence of peripheral pulses B. Decreasing end-tidal CO2 C. Altered level of consciousness D. Systolic BP less than 90 mm Hg

Types of Shock, page 438 The answer is: Decreasing end-tidal CO2

A 66-year-old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver: A. one breath over 1 second every 3 to 5 seconds B. each breath over 2 seconds at a rate of 10 breaths/min. C. one breath over 2 seconds every 5 to 6 seconds. D. each breath over 1 second at a rate of 10 to 12 breaths/min.

Ventilatory Support, page 814 The answer is: each breath over 1 second at a rate of 10 to 12 breaths/min.

Hyperventilating an apneic patient: A. reduces the incidence of gastric distention. B. is appropriate if the patient is an adult. C. is beneficial if the pulse rate is too slow. D. may decrease venous return to the heart.

Ventilatory Support, pages 811-812 The answer is: may decrease venous return to the heart.

Which of the following is NOT a reason why EMS providers are in the ideal position to serve as advocates for injury prevention? A. EMS providers are distributed widely in the population and are welcome in environments conducive to delivering prevention messages. B. Most EMS systems require their personnel to participate actively in injury prevention programs. C. EMS providers are high-profile role models and are perceived as champions of their patients. D. In many remote communities, the EMT might be the most medically educated person.

Why EMS Should Be Involved, page 81 The answer is: Most EMS systems require their personnel to participate actively in injury prevention programs.