P2 FINAL (EXCLUDING 50&51)

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Type II osteoporosis tends to progress more rapidly in: A) postmenopausal women. B) the lower extremity bones. C) males over 60 years of age. D) patients with excess calcium.

Common signs of gestational diabetes include: A) confusion. B) diaphoresis. C) polydipsia. D) tachycardia.

Commonly used antidepressants include all of the following, EXCEPT: A) Paxil. B) Celexa. C) Xanax. D) Zoloft.

The transfer of heat from a hotter object to a cooler object by direct physical contact is called: A) radiation. B) convection. C) conduction. D) evaporation.

The typical upper limit of the fetal heart rate is: A) 120 beats/min. B) 140 beats/min. C) 160 beats/min. D) 180 beats/min.

Unlike a midline venous catheter, a peripherally inserted central catheter can be used for: A) long-term drug therapy. B) the delivery of antibiotics. C) chemotherapy in cancer patients. D) narcotic analgesia administration.

Unlike an opioid, an opiate: A) is a natural product derived from opium. B) produces a distinctly different toxidrome. C) is not reversed by naloxone administration. D) is a synthetic, non-opium-derived narcotic.

When inserting an oropharyngeal airway in a child, you should: A) use a tongue blade to depress the tongue. B) open the mouth with the tongue-jaw lift. C) hyperextend the head to facilitate insertion. D) suction the oropharynx for 15 seconds first.

When painful memories are repressed, __________ is impaired. A) recall B) retention C) recognition D) registration

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) is hurt. B) feels sick. C) needs help. D) is in pain.

At term, displacement of the diaphragm by the uterus causes a(n): A) decrease in expiratory reserve volume. B) increase in functional reserve capacity. C) decrease in inspiratory reserve volume. D) marked increase in residual volume.

At the present time, the ratio of caregivers to older people is: A) low. B) high. C) adequate. D) increasing consistently.

Average blood loss during the third stage of labor is approximately: A) 150 mL. B) 250 mL. C) 400 mL. D) 500 mL.

Bag-mask ventilation of the obese patient would MOST likely be ineffective when the patient is: A) supine. B) apneic. C) semisitting. D) in reverse Trendelenburg.

Which of the following types of medications does NOT contain amphetamine? A) Diet pills B) Nasal decongestants C) Drugs used to treat insomnia D) Drugs used to treat attention deficit disorder

During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was "listening to the painting on the wall" before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is MOST consistent with the use of: A) LSD. B) PCP. C) marijuana. D) methamphetamine.

Dysarthria is: A) the inability to make speech sounds correctly. B) a speech disorder that primarily affects adults. C) the loss of ability to communicate in speech or writing. D) caused by damage to the language center of the brain.

Early distributive shock in children is characterized by: A) warm, flushed skin. B) weak peripheral pulses. C) pallor and diaphoresis. D) gross neurologic deficits.

Early hypoxia in a child would MOST likely present with: A) tachycardia. B) bradypnea. C) mottled skin. D) bradycardia.

Elderly patients experience a slower physiologic response to hypoxemia and hypercarbia because of: A) decreased sensitivity to changes in arterial blood content. B) a chronically elevated partial pressure of carbon dioxide. C) an increased PaO2 due to a natural increase in respirations. D) failure of the baroreceptors to detect blood pressure changes.

Fall-related fractures in the elderly occur MOST often to the _______, usually in patients with underlying _______. A) hip, osteoporosis B) humerus, arthritis C) elbow, osteoporosis D) pelvis, osteoarthritis

First-degree heart block in children: A) is typically asymptomatic and does not require special treatment. B) should be suspected when a randomly dropped QRS is observed. C) should be treated with cardiac pacing, even if the child is stable. D) does not respond to atropine and should be treated with dopamine.

Fluid-refractory hypotension following a barbiturate overdose is treated MOST effectively with: A) dopamine. B) naloxone. C) atropine. D) calcium.

Following exposure to the hepatitis B virus, a person may remain asymptomatic for up to: A) 200 days. B) 250 days. C) 300 days. D) an entire year.

Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should: A) closely monitor the child's cardiac rhythm. B) premedicate with 0.04 mg/kg of atropine. C) limit your intubation attempt to 10 seconds. D) use a curved blade instead of a straight blade.

Beta blocker ingestion in small children would MOST likely cause: A) acute hypoglycemia. B) agitation or irritability. C) marked hypertension. D) ventricular fibrillation.

Bradydysrhythmias in children MOST often occur secondary to: A) severe hypoxia. B) drug ingestion. C) AV heart block. D) cardiac irritability.

A 100-pound violent young woman who requires four large paramedics to subdue and contain her is MOST likely under the influence of: A) PCP. B) LSD. C) ketamine. D) mescaline.

A 19-year-old man presents with hot, moist skin; confusion; tachycardia; and tachypnea shortly after completing a marathon. According to his marathon registration form, he has no significant medical problems and takes no medications. Treatment for this patient may include all of the following, EXCEPT: A) prostaglandin inhibitors. B) immersion in ice water. C) 25 g of 50% dextrose. D) ventilation assistance.

Heat cramps are caused by: A) sodium loss due to sweating. B) failure of the hypothalamus. C) increased potassium levels. D) increased urinary frequency.

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) A fertilized ovum is implanted somewhere other than the uterus. B) The placenta has prematurely detached from the uterine wall. C) The normal flow of bile from the liver has been interrupted. D) High levels of estrogen are affecting the gastrointestinal system.

Hematologic manifestations of lead poisoning include: A) anemia. B) leukopenia. C) coagulopathy. D) polycythemia.

By the end of the third week after conception, all of the following processes occur, EXCEPT: A) the embryo is officially referred to as the fetus. B) the embryonic process of forming specialized body systems. C) the appearance of rudimentary functions of various body systems. D) the woman has missed her menstrual period and suspects pregnancy.

During your assessment of a 30-year-old woman in active labor, she admits to being a chronic heroin abuser and states that she last "shot up" about 6 hours ago. After the baby delivers, you will MOST likely need to: A) give positive-pressure ventilations. B) administer 0.1 mg/kg of naloxone. C) suction meconium from its airway. D) administer free-flow oxygen by mask.

A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient's friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The MOST effective way to treat this situation is to: A) attach a portable ventilator that provides positive end-expiratory pressure. B) insert a nasogastric tube and remove any water from the patient's stomach. C) increase your ventilation rate to 15 breaths/min and provide higher volume. D) administer morphine sulfate to promote venous pooling and decreased preload.

A 25-year-old woman presents with acute abdominal pain and vaginal bleeding. She tells you that she has soaked eight high-absorbency tampons in the past 2 hours. Approximately how much blood has she lost externally? A) 160 mL B) 200 mL C) 240 mL D) 300 mL

A woman has been pregnant three times, has had two spontaneous abortions, and has carried one baby to term. You should document her obstetric history as: A) G3A2P1. B) G1A2P3. C) G5A2P1. D) G1A2P5.

A woman is in the second stage of labor when: A) she feels a strong urge to move her bowels. B) the cervix is fully effaced and partially dilated. C) a gush of amniotic fluid pours from the vagina. D) contractions occur in 5- to 10-minute intervals.

A woman who does not take prenatal vitamins during the course of her pregnancy is at greatest risk for: A) anemia. B) leukopenia. C) post-term labor. D) abnormal bleeding.

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) 2. B) 3. C) 4. D) 5.

According to the Centers for Disease Control and Prevention, all children should be immunized against all of the following diseases, EXCEPT: A) smallpox. B) hepatitis B. C) seasonal influenza. D) Haemophilus influenzae type b.

Hemodynamically stable children with a wide QRS complex tachycardia: A) should receive amiodarone. B) respond well to adenosine. C) are likely experiencing supraventricular tachycardia. D) will respond to vagal maneuvers.

According to the Ryan White Comprehensive AIDS Resources Emergency Act, the medical facility must: A) release the source patient's status to the designated infection control officer. B) hold the source patient's laboratory results for 24 hours before releasing them. C) avoid releasing the source patient's status to anyone due to HIPAA regulations. D) release the source patient's HIV and hepatitis B status to the exposed employee.

How much naloxone should you give to a 6.5-pound newborn with respiratory depression secondary to maternal narcotic administration? A) 0.3 mg B) 0.4 mg C) 0.5 mg D) 0.6 mg

Aging brings a widespread decrease in bone mass, especially: A) in postmenopausal women. B) in men over 50 years of age. C) if the person falls frequently. D) in the presence of hypertension.

All of the following factors contribute to heat cramps, EXCEPT: A) Gender B) Dehydration C) Salt depletion D) Muscle fatigue

All of the following processes take place in the uterus, EXCEPT: A) fertilization. B) implantation. C) the act of labor. D) fetal development.

People who are overly concerned with their physical health and appearance MOST likely have a(n): A) somatoform disorder. B) dissociative disorder. C) personality disorder. D) compulsive disorder.

Altitude illness is a problem caused by: A) hypoxia due to low atmospheric pressures. B) the effects of hyperbaric hypoxia on the central nervous system. C) hypercarbia due to high atmospheric pressures. D) a decreased PaO2 while descending from altitude.

An agitated man with an antisocial personality: A) will not think twice about hurting you. B) is at highest risk for suicidal behavior. C) may be demanding and dictate your care. D) has a morbid fear of crowded environments.

An elderly person is more likely to sustain serious injury following trauma due to: A) brittle, demineralized bone. B) ineffective vasoconstriction. C) chronic renal hypertrophy. D) decreased respiratory function.

An untreated patent ductus arteriosus may cause subsequent development of: A) congestive heart failure. B) ventricular septal defect. C) pulmonary stenosis. D) a patent foramen ovale.

Antibiotic therapy following exposure to meningitis is NOT appropriate for individuals who are: A) taking birth control pills. B) older than 45 years of age. C) asymptomatic after 24 hours. D) severely immunocompromised.

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) 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) 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.

A 29-year-old woman was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patient's respirations are slow and shallow, her pulse is slow and weak, and her pupils are markedly dilated. Your partner begins assisting the patient's ventilations as you assess her blood pressure, which is 70/48 mm Hg. The patient's husband hands you an empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should: A) administer crystalloid fluid boluses to improve her blood pressure. B) give her up to 10 mg of naloxone to reverse the effects of the drug. C) instruct your partner to hyperventilate the patient at 24 breaths/min. D) begin a dopamine infusion at 10 µg/kg/min and titrate as needed.

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) provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital. B) advise her that she can probably go to the hospital via personal vehicle since she is not showing signs of shock. C) visually inspect her vagina for bleeding or discharge, start an IV line and set it to keep the vein open, and transport. D) establish vascular access and give her a 250-mL normal saline bolus, consider analgesia for her pain, and transport.

A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT: A) 81 mg of aspirin. B) free-flow oxygen. C) 250 mg of acetaminophen. D) simple cooling measures.

A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned? A) 21% B) 27% C) 30% D) 36%

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) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations. B) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls. C) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation. D) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin.

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) transport him to the hospital and thoroughly wash your hands after patient care has been completed. B) establish vascular access in case he begins to experience signs and symptoms of a severe allergic reaction. C) be highly suspicious that he has body lice and use a high-level disinfectant when cleaning the ambulance. D) administer 25 mg of diphenhydramine IM and transport him to an appropriate medical facility.

A 90-year-old nursing home resident presents with confusion and a cough after several days of complaining of being weak. She is bedridden, has numerous medical conditions, and takes a variety of medications. Your assessment reveals that her temperature is 99.0°F, her skin is cool and dry, her blood pressure is 118/66 mm Hg, and her heart rate is 68 beats/min and regular. She is not experiencing obvious respiratory distress, and her oxygen saturation is 93% on room air. This patient is MOST likely experiencing: A) pneumonia. B) heart failure. C) hypoglycemia. D) a pulmonary embolism.

A child's vocal cords can be difficult to visualize during intubation because: A) the epiglottis is floppy and U-shaped. B) the cords themselves are more posterior. C) a sniffing position is difficult to achieve. D) the area of the cricoid cartilage is narrow.

A confused, bedridden resident in a skilled nursing facility who tells you that he or she cooks dinner for the other residents each night: A) is confabulating. B) is experiencing delirium. C) has a disorder of affect. D) is experiencing echolalia.

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

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) keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access. 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) administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity. 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.

A known intravenous drug abuser presents with anorexia, body aches, a low-grade fever, and scleral icterus. She is very quiet and is not willing to share her medical history information with you. Which of the following additional clinical signs would reinforce your suspicion regarding the cause of this patient's condition? A) Jaundiced skin B) Blood-tinged sputum C) Swollen lymph glands D) Red or purple skin lesions

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) tolerance. B) drug abuse. C) habituation. D) physical dependence.

A normal respiratory rate in a child: A) may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued. B) generally ranges between 15 and 20 breaths per minute and is influenced easily by factors such as excitement, fear, or fever. C) cannot be established accurately because a toddler's respirations generally are grossly irregular and extremely difficult to count. D) is a sign of impending respiratory failure if it is observed in conjunction with a room air oxygen saturation reading of less than 96%.

A patient may become hypothermic for all of the following reasons, EXCEPT: A) decreased thermolysis. B) inadequate thermogenesis. C) impaired vasoconstriction. D) excess environmental cold stress.

A patient who ingested a significant amount of ethylene glycol 6 hours ago would MOST likely present with: A) slurred speech and ataxia. B) hypertension and tachycardia. C) an ethanol odor on the breath. D) flank pain and absent urination.

A patient who ingested a significant quantity of acetaminophen less than 24 hours ago would MOST likely present with: A) malaise, nausea, and a loss of appetite. B) signs of renal failure and severe vomiting. C) pain in the right upper abdominal quadrant. D) flushed skin, high fever, and abdominal pain.

A patient who is taking Aventyl: A) may have nonspecific T-wave changes on the ECG. B) is usually hospitalized for debilitating, chronic depression. C) can safely take an MAOI drug at the same time. D) responds better than he or she will respond to treatment with a tricyclic antidepressant.

A person is exposed to the mumps virus, is asymptomatic for 16 days, and then becomes ill. The 16-day period is called the: A) incubation period. B) resistance period. C) virulent period. D) communicable period.

A poison is a substance that is: A) toxic by nature, no matter how it enters the body or in what quantities it is taken. B) damaging to the tissues and cells, especially if injected or taken in large quantities. C) legal or illegal, and has the potential of causing permanent damage if it is ingested. D) capable of making a person ill, at a minimum, and has a great chance of causing death.

A pregnant woman with cephalopelvic disproportion: A) requires a cesarean section to prevent fetal distress. B) should be given a muscle relaxant prior to delivery. C) delivers her baby vaginally in about 75% of cases. D) generally does not experience problems during delivery.

A psychotic episode MOST often leads to violence because of: A) exaggerated fear or paranoia. B) overreaction of the paramedic. C) the influence of an illicit drug. D) the patient's family's reaction.

A ruptured ovarian cyst typically presents with: A) a sudden onset of abdominal pain that can be related to the menstrual cycle. B) chronic waxing and waning abdominal cramping between menstrual periods. C) dull or aching epigastric pain that radiates to the shoulders or lower back. D) a sudden onset of upper abdominal pain and nausea without vomiting.

A shift of heart tones and severe respiratory distress despite positive-pressure ventilations is indicative of: A) a pneumothorax. B) a diaphragmatic hernia. C) Pierre Robin sequence. D) a pericardial tamponade.

A state of delusion in which a person is out of touch with reality is MOST appropriately termed: A) psychosis. B) derealization. C) schizophrenia. D) tangential thinking.

A subtle seizure in the newborn is characterized by: A) eye deviation. B) repetitive jerking. C) flexion of the arms. D) tonic limb extension.

A terminal illness is MOST accurately defined as a(n): A) disease process that is expected to cause death within 6 months, verified by a physician. B) disease that will ultimately cause death due to a lack of effective medical treatment. C) disease that is fatal in greater than 50% of a given population, even with timely treatment. D) disease process that will ultimately require ongoing treatment in order to prevent death.

A woman drives her husband to your EMS station after he was exposed to a large amount of pesticide. Your assessment reveals that he is responsive to pain only, is hypoventilating, is markedly bradycardic, and is incontinent of urine and feces. The cardiac monitor reveals marked sinus bradycardia. As your partner assists the patient's ventilations, you should: A) establish vascular access and begin administering atropine sulfate. B) administer 1 to 2 mg of pralidoxime IM and transport immediately. C) obtain a 12-lead ECG tracing to detect signs of myocardial injury. D) start an IV line and give sodium bicarbonate to alkalinize his urine.

Cerebral palsy is a: A) nonprogressive, bilateral neuromuscular disorder in which voluntary muscles are poorly controlled. B) degenerative, unilateral neuromuscular disorder in which control of autonomic functions is impaired. C) chronic dysfunction of the endocrine system that primarily targets the respiratory and digestive systems. D) progressive weakening of the body's voluntary muscles that leaves the patient confined to a wheelchair.

Cervical effacement occurs when: A) the less muscular lower part of the uterus is pulled upward over the presenting part of the baby. B) the opening of the cervix stretches enough to accommodate passage of the entire baby's body. C) the uterine wall thickens during the wavelike contractions that cause progressive cervical dilation. D) the cervix becomes fully dilated and the baby exits the uterus and enters the birth canal.

Characteristic physical features of Down syndrome include: A) a protruding tongue. B) an excessively long neck. C) bulging of the nose and face. D) downward slanting eyes.

Chlamydia trachomatis is caused by a _________ and is treated with an _________. A) bacterium, antibiotic B) virus, antiviral drug C) fungus, antifungal drug D) virus, immunoglobulin

Cholestasis occurs when: A) hormones slow or block the normal flow of bile from the liver. B) progesterone and estrogen block the production of bile in the liver. C) pressure on the gallbladder prevents normal contraction and relaxation. D) hormone levels drop after pregnancy, resulting in gallbladder disease.

Cigarette smoking predisposes a person to frostbite because it: A) causes arteriolar constriction. B) decreases the blood pressure. C) causes peripheral vasodilation. D) increases peripheral blood flow.

Cold diuresis occurs when: A) the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine. B) the sympathetic nervous system response in hypothermia increases blood flow to the kidneys, resulting in decreased sodium reabsorption and subsequent water excretion. C) massive systemic vasoconstriction shunts cold body water to the renal system, where it is excreted from the body in an attempt to increase the core body temperature. D) warmed IV fluids administered during severe hypothermia decrease the viscosity of the blood, resulting in an acute increase in output from the kidneys.

Common causes of respiratory distress in the newborn include: A) mucous obstruction of the nose. B) unrecognized metabolic alkalosis. C) persistent pulmonary hypotension. D) maternal use of a narcotic analgesic.

Common signs and symptoms of infection with the cytomegalovirus include: A) prolonged high fever. B) lesions on the genitalia. C) enlargement of the liver. D) severe nausea and diarrhea.

Common signs and symptoms of preeclampsia include: A) edema, hypertension, and headache. B) weight loss, blurred vision, and diarrhea. C) ketones in the urine and rapid weight gain. D) facial swelling, dysuria, and chest pain.

Common signs of impending respiratory failure in infants and children include: A) a falling oxygen saturation despite high-flow oxygen administration. B) abdominal breathing and a pulse rate less than 120 beats per minute. C) marked agitation and tachycardia with ectopic ventricular complexes. D) tachypnea and hyperpnea with nasal flaring and prominent retractions.

Crack is a combination of: A) cocaine, baking soda, and water. B) marijuana, heroin, and baking soda. C) heroin, cocaine, and distilled water. D) ecstasy, marijuana, and alcohol.

Decreased elasticity of the lungs and calcification of the costochondral cartilage results in: A) an increase in residual lung volume. B) a significant increase in vital capacity. C) a decrease in airway size and resistance. D) a decrease in the total amount of air in the lungs.

Delirium is MOST accurately defined as: A) an acute alteration in mentation that indicates an underlying condition. B) any alteration in cognitive function that may or may not be reversible. C) a pattern of disorganized thinking that progresses over several weeks. D) an altered mental status that is caused by structural damage to the brain.

Detecting disorders of perception is often difficult because: A) patients are often hesitant to answer direct questions regarding hallucinations or illusions. B) patients experiencing a behavioral emergency are generally agitated and uncooperative. C) the paramedic's line of questioning is often too difficult or impossible for the patient to understand. D) it is often difficult for the paramedic to determine the patient's baseline level of mentation.

Distributive shock in children is MOST often the result of: A) sepsis. B) spinal injury. C) heart failure. D) anaphylaxis.

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

During the menstrual cycle: A) numerous follicles begin the process of maturation, but only one ultimately matures and releases an ovum. B) all of the follicles that are released begin to mature and then ultimately die in a process called atresia. C) the anterior pituitary gland releases luteinizing hormone, which facilitates the process of oocyte maturation. D) the glands of the endometrium decrease in size and secrete the materials on which the egg will implant and grow.

During third trimester vaginal bleeding: A) the mother may lose as much as 40% of her blood volume before significant signs of hypovolemia occur. B) signs of shock in the mother typically appear after she has lost approximately 500 to 1000 mL of blood. C) most patients stabilize after the vagina has been packed carefully with several sterile trauma dressings. D) you should focus your efforts on keeping the fetus oxygenated, as he or she is the one at highest risk for death.

Hypertensive emergencies in the geriatric population: A) require a controlled decline in blood pressure that often cannot be achieved in the prehospital setting. B) can cause a ruptured cerebral or aortic aneurysm and should be treated in the field with antihypertensives. C) are relatively uncommon owing to increased elasticity of the blood vessels, which facilitates vasodilation. D) are typically treated in the prehospital setting with beta blocker medications or a slow nitroglycerin infusion.

Hypotension and orthostatic vital sign changes would MOST likely occur in elderly people who take: A) diuretics. B) beta blockers. C) antidepressants. D) ACE inhibitors.

If a newborn requires epinephrine and peripheral venous access is unsuccessful, you should: A) cannulate the umbilical vein. B) insert an IO catheter. C) perform intubation immediately. D) inject the drug directly into a vein.

If a patient with severe hypothermia is pulseless and apneic, you should: A) attempt a single shock for V-fib or V-tach. B) avoid placement of an advanced airway device. C) infuse 4 L of warmed normal saline solution. D) perform high-quality CPR at half the normal rate.

If the parent or caregiver of a sick or injured child is emotionally distraught: A) provide support, but remember that your first priority is the child. B) you should firmly tell him or her that the situation is under control. C) he or she should follow the ambulance in his or her personal vehicle. D) the parent or caregiver should be removed from the scene immediately.

Impaired proprioception predisposes an elderly person to: A) falls. B) skin tears. C) depression. D) hearing loss.

In adult patients, oral ingestion of a caustic substance: A) is usually intentional. B) causes immediate death. C) contraindicates intubation. D) requires activated charcoal.

In children, complex partial seizures would MOST likely manifest with: A) focal motor jerking with loss of consciousness. B) generalized tonic-clonic movement of all extremities. C) focal motor jerking without loss of consciousness. D) a brief loss of attention without abnormal body movement.

In contrast to a complex febrile seizure, a simple febrile seizure: A) lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities. B) is focal in nature and tends to occur in children with a baseline developmental abnormality. C) is not associated with tonic-clonic body movement and occurs in children older than 6 years of age. D) is of short duration and occurs when the child's body temperature gradually rises above 102.5°F.

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

In contrast to adults, young children are more prone to liver and spleen injuries because the organs: A) extend well below the rib cage. B) are both highly vascular. C) are more mobile and less supported. D) are relatively smaller and less protected.

In contrast to endometritis, endometriosis: A) may present without abdominal pain. B) is an inflammation of the uterine lining. C) generally causes light menstrual periods. D) is often the result of gynecologic surgery.

In developing countries, there is a strong association between the hepatitis E virus and: A) inadequate hygiene. B) sexual intercourse. C) infection with HIV. D) blood transfusions.

In drowning victims, positive end-expiratory pressure is used to: A) prevent atelectasis and force fluid from the alveoli. B) increase the rate and depth of the victim's breathing. C) force fluid from the interstitium back into the alveoli. D) increase cardiac contractility and improve stroke volume.

In mild hypothermia, an older person would likely present with all of the following, EXCEPT: A) shivering. B) dysarthria. C) a flat affect. D) noted ataxia.

In pregnancy, magnesium sulfate is used principally for: A) eclamptic seizures. B) tocolytic therapy. C) ventricular dysrhythmias. D) hyperemesis gravidarum.

The avian flu: A) is caused by a virus that occurs naturally in the bird population. B) is typically contracted by people who cook and eat infected chickens. C) has been linked directly to the hantavirus found in the feces of rodents. D) is preventable if antiviral drugs are given within 48 hours after exposure.

In situations where the environment is a factor, the MOST accurate means of determining a person's core temperature is to: A) use a rectal thermometer that is capable of measuring extremes of temperature. B) use a tympanic thermometer and then add two degrees to the reading that you obtain. C) obtain a tactile temperature by placing the back of your hand on the patient's forehead. D) place a mercury thermometer in the patient's axilla and wait 2 to 3 minutes before reading it.

Law enforcement personnel request your assistance in caring for a violent patient. When you arrive at the scene, the patient, a 48-year-old man, is yelling obscenities and is threatening to kill anyone who comes near him. Despite your attempts to calm him verbally, he continues his threatening behavior. It is MOST important for you to: A) ensure that you have a route for rapid egress and visually scan the patient for potential weapons. B) utilize at least four people to physically restrain the patient so you can administer haloperidol. C) leave the scene immediately and allow law enforcement personnel to take control of the situation. D) ask law enforcement to immobilize the patient with a TASER so you can assess his blood glucose level.

Many EMS personnel may experience a lack of confidence in their ability to deal with emotional disturbances for all of the following reasons, EXCEPT: A) the uncontrollable fear of personal injury. B) the fact that they are action-oriented people. C) they like to see tangible results of their actions. D) their training only addresses such issues topically.

Many paramedics are reluctant to broach the subject of suicide with a depressed patient for fear that: A) they might put ideas into the patient's head. B) the patient may become violent and homicidal. C) the patient will be offended by such a question. D) the patient will become even more depressed.

Medications used to prevent an asthma attack include: A) inhaled steroids. B) beta-2 agonists. C) inhaled albuterol. D) oral ibuprofen.

Meningococcal meningitis with sepsis is typically characterized by a(n): A) purpuric rash. B) insidious onset. C) low-grade fever. D) persistent cough.

Metabolic causes of abnormal behavior include: A) diabetic ketoacidosis. B) vitamin deficiencies. C) thyroid hyperfunction. D) amphetamine toxicity.

Mittelschmerz is defined as: A) unilateral abdominal pain and cramping that occur during the ovulatory process. B) bilateral abdominal pain and vaginal bleeding caused by excess hormone release. C) abdominal cramping, vaginal bleeding, and a headache lasting more than a week. D) severe abdominal cramping and a vascular headache that are caused by ovulation.

Mononucleosis is caused by the ___________________ and grows in the ________________. A) Epstein-Barr virus, epithelium of the oropharynx B) pneumococcal bacterium, inner lining of the lungs C) streptococcus bacterium, epithelial cells of the trachea D) cytomegalovirus, nasopharyngeal mucous membranes

Multiple sclerosis is: A) a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord. B) most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons. C) a progressive disease in 90% of patients who have it, and is characterized by unrelenting pain, weakness, and visual impairment. D) chronic in most cases, and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density.

Nasopharyngeal airways are rarely used in children younger than 1 year of age because: A) the diameter of their nares is small and easily obstructed by secretions. B) most nasopharyngeal airways are too large and result in an obstruction. C) nasopharyngeal stimulation commonly results in a tachycardic response. D) unlike older children, small children often have a more active gag reflex.

Newborn hypoglycemia is defined as a blood glucose level lower than: A) 45 mg/dL. B) 50 mg/dL. C) 55 mg/dL. D) 60 mg/dL.

Older people are at increased risk for heat-related illnesses because: A) they are more likely to have chronic medical conditions that interfere with normal heat regulation. B) they have proportionately higher metabolic heat production when compared to younger adults. C) they are often taking beta adrenergic agonists, which can lessen a tachycardic response to heat. D) they acclimatize more rapidly than younger adults, which results in faster heat production.

Once in the body, approximately 90% of inorganic lead accumulates in: A) bone. B) the liver. C) the spleen. D) white blood cells.

Other than personal safety, your MOST immediate concern when caring for a submersion victim should be: A) the risk of vomiting and aspiration. B) determining what caused the event. C) inserting an advanced airway device. D) hypothermia-induced dysrhythmias.

Other than using a Nitrox system, the only effective way to counteract nitrogen narcosis is to: A) lower the nitrogen partial pressure through controlled ascent. B) increase the nitrogen partial pressure through controlled descent. C) lower the nitrogen partial pressure through controlled descent. D) increase the nitrogen partial pressure through controlled ascent.

Patients who alternate between mania and depression: A) are referred to as bipolar. B) present with a flat affect. C) have multiple personalities. D) have a history of schizophrenia.

Patients who are hysterical and disruptive to rescue efforts: A) may need to be made an immediate priority and transported out of the disaster site, even if they are not seriously injured. B) should immediately be directed to the rehabilitation section, where rehabilitation personnel can provide emotional support. C) must be removed from the incident by law enforcement officials and detained in a separate area until they can be properly triaged. D) should be assigned as a delayed patient and directed to the treatment section where they can be medically and psychologically evaluated.

Patients with delirium tremens often experience: A) hallucinations. B) AV heart blocks. C) hypothermia. D) acute hypertension.

Personal protective equipment: A) serves as a secondary protective barrier beyond what your body provides. B) is a standardized set of equipment that is used with every patient contact. C) is the most effective means of preventing the spread of an infectious disease. D) is required by the CDC when a paramedic draws blood or gives an injection.

Phrenic nerve stimulators function by: A) sending electrical impulses to the diaphragm, causing it to contract and passively relax. B) keeping the upper airway patent in patients who experience frequent occurrences of sleep apnea. C) sending electrical impulses to the respiratory centers in the brain that stimulate inhalation. D) sending electrical impulses to the intercostal muscles, causing them to contract and expand the thorax.

Physiologic age-related decreases in skin elasticity are the result of: A) decreased collagen and elastin production. B) chronic use of corticosteroid medications. C) slower replenishment of epidermal cells. D) frequent fungal or viral skin infections.

Pulmonary overpressurization syndrome occurs when a diver: A) holds his or her breath during ascent. B) exhales constantly as he or she ascends. C) panics and hyperventilates during descent. D) experiences a pneumothorax under water.

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

Rubella is characterized by: A) a low-grade fever. B) visual disturbances. C) abdominal discomfort. D) an isolated facial rash.

Secondary syphilitic infection is characterized by all of the following, EXCEPT: A) petechiae. B) a skin rash. C) patchy hair loss. D) swollen lymph glands.

Sensorineural hearing loss is caused by: A) decreased sound uptake through tiny hairs within the cochlea. B) an inability of sound to travel from the outer ear to the inner ear. C) destruction of the acoustic nerve from the use of certain drugs. D) failure of the brainstem to transmit messages via the acoustic nerve.

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) perform laryngoscopy and try to visualize the foreign body. B) continue chest compressions and perform a cricothyrotomy. C) open the infant's airway and sweep the infant's mouth with your finger. D) perform back slaps and chest thrusts and then look in the mouth.

Signs and symptoms of organophosphate poisoning include: A) vomiting. B) tachycardia. C) constipation. D) pupillary dilation.

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

Signs of pain in an infant would MOST likely include: A) tachycardia and inconsolability. B) a heart rate that is not variable. C) diaphoresis and dilated pupils. D) labored tachypnea and pallor.

Spray paints and lacquer thinner contain __________, and typically cause __________________ when they are inhaled recreationally. A) toluene, hallucinations and mania B) carbon tetrachloride, CNS depression C) methylene chloride, pulmonary edema D) benzene, drunken behavior and dizziness

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

The MOST common clinical finding observed in patients with type I decompression sickness is: A) joint pain. B) unsteadiness. C) pruritus and rashes. D) a cough and dyspnea.

The MOST common etiology for bradycardia in a newborn is: A) severe hypoxia. B) untreated acidosis. C) occult hypovolemia. D) increased vagal tone.

The MOST immediate treatment to prevent placental hypoperfusion in a pregnant woman who is lying on her back is to: A) place the woman in a left lateral recumbent position. B) keep the woman supine and elevate her legs 12 inches. C) manually displace the gravid uterus to the right side. D) administer 1 to 2 L of isotonic crystalloid solution.

The MOST important prehospital treatment intervention for a patient with carbon monoxide poisoning is: A) high-flow oxygen. B) establishing vascular access. C) cardiac rhythm monitoring. D) monitoring pulse oximetry.

The MOST popular form of diving is: A) scuba diving. B) saturation diving. C) breath-hold diving. D) surface-tended diving.

The approximate total blood volume of a 60-pound child is: A) 2.2 L. B) 2.9 L. C) 3.4 L. D) 3.8 L.

Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the: A) liver. B) spleen. C) gallbladder. D) intestinal tract.

The bioavailability and excretion rate of a toxin are influenced by the: A) amount of toxin and the relative speed at which it is metabolized. B) type of toxin and the condition of the patient's underlying health. C) route by which the toxin entered the body and the age of the patient. D) the presence of other substances in the body at the time of exposure.

The bite of a brown recluse spider: A) may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister. B) manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia. C) most often causes severe central nervous system depression because its venom contains a powerful neurotoxin. D) results in a local reaction only because the spider's venom is cytotoxic and spreads slowly throughout the bloodstream.

The clinical presentation of a stimulant abuser includes: A) excitement, hypertension, tachycardia, and dilated pupils. B) somnolence, hypotension, bradycardia, and a staggering gait. C) hypotension, tachycardia, constricted pupils, and hypothermia. D) an irregular pulse, hyperpyrexia, hypotension, and bradycardia.

The clinical presentation of mononucleosis includes: A) fever, swollen lymph glands, and an enlarged spleen. B) vomiting, a fever greater than 102°F, and shaking chills. C) hemoptysis, low-grade fever, and up to 10% weight loss. D) nasal drainage, a dry cough, and right upper quadrant pain.

The communicable period for HIV: A) is largely unknown. B) ranges from 7 to 10 days. C) begins at the onset of infection. D) is decreased with antiretroviral therapy.

The decision to transport an acutely ill child immediately or remain at the scene to perform additional interventions is LEAST dependent on: A) the child's age and fear level. B) transport time to the hospital. C) expected benefits of treatment. D) your EMS system's regulations.

The diagnosis of heatstroke is usually made when a patient has a high core body temperature and: A) an altered mental status. B) an absence of sweating. C) a history of heat exposure. D) a heart rate above 140 beats/min.

The fetal side of the placenta should normally be: A) gray and shiny with a smooth texture. B) pale and dull with a rough texture. C) dark maroon with a smooth texture. D) dark maroon with a rough texture.

The general area of a child's body that sustains initial trauma after being struck by an automobile depends MAINLY on: A) the child's height and the height of the bumper upon impact. B) the travel speed of the vehicle and the weight of the child. C) whether the child turns away from or toward the vehicle. D) whether the vehicle ran over the child following impact.

The goal in treating a child with epiglottitis is to: A) transport him or her to the hospital with a maintainable airway. B) administer corticosteroids to reduce edema in the upper airway. C) intubate him or her before the epiglottis blocks the upper airway. D) administer oxygen by nonrebreathing mask and transport at once.

The incidence of sudden infant death syndrome peaks between the ages of: A) 2 and 4 months. B) 3 and 6 months. C) 4 and 8 months. D) 8 and 12 months.

The initial hypoxic insult associated with a drowning occurs from: A) apnea. B) lung injury. C) pulmonary edema. D) surfactant damage.

The lesions associated with genital herpes: A) initially appear as small red bumps. B) present as moderately sized blisters. C) are isolated to the external genitalia. D) typically cause scarring after they heal.

The odor of bitter almonds on a patient's breath should make you suspicious for exposure to: A) cyanide. B) arsenic. C) phosphorus. D) turpentine.

The primary target of infection with the human immunodeficiency virus is the: A) immune system. B) lymphatic system. C) pulmonary system. D) central nervous system.

The purpose of the wafer that is included in an ostomy kit is to: A) protect the skin from irritation. B) seal the ostomy bag to the skin. C) maintain sterility of the ostomy bag. D) cover the stoma until the bag is attached.

The risk of a pulmonary embolus increases with age because of: A) increased immobility. B) chronic use of aspirin. C) frequent lung infections. D) drug-induced bradycardia.

The risk of aspiration in the pregnant woman is increased significantly because: A) decreased digestion causes a delay in gastric emptying. B) pregnancy hormones often cause nausea and vomiting. C) increased tidal volume causes air to enter the stomach. D) the gastric lining is extremely irritable during pregnancy.

The social assessment component of the GEMS diamond includes: A) determining if activities of daily living are being provided by another person. B) considering that what appears to be a medical problem may have a trauma component. C) assessing the presence of functional smoke detectors in the patient's home. D) looking for multiple prescription medications that are used to treat the same condition.

The son of a 76-year-old woman called 9-1-1 because his mother is "ill." The patient presents with mild confusion, poor skin turgor, and tachycardia. She is incontinent of urine and asks you for a glass of water. Her son tells you that she had not been feeling well for the past several weeks, but would not allow him to take her to the doctor. Which of the following assessment parameters will MOST likely reinforce your suspicion regarding the underlying cause of this patient's condition? A) Blood glucose B) Cardiac rhythm C) Orthostatic vital signs D) Cincinnati stroke scale

The third dose of the three-series hepatitis B vaccine is given: A) 6 months after the first dose. B) 4 weeks after the second dose. C) 12 months after the initial dose. D) within 2 to 3 months of the second dose.

The toxic chemical in castor beans is: A) ricin. B) cyanide. C) lantadene A. D) caladium oxalate.

Unlike dermal exposure to a strong acid, dermal exposure to a strong alkali: A) requires longer irrigation with water because alkalis are less water soluble. B) should not be treated by irrigation with water as this will worsen the burn. C) should be neutralized on the skin by applying lemon juice or dilute vinegar. D) generally causes less damage to the skin because alkalis are water soluble.

Unlike the effects of cocaine, the effects of methamphetamine: A) last much longer. B) often result in paranoia. C) can be reversed with naloxone. D) predispose the patient to violence.

Upon arriving at the residence of a 27-year-old man who has a tracheostomy tube and is being mechanically ventilated, you note that he is breathing shallowly, is cyanotic, and is diaphoretic. You should: A) disconnect the patient from the mechanical ventilator and begin bag-mask ventilations. B) immediately check the settings on the mechanical ventilator to ensure that it is working properly. C) remove the ventilator tubing from the tracheostomy tube and suction the tube for 10 to 15 seconds. D) assess his oxygen saturation level and auscultate his breath sounds to determine if he is moving adequate air.

Upon arriving at the scene of a 4-year-old girl who is ill, you assess her and note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child's mother denies any vomiting or diarrhea. This child's tachycardia and tachypnea are MOST likely the result of: A) fever and anxiety. B) early hypoxemia. C) a cardiac problem. D) moderate dehydration.

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) assess the rate and quality of his radial pulse. C) secure his airway with an ET tube. D) place a yellow tag on him and continue triage.

Uterine rupture MOST commonly occurs: A) during active labor. B) in primiparous women. C) during the third trimester. D) after the placenta delivers.

Venlafaxine is the generic name for: A) Effexor. B) Lexapro. C) Librium. D) Neurontin.

What dose and concentration of glucose would be MOST appropriate for a 6-pound hypoglycemic newborn? A) 5.5 mL of 10% dextrose (D10) B) 6 mL of 25% dextrose (D25) C) 6.5 mL of 10% dextrose (D10) D) 7.5 mL of 25% dextrose (D25)

What size and type of laryngoscope blade is recommended for use in a full-term newborn? A) No. 1, straight B) No. 2, straight C) No. 1, curved D) No. 2, curved

What type of seizure is MOST common in premature infants? A) Tonic seizure B) Subtle seizure C) Myoclonic seizure D) Focal clonic seizure

When a child who is too young to verbalize is in significant pain: A) your ability to assess accurately for physiologic abnormalities is impaired. B) narcotic analgesic drugs should be avoided unless transport will be delayed. C) benzodiazepine drugs are preferred over opiates to minimize central nervous system depression. D) pain scales using facial expressions are a valuable tool to assess pain severity.

When a person experiences a crisis in the water, the amount of time the person can hold his or her breath depends on all of the following factors EXCEPT: A) the water's tonicity. B) the victim's level of panic. C) the victim's state of health. D) the temperature of the water.

When assessing a 5-year-old child, you should: A) be able to conduct a head-to-toe exam. B) ask simple yes or no questions if possible. C) generally use a toe-to-head exam approach. D) first ask a parent where the child is hurting.

When assessing a patient who is disabled from a previous brain injury, you should: A) ask the patient's family what is normal for him or her. B) be prepared to hyperventilate the patient if apnea occurs. C) consider asymmetric pupils to be the result of the past injury. D) recall that most disabled patients are unable to communicate with you.

When assessing a patient with a behavioral emergency, the MOST important assessment tool you have is: A) your mind. B) a penlight. C) a glucometer. D) cardiac monitoring.

When assessing an unresponsive older person's airway, it is MOST important to remember that: A) delayed gastric emptying increases the risk of aspiration. B) age-related tooth loss may cause obstruction of the airway. C) a marked reduction in saliva causes dryness of the oral mucosa. D) the head should not be extended due to weakened cervical vertebrae.

When caring for a woman with an inevitable or incomplete abortion, you should be MOST concerned with: A) bleeding and shock. B) severe maternal infection. C) maternal emotional trauma. D) the risk of airway compromise.

When conducting the scene size-up of a call involving a gynecologic emergency, it is MOST important to: A) assess for danger because any scene should be considered volatile. B) quickly ascertain if the patient's problem is medical or trauma in nature. C) take standard precautions because many of these calls involve a lot of blood. D) quickly assess the need for additional resources and summon them early.

When confronted with a feared object or situation, the phobic person: A) experiences intolerable anxiety and autonomic symptoms. B) truly believes that his or her fear is completely reasonable. C) is usually able to mitigate his or her fear with redirection. D) typically becomes catatonic and unable to communicate.

When extreme anxiety occurs in conjunction with restlessness, a patient: A) becomes agitated. B) is not distractible. C) often becomes suicidal. D) presents with a flat affect.

When fever is suspected in the newborn, you should: A) observe for the presence of a rash. B) assist ventilations with a bag-mask device. C) administer acetaminophen or ibuprofen. D) quickly lower the newborn's body temperature.

When performing chest compressions on a newborn, you should: A) compress the chest one third the anteroposterior depth of the chest. B) use the two-finger compression technique if two rescuers are present. C) reassess the newborn's heart rate after every 60 seconds of compressions. D) deliver 120 compressions and 40 ventilations during any 60-second period.

When suctioning and cleaning the tracheostomy of a ventilator-dependent patient, it is MOST important to: A) keep the patient well oxygenated. B) have a new tube readily available. C) suction for no longer than 5 seconds. D) soak the inner cannula in sterile water.

When troubleshooting a hearing aid that is not working, you should: A) avoid attempting to clean the device. B) soak the device in hydrogen peroxide. C) ensure the device is set to telephone mode. D) carefully clean the device with an alcohol prep.

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a female, you should: A) insert the catheter another 1 to 3 inches. B) pull back on the catheter about 2 inches. C) carefully secure the catheter to the leg. D) inflate the balloon with the prefilled syringe.

Which of the following cardiac medications has a small therapeutic window and the GREATEST propensity to reach toxic levels? A) Digoxin B) Vasotec C) Cardizem D) Lisinopril

Which of the following conditions has been associated with death following exposure to a TASER device? A) Excited delirium B) Rhabdomyolysis C) Spinal cord injury D) Electrocution injury

Which of the following conditions is characterized by a lack of progesterone and increased androgen levels, and can lead to gestational diabetes and cardiac problems? A) Polycystic ovaries B) Ectopic pregnancy C) Corpus luteum cyst D) Tubo-ovarian abscess

Which of the following conditions would be the LEAST likely to produce psychotic symptoms? A) Hyperglycemia B) Closed head injury C) Low cardiac output D) Temporal lobe seizures

Which of the following congenital defects results in an undersized or absent right ventricle? A) Tricuspid atresia B) Pulmonary stenosis C) Tetralogy of Fallot D) Atrial septal defect

Which of the following drugs is a narcotic? A) Meperidine B) Flumazenil C) Secobarbital D) Lorazepam

Which of the following events is a critical part of fetal transition? A) Diversion of blood flow to the fetus's lungs B) An acute increase in intrapulmonary pressure C) Fetal lung expansion within 5 minutes after birth D) Blood flow diversion across the ductus arteriosis

Which of the following factors decreases the body's ability to eliminate excess heat through evaporation? A) High humidity B) Wet clothing C) Low wind chill D) Hyperventilation

Which of the following interventions is especially important when caring for a patient with a tracheostomy tube? A) Suctioning B) Mask ventilation C) Hyperventilation D) Head positioning

Which of the following is NOT a general guideline to follow when caring for a patient with a psychiatric problem? A) Be indirect when possible. B) Provide honest reassurance. C) Remain confident in your abilities. D) Maintain a nonjudgmental attitude.

Which of the following is NOT included in the Centers for Disease Control and Prevention's list of recommended immunizations and tests for health care providers? A) Annual HIV testing B) Hepatitis B vaccine C) TB testing D) Measles, mumps, and rubella

Which of the following is a proper technique when accessing an implantable venous access device? A) Aspirate 5 mL of blood and then block the flow in the line with the crimping device. B) Stabilize the implantable device and insert the needle at a 45-degree angle to the skin. C) Flush the device with 20 mL of normal saline as soon as you are able to aspirate blood. D) Remove the syringe from the needle and then block the flow in the line with the crimping device.

Which of the following is the BEST example of inadvertent medication noncompliance? A) A person takes multiple doses of the same medication because of an inability to distinguish the flavors. B) The person does not fill a prescription because of a lack of money or insufficient insurance coverage. C) A person decreases the dosage of one or more prescribed medications to make them last longer. D) A patient discontinues a medication because he or she feels better and deems the medication unnecessary.

Which of the following medications is NOT a tricyclic antidepressant? A) Prozac B) Aventyl C) Sinequan D) Tofranil

Which of the following signs and symptoms is MOST indicative of acute mountain sickness? A) A throbbing headache and fatigue. B) Chest congestion and dyspnea at rest. C) Audible wheezing and chest tightness. D) Excessive sleeping and abdominal pain.

Which of the following statements about panic disorder is correct? A) Panic disorder is characterized by sudden, unexpected fear and dread. B) Most initial panic attacks occur without a known precipitating stressor. C) Men are two thirds more likely to experience panic disorder than women. D) Panic disorder is a random disorder that usually does not run in the family.

Which of the following statements regarding Mongolian spots is correct? A) They resemble bruises and are found most commonly on the back and buttocks. B) They are abnormal bruising patterns on the back and are an indicator of abuse. C) They indicate abnormal bleeding and are associated with a high mortality rate. D) They are bruiselike patterns that most often appear in severely premature infants.

Which of the following statements regarding SSRIs is correct? A) SSRIs have fewer anticholinergic and cardiac effects than tricyclics. B) Bradycardia with AV heart block is a hallmark sign of SSRI toxicity. C) The most popular SSRIs include Pamelor, Zonalon, and Norpramin. D) They are the least preferred antidepressant because they are cardiotoxic.

Which of the following statements regarding a breech presentation is correct? A) Breech presentations are more common with premature births. B) A breech birth is characterized by a vertex position of the baby. C) Breech presentations are frequently accompanied by a nuchal cord. D) Most breech presentations are associated with a legs-first delivery.

Which of the following statements regarding abdominal trauma during pregnancy is correct? A) Use of a lap belt increases the risk of uterine injury. B) Deceleration injuries often result in placenta previa. C) Uterine trauma is common during the first trimester. D) The pubic bone protects the bladder in late pregnancy.

Which of the following statements regarding alcoholism is correct? A) A person who consumes alcohol is considered to be physically dependent if abrupt cessation of drinking causes withdrawal symptoms. B) Patients with alcoholism typically do not become psychologically dependent on alcohol until they have been drinking for many years. C) Delirium tremens occur any time a person suddenly stops drinking excessive amounts of alcohol, regardless of whether or not he or she is addicted. D) Increased blood pressure and hallucinations are common physical manifestations when a short-term alcoholic slowly tapers his or her consumption.

Which of the following statements regarding burns in the pediatric patient is correct? 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) Unlike adults, the rule of palm is an inaccurate tool to determine the extent of burns in pediatric patients. D) A child with burns to both lower extremities has burns to approximately 36% of his or her body surface area.

Which of the following statements regarding endometritis is correct? A) Untreated endometritis may result in septic shock. B) Endometritis is defined as an enlargement of the uterus. C) Endometritis is most commonly caused by an intrauterine device. D) Endometritis results when endometrial tissue grows outside the uterus.

Which of the following statements regarding frostbite is correct? A) Frostbite is an ischemic injury that is classified as superficial or deep. B) Frostbite most commonly affects the trunk and lower extremities. C) Frostbite can only occur if the ambient temperature is below 40°F. D) Increased blood flow to an extremity exacerbates deep frostbite.

Which of the following statements regarding meningitis is correct? A) Most epidemic outbreaks involve meningococcal meningitis. B) Neisseria meningitidis is the least common type of meningitis. C) The viral form of meningitis is a highly communicable disease. D) Meningitis is an acute viral inflammation of the cerebral meninges.

Which of the following statements regarding paralysis is correct? A) A paralyzed patient has lost the ability to voluntarily move a body part. B) Paralysis always entails the loss of both sensory and motor functions. C) Injuries to the thoracic or lumbar spine generally result in quadriplegia. D) Most patients who are paralyzed have normal sensation or hyperesthesia.

Which of the following statements regarding the Apgar score is correct? A) If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation. B) The Apgar score is determined on the basis of the newborn's condition at 2 and 10 minutes after birth. C) If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score. D) A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.

Which of the following statements regarding the amniotic sac and fluid is correct? A) In the latter stages of pregnancy, the fetus swallows amniotic fluid and passes wastes out into the fluid. B) The volume of amniotic fluid reaches about 500 mL by the end of pregnancy and nourishes the fetus. C) Amniotic fluid serves no real physiologic purpose and the fetus could easily survive in utero without it. D) The amniotic sac is composed of a tough, fibrous membrane that generally does not rupture until birth.

Which of the following statements regarding uterine fundus measurement is correct? A) Measurement of the fundus in centimeters corresponds to the number of gestational weeks. B) If the fundus is longer than expected, it could indicate uterine growth problems. C) A shorter than expected uterine fundus measurement is most suggestive of a breech position. D) If the fundus measures 36 cm, the woman is between 32 and 34 weeks pregnant.

Which of the following types of maltreatment is perhaps the MOST common? A) Neglect B) Physical abuse C) Sexual abuse D) Abandonment

Which of the following words would MOST likely de-escalate the symptoms of a panic attack to a more manageable level? A) Safe B) Care C) Help D) Relax

Which of the following would be considered a primary cause of obesity? A) Lack of exercise B) Hormonal changes C) Genetic predisposition D) Low basal metabolic rate

Which of the following would you MOST likely observe in a newborn with hemolytic disease? A) Jaundice B) Polycythemia C) Hot flushed skin D) Splenomegaly

With hyperbaric oxygen therapy, carbon monoxide is typically eliminated from the body within: A) 15 to 20 minutes. B) 60 to 90 minutes. C) 90 to 120 minutes. D) 120 to 240 minutes.

Women who have had a cesarean section: A) can have a normal vaginal delivery. B) most likely delivered two or more babies. C) usually have a vertical scar on the abdomen. D) are precluded from having a vaginal delivery.

You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child's level of consciousness decreases markedly. You reassess the child and note that his femoral pulse is rapid and weak. You should: A) perform immediate synchronized cardioversion and reassess. B) begin chest compressions as your partner establishes the IV line. C) preoxygenate the child and then perform endotracheal intubation. D) establish vascular access and administer 0.1 mg/kg of adenosine.

You are assessing a 34-year-old woman who appears to be depressed. You were summoned to see the patient by her husband, who tells you that she won't talk to him. During your interview of the patient, which of the following questions or comments would MOST likely yield a response from the patient? A) "You appear to be very sad." B) "Do you want to hurt anyone?" C) "Are you under psychiatric care?" D) "Are you mad at your husband?"

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) coining. C) physical abuse. D) phytophotodermatitis.

You are called to a residence for a 74-year-old woman who fainted. During your assessment, the patient's son tells you that he was standing next to his mother when she fainted and that he caught her before she fell to the floor. He further tells you that his mother has angina and kidney disease. The patient is now conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 110 beats/min and weak, and respirations are 22 breaths/min and regular. As your partner administers supplemental oxygen to the patient, you should: A) assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one. B) quickly establish vascular access and administer a 20-mL/kg bolus of an isotonic crystalloid. C) obtain a detailed list of all of the patient's medical problems and the medications that she is taking. D) perform a rapid head-to-toe assessment to determine if she has gross injuries or any hidden conditions.

You are caring for a 44-year-old woman who was sexually assaulted by several men. She is conscious but very quiet. Your partner, a female paramedic, quickly examines her and finds no immediate life-threatening injuries. The patient tells you that all she wants to do is go home and take a shower. After multiple attempts to convince the patient to consent to transport, you are unsuccessful. Your MOST appropriate action should be to: A) ask the patient if there is a friend you can call with whom she can stay. B) advise her that she cannot take a shower because her body is evidence. C) explain the seriousness of the incident and have her sign a refusal form. D) allow her to take a shower, but insist upon EMS transport to the hospital.

You are caring for a young woman with a local cold injury to her hands. Your assessment reveals that her hands are hard to the touch, mottled, cold, and without sensation. Her body temperature is 96.3°F per tympanic thermometer. Your estimated transport time to the hospital is 45 minutes. The MOST appropriate treatment for this patient includes: A) preventing further loss of body heat; protecting her hands from injury with dry, bulky dressings; and transporting without delay. B) applying chemical heat packs to her axilla and groin, rapidly rewarming her hands with hot water, bandaging her hands, and transporting. C) starting an IV and infusing warm normal saline, having her place her hands in her armpits to keep them warm, and transporting as soon as possible. D) immersing her hands in water that is between 95°F and 104°F, starting an IV and administering fentanyl, bandaging her thawed hands, and transporting.

You are caring for an alcoholic patient who has been abstinent for about 2 days. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52 mm Hg, pulse rate is 140 beats/min and weak, and respirations are 24 breaths/min with adequate depth. In addition to administering oxygen, you should: A) treat his hypotension with crystalloid fluid boluses. B) administer 6 mg of adenosine to slow his heart rate. C) sedate him with 5 mg of Valium and transport at once. D) provide emotional support only and transport immediately.

You are caring for numerous patients in the treatment section at the scene of a school shooting. During secondary triage, you encounter a patient wearing a yellow tag. Her level of consciousness is markedly diminished and she is breathing inadequately. You should: A) recategorize her as an immediate patient, begin treatment, and notify the transportation officer. B) downgrade her triage status to expectant because of the numerous other patients that also require treatment. C) remove the yellow tag, replace it with a red tag, and continue secondary triage of the other patients in the section. D) provide aggressive basic airway management for 5 minutes and recategorize her as an expectant patient if she does not improve.

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) remove both patients from the residence at once. B) immediately open all of the windows in the house. C) carefully assess the residence for any unusual findings. D) suspect that both patients have been exposed to cyanide.

You are dispatched to a skilled nursing care facility for a 74-year-old male resident who is ill. During your assessment, you note that the patient has his head cocked to the side and is unable to move it. The charge nurse tells you that the patient was placed on Seroquel 2 days ago. Based on this patient's clinical presentation and medication history, you should: A) administer 25 to 50 mg of diphenhydramine. B) suspect that the patient has catatonic schizophrenia. C) establish vascular access and administer naloxone. D) expect to find that his blood sugar level is elevated.

You are in the process of assisting a woman in labor. She is 38 weeks pregnant with her second child, and her contractions are 3 minutes apart and are strong and regular. Her first baby was delivered by cesarean section. As you prepare for imminent delivery, the woman tells you that her contractions have decreased significantly and that she is very dizzy. Assessment of her vaginal area reveals moderate vaginal bleeding. You quickly assess her and note that she is diaphoretic, tachycardic, and hypotensive. You should be MOST suspicious for: A) uterine rupture. B) placenta previa. C) abruptio placenta. D) threatened abortion.

You are performing an interfacility transfer of a patient who received a cardiac catheterization and has a sheath in his femoral artery. During transport, it is important that the patient: A) remain in a supine position with his legs straight. B) be placed onto his left side with his head elevated. C) receive IV fluid boluses to keep the sheath patent. D) remain in a sitting position to prevent an embolism.

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) assist his ventilations with a bag-mask device. B) secure his airway with an ET tube. C) begin treatment with a beta-2 agonist medication. D) auscultate his lung sounds and reassess his SpO2.

You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather in the vicinity. A peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn's heart rate suddenly drops more. You should: A) abort the intubation attempt and continue ventilations. B) continue the intubation attempt and administer atropine. C) administer 0.1 to 0.3 mL/kg of epinephrine rapid IV push. D) ensure that chest compressions are of adequate rate and depth.

You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for: A) QRS widening. B) AV heart block. C) QT interval narrowing. D) a prolonged PR interval.

You are transporting an unresponsive intubated 4-year-old child. An IO catheter is in place, and you are ventilating the child at an age-appropriate rate. Suddenly, the child becomes cyanotic and experiences a significant drop in her heart rate and oxygen saturation, and loss of a capnographic waveform. You attempt to auscultate her lung sounds but are unable to hear over the drone of the engine. You should: A) extubate immediately and ventilate with a bag-mask device. B) increase your ventilation rate and reassess the child's condition. C) administer 0.02 mg/kg of atropine via rapid IO push and reassess. D) look for vapor mist in the ET tube and attach a colorimetric device.

You receive a call to a residence for a 6-year-old girl with a decreased level of consciousness. The child has hydrocephalus following surgery to remove a brain tumor and has a ventricular shunt in place. The child's level of consciousness is markedly decreased from its baseline, and the child's caregiver tells you that she thinks the shunt is obstructed. Which of the following sets of vital signs is MOST indicative of shunt obstruction and increased intracranial pressure? A) Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min B) Blood pressure 106/66 mm Hg; pulse 80 beats/min; respirations 14 breaths/min C) Blood pressure 90/50 mm Hg; pulse 110 beats/min; respirations 10 breaths/min D) Blood pressure 130/68 mm Hg; pulse 70 beats/min; respirations 28 breaths/min

You respond to a dialysis center for a patient with shortness of breath. When you arrive, you find the patient, an older male, still receiving dialysis. He is conscious and alert and is experiencing mild respiratory distress. As your partner administers oxygen, you should: A) ask the dialysis technician how long the patient has been on the dialysis machine. B) start an IV in the arm opposite the AV shunt and set the flow rate to 25 mL/hr. C) instruct the dialysis technician to remove the patient from the dialysis machine. D) administer a beta-2 agonist medication and contact medical control for guidance.

You should be MOST suspicious for child abuse when caring for an injured 4-year-old child if: A) there was an unusual delay in calling 9-1-1. B) the child presents with bruises to both shins. C) the caregiver demands that you treat the child. D) you can smell alcohol on the caregiver's breath.

You transported a patient with flu-like symptoms to the hospital 4 days ago. Your designated infection control officer advises you that the patient was diagnosed with the avian flu. If you documented an exposure to this patient, you will MOST likely be: A) offered an antiviral medication. B) referred to an infectious disease physician. C) restricted from duty for a 2-week period. D) mandated to get a regular flu vaccination.

Your unit is the first to arrive at the scene of a bus crash. As you approach the scene, you see multiple patients, some of them lying on the ground not moving and others walking around in a dazed state. You should: A) remain aware of the potential for hazards. B) immediately request additional ambulances. C) establish incident command and begin triage. D) move the walking patients away from the bus.

Naloxone is NOT recommended for use in newborns: A) who weigh less than 5.5 lbs. B) who are born to narcotic-addicted mothers. C) unless the umbilical vein has been cannulated. D) with shallow breathing and persistent bradycardia.

A 10-month-old infant presents with an acute onset of increased work of breathing. According to the infant's mother, the child was crawling around in the living room prior to the event and was fine 10 minutes earlier. Your assessment reveals that the infant appears alert to his surroundings, has loud inspiratory stridor, and pink skin. You should: A) look inside the infant's mouth using a tongue blade and penlight. B) avoid agitating the infant, offer supplemental oxygen, and transport. C) deliver five sharp back slaps between the infant's shoulder blades. D) apply a pediatric nonrebreathing mask and transport expeditiously.

A 10-year-old child fell approximately 15 feet from a balcony, landing on a sidewalk. He is conscious and alert, and complains of pain to the right side of his body. After completing your primary assessment, you should: A) apply spinal precautions, begin transport, and perform a rapid assessment while en route to the hospital. B) provide any immediately needed care, perform a rapid assessment, apply spinal precautions, and transport. C) perform a focused physical exam, obtain baseline vital signs, apply spinal precautions, and transport. D) correct immediate life threats, perform a detailed head-to-toe exam, apply spinal precautions, and transport.

A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child's grandmother, his symptoms began suddenly about 30 minutes ago. You should be MOST suspicious for: A) acute viral croup. B) bacterial epiglottitis. C) subglottic narrowing. D) laryngotracheobronchitis.

A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to 3 puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should: A) give 0.35 mg of epinephrine 1:1,000 SQ. B) give 0.5 mg of nebulized ipratropium. C) administer another 2.5-mg dose of albuterol. D) assist her ventilations with a bag-mask device.

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

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) the risk of fetal compromise. B) the possibility of a seizure. C) lowering her blood pressure. D) her current blood sugar level.

A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should: A) cover the burn and transport at once. B) begin immediate irrigation with water. C) apply a light coat of baking soda to the burn. D) administer oxygen via nonrebreathing mask.

A 45-year-old man is found unresponsive in an alley. During your assessment, you note that he is tachycardic and breathing rapidly. He has an obvious odor of alcohol on his breath. Your MOST immediate concern should be to: A) obtain a blood glucose reading. B) take actions to prevent aspiration. C) determine the etiology of his tachycardia. D) start an IV line and administer naloxone.

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) treat her as though she is experiencing viral meningitis. D) attempt to assist her ventilations with a bag-mask device.

A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should: A) apply chemical ice packs to the child's face to try to slow her heart rate. B) establish vascular access and administer a 20-mL/kg normal saline bolus. C) start an IV line and give adenosine while monitoring her cardiac rhythm. D) transport immediately and establish vascular access en route to the hospital.

A 71-year-old man with a history of emphysema, coronary artery disease, and hypertension presents with increased shortness of breath and fatigue. His oxygen saturation is 80% on home oxygen at 2 L/min via nasal cannula. His blood pressure is 140/76 mm Hg, pulse rate is 104 beats/min, and respirations are 28 breaths/min and labored. His medications include an albuterol inhaler, prednisone, hydrochlorothiazide, and lisinopril. Auscultation of his lungs reveals scattered wheezing in all fields. Which of the following prehospital interventions is NOT indicated for this patient? A) Nebulized ipratropium B) Subcutaneous epinephrine C) High-flow oxygen therapy D) Continuous positive airway pressure

A child in decompensated shock with hypotension should: A) be intubated to protect his or her airway. B) receive initial fluid resuscitation at the scene. C) be given 25% dextrose to prevent hypoglycemia. D) receive volume expansion with 5% dextrose in water.

A child who is experiencing a moderate asthma attack would MOST likely present with: A) a markedly prolonged expiratory phase. B) wheezing during inspiration and expiration. C) an inability to speak in complete sentences. D) an oxygen saturation between 80% and 90%.

A common sign of the measles is: A) petechiae. B) a blotchy red rash. C) severe diarrhea. D) a purpuric rash.

A decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to: A) heart block. B) bradycardia. C) tachycardia. D) atrial fibrillation.

A decreased wind chill factor increases heat loss through: A) radiation. B) convection. C) conduction. D) evaporation.

A key element of the "G" in the GEMS diamond includes: A) checking the physical condition of the patient's home. B) recalling that elderly patients often present atypically. C) assessing the elderly patient's activities of daily living. D) obtaining a complete medical history.

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) assess his blood glucose level and apply a cardiac monitor. C) start an IV line and begin administering a saline fluid bolus. D) give him 100 mg of thiamine IM and assess his blood pressure.

A major issue for people taking MAOIs is that: A) they are associated with a high rate of suicidal behavior. B) they have a high potential for lethal drug interactions. C) high doses are required to achieve a therapeutic effect. D) they must be used in conjunction with other antidepressants.

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

A nulliparous woman: A) has never been pregnant. B) has never delivered a baby. C) has never had a miscarriage. D) has had at least one miscarriage.

A paramedic would MOST likely be infected with TB if he or she: A) was close to a coughing patient who had a positive TB skin test. B) performed mouth-to-mouth on a patient with active untreated TB. C) was exposed to blood-stained vomitus of a patient with active TB. D) received a needlestick from a person suspected of having active TB.

A patient presents with a sudden onset of unilateral eye pain and blurred vision. You should suspect: A) acute optic nerve hypoplasia. B) acute angle-closure glaucoma. C) central retinal arterial occlusion. D) spontaneous retinal detachment.

A patient with high-altitude cerebral edema: A) should be given 40 mg of Lasix to help reduce swelling in the brain and improve neurologic symptoms. B) presents with ataxia and confusion after experiencing acute mountain sickness for greater than 24 hours. C) should not receive hyperbaric therapy due to the risk of an acute increase in intracranial pressure. D) typically presents with blurred vision, nausea, and dizziness within 15 minutes of reaching a high altitude.

A person blowing on hot food in an attempt to cool it is an example of: A) radiation. B) convection. C) conduction. D) passive cooling.

A person who compulsively uses a drug, despite the fact that he or she knows the drug will cause physical or psychological harm, is: A) tolerant. B) addicted. C) dependent. D) an abuser.

A person who is "speedballing" is: A) highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria. B) using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high. C) packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location. D) 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.

A psychotic person may have thought insertions, which are defined as: A) a gross distortion of your comments into what he or she believes to be true. B) the belief that thoughts are being thrust into his or her mind by another person. C) the fear that his or her thoughts are being broadcast aloud and heard by others. D) strange or pressured speech because of unusual words the patient has invented.

A small percentage of clinically depressed patients: A) complain of persistent anorexia. B) may report an increased appetite. C) experience guilt and self-reproach. D) have pervasive thoughts of suicide.

A spontaneous abortion: A) affects one out of every three pregnancies and is typically idiopathic. B) occurs naturally and may or may not have an identifiable cause. C) is generally performed by a physician to prevent maternal death. D) is most often the result of a congenital abnormality of the placenta.

Abortion is defined as expulsion of the fetus, from any cause, before the ____ week of pregnancy. A) 18th B) 20th C) 24th D) 28th

Abruptio placenta is MOST accurately defined as: A) separation of the placenta secondary to blunt maternal abdominal trauma. B) premature separation of a normally implanted placenta from the uterine wall. C) a condition in which the placenta progressively detaches from the uterine wall. D) a placenta that implants low in the uterus and partially or fully covers the cervix.

After an employee who believes he or she has been exposed to an infectious disease notifies the designated infection control officer (DICO), the DICO should: A) execute the postexposure plan within 24 to 36 hours. B) determine whether an actual exposure occurred. C) immediately refer the employee to a designated physician. D) obtain the patient's consent to have his or her blood drawn.

After obtaining an elderly patient's chief complaint, gathering additional information about the history of present illness would MOST likely be complicated because: A) the patient may ask you to repeat your questions. B) chronic problems may affect the acute problem. C) most elderly patients take numerous medications. D) the aging process causes difficulty in understanding.

After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should: A) immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn's pulse rate in 30 seconds. B) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation. C) begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube. D) perform tactile stimulation for 30 seconds, reassess the infant's respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement.

Aging is a linear process, which means that: A) the older we get, the faster our bodies decline in function. B) the rate at which we lose functions does not increase with age. C) older people exhibit the cumulative results of a longer aging process. D) older adults experience decreased functions faster than younger adults.

Almost all disoriented behavior: A) has an underlying physical etiology that may be life threatening. B) represents a person's effort to adapt to internal or external stress. C) can be identified and treated definitively in the prehospital setting. D) is the result of an acute behavioral crisis that requires intervention.

An 82-year-old man presents with confusion that has worsened progressively over the past 2 weeks. Because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter. She tells you that her father has high blood pressure but refuses to take medication for it. She also tells you that she thinks he fell about 3 weeks ago, although he denies falling. The patient's blood pressure is 168/98 mm Hg, pulse rate is 60 beats/min and occasionally irregular, and respirations are 22 breaths/min and regular. This patient MOST likely: A) has an acute onset of dementia. B) is experiencing a subdural hematoma. C) had a stroke secondary to atrial fibrillation. D) has normal age-related physiologic changes.

An estimate of the pressure to which a diver is exposed is based on the: A) diver's heart rate. B) depth of the dive. C) water temperature. D) length of time under water.

An increase in core body temperature due to inadequate thermolysis is called: A) heatstroke. B) heat illness. C) heat cramps. D) heat exhaustion.

An increase in core temperature causes the: A) anterior pituitary gland to send signals via afferent pathways in the sympathetic nervous system to increase the heart rate. B) hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating. C) anterior pituitary gland to send signals via efferent pathways in the sympathetic nervous system, causing widespread vasoconstriction. D) hypothalamus to send signals via afferent pathways in the parasympathetic nervous system, resulting in vasoconstriction and sweat production.

An oropharyngeal airway would MOST likely be indicated for a newborn with: A) gasping respirations. B) Pierre Robin sequence. C) a diaphragmatic hernia. D) prolonged periods of apnea.

Any child with unexplained hyperpnea should be suspected of having _________ toxicity. A) opiate B) salicylate C) beta blocker D) organophosphate

Any sympathomimetic drug will cause: A) ataxia. B) tachycardia. C) hallucinations. D) hypothermia.

Appropriate prehospital treatment for a patient who has overdosed on a stimulant and is excessively tachycardic and violent includes all of the following, EXCEPT: A) IM haloperidol. B) beta-adrenergic antagonists. C) benzodiazepines if seizures occur. D) fluid boluses if hypotension occurs.

Appropriate treatment for a conscious child with anaphylaxis includes: A) 0.5 mg/kg of diphenhydramine IV. B) 0.01 mg/kg epinephrine 1:1,000 IM. C) pharmacologically assisted intubation. D) a dopamine infusion to increase the blood pressure.

Approximately ___% of all penetrating abdominal wounds to the mother result in fetal injury. A) 50 B) 70 C) 85 D) 90

As the preovulatory phase of the menstrual cycle progresses: A) the maturation of an oocyte occurs when follicle cells respond to follicle-stimulating hormone. B) the anterior pituitary gland releases luteinizing hormone, which stimulates the release of an ovum. C) gonadotropin-releasing factor stimulates the hypothalamus to release follicle-stimulating hormone. D) follicle-stimulating hormone is released by the hypothalamus, which stimulates the process of ovulation.

At a core body temperature of 90°F: A) hyperventilation is profound. B) oxygen consumption decreases. C) ventricular fibrillation is likely. D) shivering becomes involuntary.

Caput succedaneum is defined as: A) bilateral temporal bone fractures caused by a delivery that includes the use of forceps. B) temporary swelling of the soft tissue of the baby's scalp secondary to pressure from the dilating cervix. C) an area of bleeding between the parietal bone and its covering periosteum that resolves in 1 to 2 months. D) permanent cranial disfigurement caused by vaginal delivery in a woman with cephalopelvic disproportion.

Cervical spondylosis is a degenerative change in the cervical spine that causes: A) destruction of the intervertebral discs and vertebral fractures. B) narrowing of the spinal canal and pressure on the spinal cord. C) lateral curvature of the cervical spine with cord impingement. D) fracture of the odontoid process of the second cervical vertebra.

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

Common medications used to treat pediatric seizures in the prehospital setting include all of the following, EXCEPT: A) Ativan. B) Dilantin. C) Diazepam. D) Midazolam.

Common signs and symptoms of TB include all of the following, EXCEPT: A) hemoptysis. B) photophobia. C) weight loss. D) a persistent cough.

Common signs and symptoms of meningitis in young children include all of the following, EXCEPT: A) poor feeding. B) nuchal rigidity. C) bulging fontanelle. D) irritability and fever.

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

Counting an infant's respiratory rate for 15 seconds and then quadrupling that number: A) is recommended because it is the quickest way to determine if the infant's baseline respiratory rate is abnormally slow or abnormally fast. B) may yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea. C) is impractical because the inherent respiratory rate of an infant is usually rapid and counting for such a short period of time leaves room for error. D) is appropriate only if you are auscultating the child's respirations with a stethoscope while simultaneously listening to lung sounds.

Difficulty walking or sitting, nightmares, and bedwetting are MOST suggestive of: A) neglect. B) sexual abuse. C) physical abuse. D) emotional abuse.

Diffuse rales, rhonchi, and wheezing in an infant: A) can usually be heard without a stethoscope. B) are typical signs of lower airway inflammation. C) suggest swelling of the supraglottic structures. D) are signs of acute asthma until proven otherwise.

Disorders of thinking include all of the following, EXCEPT: A) phobias. B) anxiety. C) delusions. D) obsessions.

Drug abuse is MOST accurately defined as: A) the habitual use of illicit drugs for the purpose of inducing a euphoric feeling. B) any use of drugs that causes physical, psychological, or legal harm to the user. C) the use of legal medications that is not in accordance with a physician's order. D) inadvertent misuse of a licit or illicit drug that causes physical harm to the user.

Due to the process of aging, an elderly person commonly experiences: A) increased thirst. B) moderate hyperglycemia. C) increased insulin secretion. D) high fever with a minor illness.

During the proliferative phase: A) fertilization of the egg occurs in the distal third of the fallopian tube within 24 hours following ovulation. B) estrogen stimulates the endometrium to increase in thickness in preparation for the reception and future growth of a fertilized egg. C) the stratus functionalis of the endometrium is shed during menstruation when implantation of a fertilized egg does not occur. D) the middle, muscular layer of the fallopian tube propels a fertilized egg toward the uterus where it implants on the uterine wall.

During true labor: A) analgesics often abolish the pain from contractions. B) the interval between contractions gradually shortens. C) the intensity of uterine contractions remains constant. D) contractions are irregularly spaced from one to the next.

During your rapid assessment of a newborn's cardiopulmonary status, you note that its respirations are adequate, you feel 8 pulsations in a 6-second time frame, and the newborn is centrally pink but peripherally cyanotic. The MOST appropriate next action should be to: A) provide 30 seconds of tactile stimulation. B) administer positive-pressure ventilations. C) assess the newborn's blood glucose level. D) give free-flow oxygen by mask at 5 L/min.

During your visual exam of a woman in active labor, you see a loop of the umbilical cord protruding from her vagina. She is in the middle of a strong contraction, and you can see the baby's head just beyond the cord. You should immediately: A) place her on 100% supplemental oxygen. B) instruct her to pant during the contraction. C) push the baby's head back into the vagina. D) apply sterile, moist dressings over the cord.

Elderly _________ are at highest risk for suicide, and most often use ___________ as their suicide method of choice. A) women, pills B) men, firearms C) women, knives D) men, hanging

Endotracheal intubation is clearly indicated in the newborn if: A) its heart rate is improving, but only because of adequate ventilations and chest compressions. B) meconium is present in the amniotic fluid and the newborn is limp and has a heart rate of 70 beats/min. C) central cyanosis is persistent despite the administration of free-flow oxygen for 30 to 45 seconds. D) a small, 27-gauge IV line is present and epinephrine is required to treat refractory bradycardia.

Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because: A) caregivers often take their anger out on prehospital professionals. B) he or she will be a source of important information and assistance. 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.

Failure of a child's SpO2 to increase despite high-flow oxygen is MOST indicative of: A) relative hypovolemia. B) congenital heart disease. C) right-sided heart failure. D) decreased vascular tone.

Fever in infants younger than 2 months of age is defined as a body temperature that is ____°F or greater. A) 99.2 B) 100.4 C) 101.2 D) 102.0

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) a septic abortion. C) toxoplasmosis. D) bacterial vaginosis.

Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should: A) assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center. B) administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion. C) apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility. D) apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.

From an anatomic and physiologic perspective, inhaled toxins: A) generally provide a large window of opportunity for treatment. B) quickly reach the alveoli and rapidly gain access to the circulatory system. C) typically take between 15 and 20 minutes to exert a systemic effect. D) often take several hours before clinical signs and symptoms manifest.

Generalized anxiety disorder is characterized by: A) symptoms for at least 1 month. B) persistent and unproductive worrying. C) feelings of grandeur and inattentiveness. D) unreasonable fear of a particular situation.

Gestational diabetes is caused by: A) a decreased production of insulin secondary to excess estrogen levels. B) increased insulin production and decreased cellular sensitivity to insulin. C) decreased cellular utilization of insulin secondary to increased estrogen. D) ketones that are excreted in the urine during the course of the pregnancy.

Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons, EXCEPT: A) impaired circulation. B) chronic hyperthyroidism. C) atherosclerotic vessels. D) decreased sweat production.

Human chorionic gonadotropin hormone sends signals to the corpus luteum, which in turn: A) produces cells that clump together and ultimately form the main tissues of the placenta. B) produces hormones designed to support the pregnancy until the placenta has developed. C) facilitates transition of the blastocyst into an embryo and causes further maturation of the placenta. D) causes the developing placenta to produce projections that tap into the external tissue of the blastocyst.

Hydrocephalus may occur if: A) too much cerebrospinal fluid is forced into the spinal canal. B) cerebrospinal fluid absorption into the bloodstream is reduced. C) bleeding in the brain causes an increase in intracranial pressure. D) the brain produces less than 500 mL of cerebrospinal fluid per day.

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

If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should position him or her supine and then: A) visualize the upper airway. B) perform chest compressions. C) assess for a carotid pulse. D) perform abdominal thrusts.

If a child with a functioning central venous line requires emergency drug therapy, you should: A) administer the drug through the central line, but only give half the usual dose of the drug. B) avoid using the central line if possible and attempt to establish peripheral IV access elsewhere. C) carefully cleanse the injection port on the central line and administer the drug in the usual fashion. D) flush the central line with at least 30 mL of normal saline first and then administer the emergency drug.

If a newborn does not respond to the initial steps of resuscitation, the need for further intervention is based upon: A) pulse rate, activity, and appearance. B) respiratory effort, pulse rate, and color. C) appearance, skin color, and muscle tone. D) respirations, appearance, and muscle tone.

If a paramedic is exposed to lice: A) he or she should immediately report to the designated infection control officer for prophylactic antiviral treatment. B) permethrin cream treatment may be prescribed and restrictions from patient care may be indicated until the paramedic is free of lice. C) infection is unlikely because paramedics have strong immune systems due to exposure to patients with various diseases. D) a specially made shampoo that contains a combination of a steroid and an antibiotic should be used within 6 hours after exposure.

If a patient with a behavioral emergency misperceives reality, you should: A) disagree and correct the patient's perception. B) avoid arguing about the patient's misperception. C) conclude that he or she is suffering from schizophrenia. D) agree with the patient to facilitate his or her cooperation.

If a small amount of water is aspirated into the trachea during a submersion event: A) the victim asphyxiates, becomes profoundly acidotic, and dies. B) laryngospasm occurs and temporarily protects the lower airway. C) permanent laryngeal spasm occurs and requires cricothyrotomy. D) resulting hypoxemia causes the body to shift to aerobic metabolism.

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

If a woman's prepregnancy resting heart rate is 70 beats per minute, you would expect her heart rate to range between ____ and ____ at term. A) 75, 85 B) 85, 90 C) 90, 100 D) 100, 110

If administered in conjunction with nitrates, sildenafil would MOST likely cause: A) hypertensive crisis. B) severe hypotension. C) coronary vasospasm. D) ventricular tachycardia.

If hypovolemia is suspected or confirmed, you should administer ____ mL of normal saline to a 6-pound newborn over a period of ____. A) 18, 10 to 20 minutes B) 27, 5 to 10 minutes C) 33, 10 to 20 minutes D) 55, 5 to 10 minutes

If the source patient's blood tests positive for HIV: A) the exposed individual will receive a one-time injection of immune globulin and will be tested for HIV in 2 weeks. B) the blood will be assessed for viral load and the exposed individual may be offered a 4-week trial of antiretroviral therapy. C) the most rapid method for determining if the exposed individual was infected is by assessing his or her lymphocyte count. D) federal law requires that the exposed individual be placed on antiretroviral therapy and not be allowed to work in a health care setting.

If you are exposed to the hepatitis B virus and have a positive titer on file: A) the source patient will be retested. B) no follow-up treatment is required. C) the vaccination series should be repeated. D) you will be offered HBV immune globulin.

If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose: A) avoid administering flumazenil and transport the patient immediately. B) you should consider concomitant overdose with another CNS depressant. C) it is likely that the patient is also under the influence of methamphetamine. D) you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.

If you do not receive a flu vaccine and are exposed to a person with the flu: A) symptoms of the flu, if you contract it, will become evident within 12 to 24 hours after the exposure. B) antiviral drugs may be given within 48 hours after the exposure to reduce the severity of the flu if you contract it. C) an injection of immune globulin given within 12 hours after the exposure will prevent you from contracting the flu. D) a nasal spray that contains the live flu virus in an attenuated form will be administered to you within 48 hours.

If you have reason to believe that an unresponsive child has a foreign body airway obstruction, you should: A) assess for a pulse and then begin chest compressions. B) perform 30 chest compressions and then look in the mouth. C) administer abdominal thrusts until the object is expelled. D) try to remove it by performing a finger sweep of the mouth.

Impaired vasodilation: A) increases heat absorption. B) interferes with heat dissipation. C) decreases internal heat production. D) is caused by beta blocker medications.

Implantation of a fertilized egg within a fallopian tube: A) produces atypical signs of pregnancy. B) can cause severe intra-abdominal hemorrhage. C) represents only 3% of all ectopic pregnancies. D) is usually detected after the 20th week of pregnancy.

In addition to children, the hepatitis A vaccine is recommended for: A) any health care worker who functions in an actual patient care setting. B) emergency response team members traveling outside the United States. C) all Federal Emergency Management Agency response team members. D) all health care workers when an outbreak of hepatitis A is documented.

In addition to meeting the metabolic needs of the developing fetus, the mother's blood supply increases significantly in order to perfuse her own organs, especially the: A) heart and lungs. B) uterus and kidneys. C) liver and pancreas. D) central nervous system.

In addition to your transport time to the hospital, prehospital treatment of a frostbitten body part is MAINLY dependent upon: A) the percentage of the body surface affected and the patient's general underlying health. B) whether the affected part has been partially or completely thawed prior to your arrival. C) the patient's core body temperature and blood pressure at the time of initial patient contact. D) the estimated length of exposure to the cold environment and the potential for concomitant injuries.

In contrast to a child with pulmonary edema secondary to congestive heart failure, the respirations of a hypercarbic child without pulmonary edema would MOST likely be: A) rapid with audible rhonchi. B) tachypneic and without retractions. C) slow with increased work of breathing. D) bradypneic with periods of marked apnea.

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

In contrast to dementia, delirium: A) generally results from conditions such as Alzheimer disease. B) is characterized by acute global impairment of cognitive function. C) is an irreversible process caused by premature cerebral deterioration. D) is a chronic process that causes deficits in memory and abstract thinking.

In contrast to salt-depleted heat exhaustion, water-depleted heat exhaustion: A) is much less likely to occur in a patient who takes diuretic medications for hypertension. B) occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility. C) usually takes several hours or days to develop and occurs when regular water is used to replenish sodium and water. D) is the result of prolonged exertion in a hot environment coupled with the excessive intake of hypotonic fluids.

In contrast to toxic ingestions in toddlers, toxic ingestions in adolescents: A) are usually unintentional. B) typically involve multiple agents. C) are associated with lower mortality. D) involve small quantities of a single agent.

In early hypothermia, the cardiovascular system typically responds with: A) bradycardia. B) tachycardia. C) conduction delays. D) atrial dysrhythmias.

In hypochondriasis, patients have significant anxiety or fear that they: A) will attempt to hurt others. B) may have a serious disease. C) are being undermedicated. D) will go to sleep and not awake.

In males, infection with Chlamydia trachomatis would MOST likely lead to: A) hepatitis. B) prostatitis. C) bladder cancer. D) testicular torsion.

In older adults, shingles arises when the _________ virus resides in the ganglion of a nerve. A) rubella B) varicella C) rubeola D) herpes

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

In the late stage of syphilis: A) most patients become acutely ill and complain of symptoms such as blurred vision, a headache, and nausea. B) the patient is usually asymptomatic, but damage to the brain, heart, blood vessels, and liver is occurring. C) the patient experiences weight loss, muscle aches, and headaches that will not resolve without treatment. D) the disease has damaged the central nervous system permanently and is considered untreatable at this point.

Inadvertent lithium toxicity would MOST likely occur in a patient who is taking: A) a tricyclic antidepressant. B) NSAIDs. C) SSRIs. D) any medication used to control blood pressure.

Klonopin and BuSpar: A) are both benzodiazepines. B) are anxiolytic medications. C) are used to control seizures. D) block the reuptake of serotonin.

LSD is classified as a: A) psychedelic. B) hallucinogen. C) sympatholytic. D) sedative/hypnotic.

Law enforcement request 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) Asking her if she recognized the perpetrator B) Identifying and treating immediate life threats C) Not allowing her to shower or use the restroom D) Quickly assessing her blood pressure and pulse

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) 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. B) 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. 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 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.

Liver disease predisposes a patient to hypothermia secondary to: A) decreased glucagon uptake. B) inadequate glycogen stores. C) severe portal hypertension. D) increased bilirubin production.

MOST age-related visual disturbances are the result of: A) diabetic retinopathy. B) cataracts or glaucoma. C) macular degeneration. D) retinal artery occlusion.

Manic patients may report that their thoughts are racing and they may rapidly skip from one topic to another. This is called: A) confabulation. B) tangential thinking. C) circumstantial thinking. D) thought broadcasting.

Most children begin to develop stranger anxiety between ___ and ___ months of age. A) 3, 6 B) 6, 12 C) 12, 18 D) 18, 24

Most patients infected with the hepatitis C virus are unaware that they acquired the infection because: A) a blood test to detect the virus does not exist. B) they do not develop phase 2 signs and symptoms. C) the incubation period ranges from 15 to 20 years. D) hepatitis C does not produce any signs or symptoms.

Nearly half of all birth-related injuries: A) result in varying degrees of central nervous system dysfunction. B) are potentially avoidable with anticipation of obstetric risk factors. C) cause death of the newborn secondary to prolonged cerebral anoxia. D) are associated with negligence on the part of the health care provider.

Nitrogen causes decompression sickness: A) on descent because of the bubbles that form on reduction of pressure. B) on ascent because of the bubbles that form on reduction of pressure. C) on descent because of a progressive increase in atmospheric absolute. D) on ascent because of a progressive increase in atmospheric absolute.

Patients with alcoholism are prone to subdural hematomas and gastrointestinal bleeding because: A) they fall more frequently than sober people. B) their blood-clotting mechanisms are impaired. C) they are at higher risk for violent assault. D) alcohol causes significant immunocompromise.

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

Pharmacologic management for a black widow spider bite may include: A) atropine. B) diazepam. C) diltiazem. D) etomidate.

Pneumonia can be especially virulent during pregnancy because: A) pregnancy causes a reduction in tidal volume. B) the mother's immune system is already depressed. C) pregnancy causes an increased risk of bronchospasm. D) the mother's cough reflex markedly diminishes.

Polypharmacy is MOST accurately defined as: A) a harmful interaction when several drugs are taken together. B) the prescribing of multiple drugs to treat multiple conditions. C) unnecessarily prescribing numerous drugs to prevent a disease. D) the unintentional ingestion of multiple doses of the same drug.

Postexposure prophylaxis is available for all of the following diseases, EXCEPT: A) HIV. B) hepatitis C. C) syphilis. D) gonorrhea.

Prehospital treatment for a patient with moderate hypothermia may include: A) esophageal rewarming tubes. B) warm IV fluids and heat packs. C) caffeine to increase metabolism. D) extracorporeal rewarming.

Premonitory signs of labor include all of the following, EXCEPT: A) vaginal expulsion of the mucous plug. B) contractions at 5- to 15-minute intervals. C) a relief of pressure in the upper abdomen. D) an increase in pressure in the pelvic area.

Proficiency in ventilating apneic infants or children with a bag-mask device: A) cannot be achieved by practicing on a manikin. B) may avert the need for endotracheal intubation. C) is more important for paramedics than EMTs. D) is difficult because their faces are much smaller.

Reiter syndrome is: A) an acute life-threatening condition that has been linked directly to the use of high-absorbency tampons. B) a rare complication associated with untreated chlamydia and is characterized by arthritis and skin lesions. C) a far more common and serious complication of untreated chlamydia than pelvic inflammatory disease. D) a relatively common complication of untreated gonorrhea, and is characterized by low-grade fever and myalgia.

Repetitive actions that are carried out to relieve the anxiety of obsessive thoughts are called: A) perseverations. B) compulsions. C) stereotyped movements. D) confabulations.

Respiratory distress in a premature infant is MOST often the result of: A) a pneumothorax. B) surfactant deficiency. C) pneumonia at birth. D) intracranial hemorrhage.

Respiratory distress in children: A) represents the end result of prolonged hypoxia and indicates impending cardiopulmonary failure. B) is a compensated state in which increased work of breathing results in adequate pulmonary gas exchange. C) is associated with a decreased level of consciousness, abnormally slow respirations, and weak muscle retractions. D) is characterized by prominent use of the sternocleidomastoid muscles in infants and children younger than 2 years of age.

Several attempts to clear a plugged tracheostomy tube with suction have failed. The patient, who is on a mechanical ventilator, has a pulse rate of 150 beats/min and is making exaggerated attempts to breathe. You should: A) remove the tracheostomy tube, place a mask over the stoma, and ventilate with a bag-mask device. B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device. C) administer high-flow oxygen via nonrebreathing mask as you prepare to replace the tracheostomy tube. D) provide free-flow oxygen as you remove the tracheostomy tube and replace it with a similarly sized endotracheal tube.

Severe salicylate toxicity produces: A) bradypnea. B) metabolic acidosis. C) increased pH levels. D) respiratory acidosis.

Signs and symptoms of anticholinergic medication toxicity include: A) Hypotension, palpitations, and respiratory distress. B) urinary difficulty, constipation, and hypertension. C) epistaxis, abdominal pain, and blood in the urine. D) hypoglycemia, depression, and poor muscle movement.

Signs of a diaphragmatic hernia include all of the following, EXCEPT: A) a scaphoid or concave abdomen. B) bilaterally absent breath sounds. C) noted increased work of breathing. D) audible bowel sounds in the chest.

Some patients with a terminal illness will continue aggressive medical treatment, hoping for a statistically improbable recovery or attempting to prolong life as much as possible. This is called: A) hospice care. B) curative care. C) palliative care. D) investigational care.

Sorbitol is not recommended for use in young children because it: A) induces vomiting, which increases the risk for pulmonary aspiration. B) can cause severe diarrhea and life-threatening electrolyte abnormalities. C) has been linked to sudden cardiac death due to ventricular dysrhythmias. D) prolongs the QT interval and is associated with ventricular fibrillation.

Spina bifida occurs when: A) hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord. 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) trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. D) growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.

The BEST example of an impulse control disorder is: A) stealing. B) pathologic gambling. C) uncontrollable worrying. D) obsessing over one's health.

The BEST way to ensure that no one is harmed during an EMS call is to: A) ensure that all EMS providers wear body armor. B) assess the potential for violence on every EMS call. C) stand to the side of the patient's door when knocking. D) routinely ask the police to respond to the scene with you.

The LEAST common sign or symptom of carbon monoxide toxicity is: A) nausea and vomiting. B) cherry red skin color. C) pallor or cyanosis. D) roaring sensation in the ears.

The MOST appropriate vagal maneuver for an infant involves: A) blowing into an occluded straw. B) holding ice packs firmly to the face. C) firmly massaging the carotid artery. D) applying a heat stimulus to the body.

The MOST common cause of death following a tricyclic antidepressant overdose is: A) respiratory failure. B) a cardiac dysrhythmia. C) intracerebral hemorrhage. D) pulmonary aspiration.

The MOST common device used to provide positive-pressure ventilation to a newborn in the prehospital setting is a: A) T-piece resuscitator. B) self-inflating bag-mask device. C) flow-inflating bag-mask device. D) manually triggered ventilator.

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

The MOST common underlying cause of a tubo-ovarian abscess is: A) vaginitis. B) gonorrhea. C) an ectopic pregnancy. D) a ruptured ovarian cyst.

The MOST important aspect in the care of a patient who is at risk for suicide is: A) identifying the patient's plan. B) never leaving the patient alone. C) acknowledging the patient's feelings. D) eliciting the help of family members.

The MOST likely cause of heat syncope is: A) paroxysmal tachycardia. B) vasodilation and dehydration. C) underlying cardiovascular disease. D) profound peripheral vasoconstriction.

The basal metabolic rate is MOST accurately defined as: A) the expenditure of heat energy during strenuous exertion or exercise. B) the heat energy produced at rest from normal body metabolic reactions. C) the balance between heat production and heat elimination from the body. D) a constant fluctuation in core body temperature to maintain homeostasis.

The external female genitalia are collectively referred to as the: A) vagina. B) pudendum. C) external labia. D) mons veneris.

The female urinary meatus is located: A) superior to the clitoris. B) just above the vaginal opening. C) inferior to the vaginal opening. D) between the vagina and perineum.

The fistula used for hemodialysis is a surgical connection between: A) two large veins. B) an artery and a vein. C) two large arteries. D) a vein and the peritoneum.

The foxglove plant contains ______________ and can result in ______________ when it is ingested. A) lantadene A, renal failure B) cardiac glycosides, dysrhythmias C) solanine, severe gastroenteritis D) caladium oxalate crystals, bradycardia

The hymenoptera family of insects includes ___________, which usually cause death secondary to ___________. A) spiders, acute heart failure B) yellow jackets, anaphylaxis C) snakes, severe coagulopathy D) centipedes, central nervous system depression

The initial steps of newborn resuscitation include: A) free-flow oxygen. B) proper positioning. C) assessment of pulse rate. D) positive-pressure ventilation.

The inner cannula of a tracheostomy tube: A) should be equipped with a cuff if used in pediatric patients. B) has a 15-mm port that can be attached to a ventilator circuit. C) is the larger tube that passes directly into the patient's trachea. D) should only be removed during tracheostomy tube replacement.

The leading cause of death from infection in Americans older than 65 years of age is: A) nephritis. B) pneumonia. C) encephalitis. D) meningitis.

The onset of menses is called ___________, and typically occurs between the ages of ___________. A) menorrhea, 10 and 12 years B) menarche, 11 and 14 years C) menopause, 12 and 15 years D) the climacteric, 14 and 16 years

The outer layer of the fallopian tube: A) is made of smooth muscle that contracts and relaxes. B) consists of a serous membrane that protects the tube. C) is where fertilization of the ovum typically occurs. D) contains secretory cells and cilia that help move the ovum.

The pediatric assessment triangle will help answer all of the following questions, EXCEPT: A) "Is the child sick or not sick?" B) "Will the child cooperate during my exam?" C) "Does the child require emergency treatment?" D) "What is the most likely physiologic abnormality?"

The preferred initial pharmacologic agent for pediatric bradycardia is: A) atropine. B) epinephrine. C) dobutamine. D) amiodarone.

The purpose of hospice care is to: A) render quality care to patients with a debilitating but temporary disease. B) provide quality end-of-life care through pain and symptom management. C) restore a person to his or her maximum physical and emotional potential. D) render around-the-clock intensive care to prevent cardiopulmonary arrest.

The quickest way to prevent newborn hypothermia involves: A) administering warmed IV fluids. B) thoroughly drying the newborn after birth. C) applying a hot water bottle to the groin area. D) administering warmed, humidified oxygen.

The single MOST common cause of seizures in both term and preterm infants is: A) intracranial hemorrhaging. B) hypoxic ischemic encephalopathy. C) congenital or developmental defects. D) a severe derangement in electrolytes.

The toxicity of carbon monoxide arises primarily from: A) its destructive properties on ferric ions. B) its affinity for hemoglobin in red blood cells. C) the fact that carbon monoxide destroys hemoglobin molecules. D) its ability to markedly decrease the metabolic rate.

The transducer or drainage system of an intracranial pressure monitor is typically aligned at the same height as the patient's: A) forehead. B) ear canal. C) eyebrow. D) temporal bone.

The use of a straight blade during pediatric intubation: A) is generally reserved for neonates only. B) makes it easier to manipulate the epiglottis. C) is associated with a higher risk of bradycardia. D) facilitates laryngoscopy by lifting the vallecula.

The uterine fundus is measured: A) horizontally from one side of the uterus to the other side. B) vertically from the top of the pubic bone to the top of the fundus. C) from just below the umbilicus to the inferior part of the sternum. D) vertically from the top of the fundus to just below the umbilicus.

The venom from a pit viper causes all of the following effects, EXCEPT: A) local tissue necrosis. B) increased blood clotting. C) neuromuscular dysfunction. D) increased vascular permeability.

There is evidence that a 21-year-old woman was given Rohypnol before being raped. She presents with alcohol on her breath, drowsiness, and memory loss. Her blood pressure is 98/68 mm Hg, pulse is 58 beats/min and weak, and respirations are decreased and shallow. You attempt to administer high-flow oxygen, but she resists. What should you do now? A) Administer a sedative medication to facilitate her acceptance of the oxygen. B) Consider administering naloxone in case she was also given a narcotic drug. C) Start an IV line and administer 1 to 2 liters of an isotonic crystalloid solution. D) Recognize that because the patient is of legal age, she can refuse EMS treatment.

Thermoregulation is a function of the: A) diencephalon. B) anterior hypothalamus. C) peripheral vasculature. D) posterior pituitary gland.

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.

To evaluate function of an infant's or child's cerebral cortex, you should: A) assess pupil reaction. B) use the AVPU scale. C) assess for posturing. D) evaluate motor activity.

Total anomalous pulmonary venous return is a rare congenital defect in which: A) pressure in the lungs causes pulmonary hypertension. B) the four pulmonary veins connect to the right atrium. C) venous blood mixes with arterial blood in the heart. D) blood returns to the lungs after being reoxygenated.

Transmission of gonorrhea occurs when contact is made with: A) the infected person's blood through an area where the skin is not intact. B) pus-containing fluid from the mucous membranes of the infected person. C) any portion of the infected person's genitalia during sexual intercourse. D) all of the infected person's bodily fluids, with or without sexual contact.

Transmission of mumps occurs by direct contact with the ________ of an infected person. A) tears B) saliva C) sweat D) blood

Treatment for a superficial frostbite injury includes: A) rewarming with radiant heat. B) elevating the frostbitten part. C) rewarming the area with hot water. D) gently rubbing the frostbitten area.

Treatment for pediatric asystole includes: A) atropine. B) epinephrine. C) cardiac pacing. D) hyperventilation.

Tricyclic antidepressant medications: A) are the first-line therapy for the treatment of depression. B) may produce toxic effects with even minimal dosing errors. C) generally require high doses to achieve a therapeutic effect. D) are very safe because they have a large therapeutic window.

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

Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by: A) a presence of P waves. B) an unvarying pulse rate. C) a history of fever or dehydration. D) a pulse rate greater than 180 beats/min.

Unlike the insertion of an indwelling urinary catheter, insertion of an intermittent (straight) urinary catheter: A) is necessary when the patient is bedridden for prolonged periods. B) does not involve inflation of a balloon to hold the catheter in place. C) is associated with a greater risk for damage to the urinary sphincter. D) generally does not require catheter lubrication with a water-soluble gel.

Upon arriving at the scene of an incident involving a chlorine gas spill, you should: A) begin triaging all patients. B) park the ambulance upwind. C) remove all patients from the scene. D) don a protective breathing apparatus.

Uterine inversion occurs when: A) the musculature of the uterine fundus is inherently weak, causing the uterus to prolapse. B) the placenta fails to detach properly and adheres to the uterine wall when it is expelled. C) postpartum bleeding is improperly managed with inadequate massage of the uterine fundus. D) excessive postpartum hemorrhage causes uterine ischemia and subsequent expulsion from the vagina.

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

What is the pathophysiology of cystic fibrosis? A) Acquisition of a virus or bacterium that takes residence inside the parenchyma of the lungs, resulting in the production of thin but copious secretions B) A defective gene that makes it difficult for chloride to move through the cells, which causes unusually high sodium loss and abnormally thick mucus secretions C) An underproduction of pulmonary surfactant, which causes chronic respiratory distress, thick pulmonary secretions, and severe intrapulmonary shunting D) Delayed lung growth and development that is typically caused by a variety of congenital cardiovascular defects, most notably a ventriculoseptal defect

What is the pathophysiology of decompression sickness? A) Diffusion of nitrogen out of the tissues during too slow of an ascent B) An imbalance of nitrogen in the tissues and alveoli due to rapid ascent C) Increasing quantities of nitrogen and oxygen in the blood during descent D) Excess carbon dioxide accumulation in the muscles due to a rapid ascent

What part of the female genitalia is homologous to the glans penis of the male? A) Hymen B) Clitoris C) Urethra D) Vestibule

When assessing a child's circulation by looking at his or her skin, pallor is MOST indicative of: A) vasomotor instability and decompensated shock. B) peripheral vasoconstriction and compensated shock. C) poor oxygenation and a state of circulatory collapse. D) systemic vasodilation with resulting low blood pressure.

When assessing an otherwise healthy child who is injured, you notice that his general appearance is abnormal. This should make you MOST suspicious for: A) child abuse. B) a head injury. C) hypoglycemia. D) internal bleeding.

When assessing the abdomen of a woman who is 36 weeks pregnant, you should expect it to be: A) rigid and distended. B) firm and nontender. C) enlarged and tender. D) distended and guarded.

When attempting resuscitation of a child with pulseless electrical activity, you should: A) administer epinephrine via the ET tube if possible. B) attempt to identify an underlying cause of the arrest. C) perform synchronized cardioversion if the rate is fast. D) give atropine if the heart rate is less than 60 beats/min.

When caring for a child with a ventricular shunt or gastrostomy tube, it is important to: A) provide supportive care only and then rapidly transport the child to the most appropriate medical facility. B) recognize that the caregiver is a key resource and that his or her expertise should be utilized to assist in the care of the child. C) assure the caregiver that you can care for the child effectively and recommend that he or she follow the ambulance in his or her own vehicle. D) obtain a complete medical history from the caregiver and then develop a treatment plan based on your knowledge of special health care devices.

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) keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital. C) have your partner cover the exposed portion of the umbilical cord with dry, sterile dressings. D) instruct the mother to push during each contraction to facilitate passage of the baby past the cord.

When determining the optimal method to communicate with, assess, treat, and transport a patient with a special health care challenge, the paramedic should: A) routinely call medical control before talking to a caregiver. B) demonstrate confidence and enlist the expertise of the patient. C) recall that caregivers are often upset and therefore unreliable. D) remain professional and obtain initial information from a caregiver.

When elderly patients are prescribed medications, the risk for drug toxicity increases because of: A) an increase in the glomerular filtration rate. B) age-related changes in hepatic enzyme systems. C) the presence of chronic conditions, such as diabetes. D) an increase in the production of antidiuretic hormone.

When evaluating a child's oxygen saturation level with a pulse oximeter: A) you should recall that peripheral vasodilation from a warm environment will typically yield a false reading. B) it should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment. C) you should provide ventilatory assistance with a bag-mask device if the reading is below 94% and not increasing rapidly. D) a reading of less than 96% on room air indicates respiratory distress and necessitates the administration of supplemental oxygen.

When mechanically securing an injured child's head and neck to a backboard, you should: A) place padding underneath the occiput. B) avoid placing a strap or tape over the chin. C) use towel rolls instead of a cervical collar. D) manually stabilize the child's torso first.

When obtaining the SAMPLE history of a person suspected of having an infectious disease, you should specifically inquire about: A) the patient's HIV status. B) a history of recent travel. C) any prior hospitalizations. D) the last sexual encounter.

When poisoning occurs because of a toxic environment: A) the patient typically does not present with symptoms for hours. B) you are more likely to encounter more than one patient at the scene. C) you should limit your exposure to the environment to less than 5 minutes. D) exposure continues, even after the patient is removed from the environment.

When washing your hands after a call, you should: A) wash your hands for at least 10 seconds. B) use an antimicrobial, alcohol-based foam or gel. C) wash with cold water and let your hands air dry. D) scrub your hands vigorously with an antibacterial gel.

Which of the following assessment findings is MOST suggestive of an organic cause of abnormal behavior? A) Multiple tattoos B) Unusual breath odor C) Skin that is cool and dry D) Auditory hallucinations

Which of the following assessment parameters is MOST difficult to interpret when a pregnant woman is injured? A) Pupils B) Pulse rate C) Mental status D) Blood glucose

Which of the following cardiac rhythm disturbances MOST commonly results from inadvertent overdose of a prescribed cardiac medication? A) Atrial flutter B) Bradycardia C) Tachycardia D) Atrial fibrillation

Which of the following changes occurs in the respiratory system of a pregnant woman? A) Progesterone increases the threshold of the medullary respiratory center to carbon dioxide. B) Minute ventilation increases by as much as 50%, which causes the PaCO2 to drop by about 5 mm Hg. C) Oxygen consumption decreases by approximately 20%, causing a 40% decrease in tidal volume. D) An increase in blood bicarbonate levels causes a slight decrease in the pH level of the blood.

Which of the following clinical findings suggests a cause of a patient's hyperthermia other than heatstroke? A) Dehydration B) Intermittent chills C) Moist, pale, hot skin D) Pupillary constriction

Which of the following clinical presentations is MOST consistent with a malfunctioning cerebrospinal fluid shunt? A) Tachycardia, tinnitus, and a narrowing pulse pressure B) Visual disturbances, headache, and altered mental status C) Hypotension, sudden loss of hearing, and severe nausea D) Tachypnea, fluid drainage from the ears, and restlessness

Which of the following conditions poses the LEAST risk for shock due to vaginal bleeding? A) Metrorrhagia B) Dysmenorrhea C) Polymenorrhea D) Hypermenorrhea

Which of the following conditions would MOST likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure? A) Asthma B) Kyphosis C) Spondylosis D) Osteoporosis

Which of the following disease processes would MOST likely present with signs and symptoms that mimic those seen with normal aging? A) Type 2 diabetes B) Hypothyroidism C) Thyrotoxicosis D) Hyperglycemia

Which of the following does NOT occur after the ovum is not fertilized? A) The endometrium breaks down and is shed as menstrual flow. B) The secretory phase increases the size of the endometrial glands. C) The ovum dies and degenerates 36 to 48 hours after being released. D) The corpus luteum degenerates 10 to 12 days after lack of fertilization.

Which of the following drugs is an MAOI? A) Elavil B) Parnate C) Sinequan D) Pamelor

Which of the following drugs is classified as an anticholinergic? A) Diazinon B) Atropine C) Thiopental D) Phenylephrine

Which of the following events occur during the third stage of labor? A) Crowning B) Placental delivery C) Delivery of the baby D) Mucous plug expulsion

Which of the following examples provides the BEST description of indirect contact with a microorganism? A) Becoming infected with West Nile virus from a mosquito bite B) Touching a bloody stretcher railing with an open wound on your hand C) Inhaling infected droplets from a person after he or she sneezes or coughs D) Making brief physical contact with a person who has an infectious disease

Which of the following factors complicates airway management in an obese patient? A) Larger upper airway B) Limited neck mobility C) Smaller patient head size D) Proportionately small tongue

Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia? A) Neonatal polycythemia B) Morbid obesity in the mother C) The larger of discordant twins D) 5-minute Apgar score of less than 7

Which of the following injury patterns is MOST suggestive of child abuse? A) Burns with splash marks B) Bruises on the abdomen C) Bruises on the lower leg D) Laceration to the chin

Which of the following is NOT a common sign of lead poisoning? A) Irritability B) Hypotension C) Hypertension D) Constipation

Which of the following is NOT a function of the placenta? A) Synthesis of glycogen and cholesterol B) Fetal protection against all harmful substances C) Antibody production that protects the fetus D) Excretion of wastes in the maternal circulation

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

Which of the following is NOT an antepartum risk factor that increases the potential that a newborn may require resuscitation? A) Preeclampsia B) Prolapsed cord C) Polyhydramnios D) Multiple gestations

Which of the following is NOT characteristic of the secondary stage of syphilis? A) The presence of a skin rash B) A single or multiple chancres C) Mucous membrane lesions D) Fever and swollen lymph glands

Which of the following is a potential complication of pelvic inflammatory disease? A) Uterine rupture B) Ectopic pregnancy C) Respiratory failure D) Urinary tract infection

Which of the following is a sign of severe barbiturate withdrawal? A) Diaphoresis B) Hallucinations C) Nausea and vomiting D) Abdominal cramping

Which of the following is the MOST immediate danger to an unresponsive patient with acute alcohol intoxication? A) Acute hypovolemia B) Aspiration of vomitus C) Profound bradycardia D) Ventricular dysrhythmias

Which of the following medications would MOST likely be used in the prehospital setting to treat some women with severe premenstrual syndrome? A) Haldol and Tylenol B) Glucose and fentanyl C) Valium and ibuprofen D) Insulin and acetaminophen

Which of the following patient populations is at GREATEST risk for abuse or neglect? A) Females between 6 and 12 years of age B) Children with chronic medical conditions C) Adolescents who rebel against their parents D) Males between 2 and 14 years of age

Which of the following questions often yields the LEAST reliable answer when questioning a patient who intentionally exposed himself or herself to a toxic substance? A) Have you vomited? B) Why did you take the substance? C) When did you take the substance? D) How much of the substance did you take?

Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm? A) Albuterol, 1 mg nebulized B) Ipratropium, 0.5 mg nebulized C) Albuterol, 0.25 mg nebulized D) Epinephrine, 0.1 mg/kg IM

Which of the following scenarios is MOST indicative of posttraumatic stress disorder? A) An advanced EMT student who has a morbid fear of needles experiences a syncopal episode during IV skills practice during class B) A paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor-vehicle-versus-pedestrian incident C) An elderly woman who is afraid of losing her independence becomes agitated when being told that she is being admitted to a skilled nursing care facility D) An experienced paramedic who had a nightmare regarding a case of sudden infant death syndrome cries at the scene of a cardiac arrest involving an infant

Which of the following statements regarding Alzheimer disease is NOT correct? A) Alzheimer disease is likely not a part of the normal process of aging. B) Age alone is thought to be the underlying cause of Alzheimer disease. C) The symptoms of Alzheimer disease are generally obvious at its onset. D) Common signs of Alzheimer disease include paranoia and delusions.

Which of the following statements regarding a child's chest wall is correct? A) Lung sounds are difficult to hear because of the thick intercostal muscles. B) Children are belly breathers because they rely heavily on their diaphragms. C) A child's chest wall has proportionately more subcutaneous fat on the chest. D) Retractions are less obvious in children owing to their noncompliant rib cages.

Which of the following statements regarding a person's intelligence is MOST correct? A) All individuals possess the same basic level of intelligence. B) A person with mental retardation has a disorder of intelligence. C) Patients with Down syndrome typically lack basic intelligence. D) Intelligence is generally a reflection of a person's past education.

Which of the following statements regarding aging is correct? A) Although aging causes various anatomic changes, physiologic functions generally remain intact. B) Health care providers may attribute genuine disease symptoms to age, resulting in inadequate care. C) All of the tissues and organs in the human body undergo the effects of aging at the same rate. D) Health care providers typically recognize the normal changes of aging and tend not to render unnecessary care.

Which of the following statements regarding autism is correct? A) The vast majority of patients with autism are mute and have an IQ of less than 20. B) Some patients with autism are able to easily solve complex mathematical problems. C) Common causes of autism include traumatic brain injury and severe emotional trauma. D) You should expect that a patient with autism will respond favorably to physical contact.

Which of the following statements regarding lightning strikes is correct? A) Ventricular fibrillation is the most common dysrhythmia seen following a lightning strike. B) Most lightning-related injuries occur when the person is standing near an object that is struck. C) The Lichtenberg figure caused by a lightning strike is a full-thickness burn that resembles a fern. D) Following a lightning strike, the person experiences apnea that typically resolves spontaneously.

Which of the following statements regarding patients with emotional or mental impairment is correct? A) Repeating the patient's statements often causes him or her to become agitated. B) A person's mental status can influence his or her physical well-being, and vice versa. C) Most patients with a mental impairment must be spoken to in a firm, direct tone of voice. D) Agitated speech is common in this patient population and generally does not suggest a potential for violence.

Which of the following statements regarding simple febrile seizures is correct? A) The overall prognosis for a child with simple febrile seizures worsens with each seizure episode. B) There is no relationship between simple febrile seizures and future developmental or learning disabilities. C) More than one simple febrile seizure in a child is highly suggestive of an underlying neurologic problem. D) Any child who experiences a simple febrile seizure is at significant risk for developing epilepsy.

Which of the following statements regarding toxic shock syndrome (TSS) is correct? A) TSS is a condition that is exclusive to females. B) Patients with TSS may show signs of liver failure. C) Most cases of TSS occur in the absence of a fever. D) Group B Streptococcus is a causative agent in TSS.

Which of the following statements would be appropriate when documenting a case of suspected abuse? A) "The patient's injury is not consistent with an accident." B) "The injury was reported to have occurred at 1420 hours." C) "The abdominal exam of the patient was within normal limits." D) "There was a gross discrepancy between the caregivers' stories."

Which of the following vascular access devices is "tunneled" under the skin and placed into the superior vena cava? A) Midline catheter B) Broviac catheter C) Dialysis catheter D) Double lumen catheter

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) Diffuse alveolar collapse C) Water within the pleural space D) Excess pulmonary surfactant

While transporting a cancer patient who is receiving chemotherapy, you should recall that: A) it is likely that the patient's condition is terminal. B) chemotherapy weakens a patient's immune system. C) prophylactic antiemetic medications are often needed. D) chemotherapy is only used to treat metastatic cancer.

Within a few days after having a therapeutic abortion, 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) acute cystitis. B) endometritis. C) a ruptured ovarian cyst. D) pelvic inflammatory disease.

Women who experience hyperemesis gravidarum: A) have been pregnant at least two times and are commonly underweight. B) have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition. C) vomit once or twice a day, usually during the morning hours, and often develop hyperglycemia as a result. D) develop the condition secondary to increased progesterone and decreased human chorionic gonadotropin levels.

You are assessing a middle-aged woman who is acutely disoriented. According to her husband, she has bipolar disorder and, to the best of his knowledge, has been compliant with her medication. Her blood pressure is 106/66 mm Hg, pulse rate is 100 beats/min and strong, and respirations are 14 breaths/min and regular. During your care of this patient, it is MOST important to: A) establish vascular access and administer naloxone. B) assess her oxygen saturation and blood glucose level. C) attempt to assist her breathing with a bag-mask device. D) ask her simple questions that can be answered yes or no.

You are assessing the circulation status of an injured patient using the START triage system. The patient, a 33-year-old man, has strong radial pulses bilaterally. You should: A) assign him a triage category of delayed. B) control any bleeding and assess his mental status. C) identify him with a red tag and continue triaging. D) ask him if he can get up and walk to another area.

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) carefully dry its face. B) assess for a nuchal cord. C) thoroughly suction its airway. D) gently guide the head upward.

You are caring for a middle-aged woman who is pulseless and apneic. Per rectal thermometer, the patient's core body temperature is 90°F. The cardiac monitor displays ventricular tachycardia. How will your treatment for this patient differ from that of a normothermic patient? A) Administer half the standard dose of epinephrine. B) Increase the interval between cardiac medications. C) Perform compressions at a rate of at least 120 per minute. D) Attempt defibrillation one time until the temperature rises.

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) provide a brief overview of the current situation. B) direct the reporters to the public information officer. C) firmly tell the reporters to leave the scene immediately. D) ignore the reporters' questions and continue patient care.

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) recognize that the patient's death is imminent and remain at the scene to provide any needed emotional support. B) administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son. C) apply high-flow oxygen via nonrebreathing mask, establish vascular access, and transport her to the hospital. D) leave the patient on her nasal oxygen, keep her warm, and transport her safely to the hospital for further palliative care.

You are dispatched to a residence at 6:15 AM for an unconscious 3-month-old infant who is not breathing. Upon arrival at the scene, you find the father performing CPR on the infant. The infant's mother is sitting on the couch, crying. Your assessment reveals that the child is apneic and pulseless. His skin is pale and cold, and there is gross lividity to his chest. You should: A) continue CPR and assess the infant's cardiac rhythm to confirm asystole. B) recognize that the infant has been deceased for an extended period of time. C) pronounce the infant dead if he does not respond to 5 minutes of full ACLS. D) tell the parents that the child likely suffocated because he slept on his stomach.

You are dispatched to a residence for a 17-year-old woman with acute abdominal pain. When you arrive and begin your assessment, it is clear that the patient is uncomfortable with the presence of her parents because she is reluctant to answer your questions. You should: A) recognize that the parents are an invaluable resource for information. B) diplomatically ask the parents if their daughter can have some privacy. C) tell the patient that her parents must legally be present during the exam. D) reassure the patient and tell her that her candor is vital to your treatment.

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) an ectopic pregnancy. B) a ruptured ovarian cyst. C) a tubo-ovarian abscess. D) pelvic inflammatory disease.

You are dispatched to a residence for a patient who has overdosed. You immediately recognize the address as that of a patient with a known psychiatric condition. Law enforcement is at the scene and has ensured its safety. When you arrive and enter the residence, you find the patient, a man in his mid-20s, sitting on the floor. He is conscious and appears anxious. Which of the following questions should you ask the patient FIRST? A) "How are you feeling right now?" B) "What medication did you take?" C) "Did you attempt to kill yourself?" D) "How long ago did this happen?"

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) give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm. C) 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. D) 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.

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 with 40 joules 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.

You are dispatched to the parking lot of a shopping mall for a pregnant woman with severe vomiting. When you arrive and assess the patient, she tells you that she is 26 weeks pregnant and that this is her first child. She further tells you that her normal morning sickness nausea became worse 3 days ago and that she has vomited numerous times since then; she also noticed small amounts of blood in her vomitus. Her blood pressure is 94/60 mm Hg, pulse rate is 124 beats/min and weak, and respirations are 22 breaths/min and regular. After loading the woman in the ambulance and placing her on her left side, you should: A) conclude that increased hormone levels are causing a transient worsening of her morning sickness, start an IV of normal saline and set it to keep the vein open, administer 12.5 mg of promethazine to control the vomiting, and transport her. B) suspect hyperemesis gravidarum, administer high-flow oxygen, start a large-bore IV and give a 250-mL normal saline bolus, assess her blood sugar and cardiac rhythm, consider administering diphenhydramine if protocols allow, and transport promptly. C) suspect upper gastrointestinal bleeding, administer oxygen via nonrebreathing mask, start two large-bore IV lines and give 2 L of normal saline, apply the cardiac monitor, insert a nasogastric tube to evacuate blood from her stomach, and transport at once. D) be suspicious that she has acute gastritis, apply oxygen via nasal cannula at 4 L/min, start an IV line and give a 20-mL/kg normal saline bolus, administer an antiemetic if she continues to vomit, obtain a 12-lead ECG tracing, and transport her promptly.

You are transporting a 22-year-old man whose violent behavior required physical restraint. A law enforcement officer is in the back of the ambulance with you. The patient tells you that he is sorry for his behavior and did not mean to take it out on you and your partner. You should: A) loosen the restraints if the patient promises to cooperate with you. B) continue to talk to the patient and monitor his peripheral circulation. C) administer droperidol IM and then remove the restraints. D) tell the patient that his behavior is inexcusable and keep him restrained.

You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm Hg, a pulse rate of 140 beats/min, and a respiratory rate of 24 breaths/min. The patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. After asking your partner to stop the ambulance to assist you with the patient, you should: A) assess his blood glucose level. B) administer IM haloperidol. C) start an IV line and give him morphine. D) administer a beta blocker and reassess.

You are triaging four patients who were involved in a motor vehicle crash. Victim 1 has bilateral femur fractures, is in severe pain, and is conscious and alert. Victim 2 is unresponsive, apneic, and pulseless. Victim 3, who is profusely diaphoretic, is wearing a medical alert bracelet identifying her as a diabetic. Victim 4 is responsive to pain only and is in obvious respiratory distress. How should you categorize these patients? A) Victim 1, immediate; victim 2, immediate; victim 3, delayed; and victim 4, delayed B) Victim 1, delayed; victim 2, expectant; victim 3, immediate; and victim 4, immediate C) Victim 1, delayed; victim 2, immediate; victim 3, delayed; and victim 4, immediate D) Victim 1, immediate; victim 2, expectant; victim 3, immediate; and victim 4, delayed

You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should: A) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport. B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately. C) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital. D) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.

You receive a call for a 33-year-old man with difficulty breathing. Upon arrival, you begin to assess the patient, who tells you that he is HIV-positive. During the primary assessment, you should: A) immediately place a nonrebreathing mask on the patient. B) identify and correct immediately life-threatening conditions. C) inquire about any antiretroviral medications he is taking. D) apply two pairs of gloves in case you encounter any gross bleeding.

You receive a call for an "unresponsive person." Law enforcement arrives at the scene before you and advises that the scene is secure. When you arrive, you find the patient, a young man, lying supine on the floor of his poorly kept apartment. He is unresponsive and is breathing with a marked reduction in tidal volume. One of the police officers recognizes the patient as a known intravenous drug abuser. During your care of this patient, you should: A) apply a nonrebreathing mask and set the flow rate at 15 L/min. B) avoid removing his wallet or any other possessions from his pockets. C) defer vascular access until the patient is in the emergency department. D) establish an IV line of normal saline and administer 2 mg of flumazenil.

You respond to a residence where an infant's apnea monitor has alarmed several times within the last 30 minutes. When you assess the infant, you note that she is alert, she has strong peripheral pulses, and her skin is pink, warm, and dry. You should: A) expect that her oxygen saturation will be below 90%. B) transport the infant and monitor her breathing en route. C) administer blow-by oxygen to the infant and reassess her. D) advise the parents to contact the apnea monitor manufacturer.

You would NOT expect a person using methamphetamine to present with: A) insomnia. B) bradypnea. C) restlessness. D) hypertension.

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) 0.3 mg of naloxone B) 32 mL of normal saline C) 6.5 mL of 10% dextrose D) 0.06 mg of epinephrine

Your assessment of an elderly man gives you reason to suspect that he has been abused. The patient does not appear to have any life-threatening injuries. His son, who is the only family member present at the scene, asks you if he can accompany his father in the back of the ambulance during transport. You should: A) ask the son why he wants to accompany his father in the ambulance. B) allow the son to accompany his father in the back of the ambulance. C) advise the son to follow the ambulance in his own personal vehicle. D) remain at the scene until law enforcement arrives and questions the son.

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan 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) 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. C) 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. 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.

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) placenta previa. B) a ruptured uterus. C) abruptio placenta. D) a threatened abortion.

A 39-year-old man's car broke down, stranding him out in the country for approximately 18 hours. The outside temperature is 23°F. When you arrive and assess the man, you determine that he is pulseless and apneic; his core body temperature is estimated to be below 86°F. CPR is immediately initiated and the man is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient? A) Give a single monophasic shock at 360 joules, reassess the rhythm and pulse, continue CPR, place advanced airway, hyperventilate at 20 breaths/min, establish vascular access, give 300 mg of amiodarone, and provide rapid transport B) Perform CPR for 2 minutes, give up to three stacked shocks, immediately resume CPR, reassess in 30 seconds, place advanced airway, ventilate at 8 to 10 breaths/min, establish vascular access, give a saline bolus, and provide rapid transport C) Give a single shock, immediately resume CPR, place advanced airway, provide ventilations at 8 to 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport D) Provide immediate defibrillation with maximum energy, reassess the rhythm and pulse, continue CPR, place advanced airway, give one breath every 3 to 5 seconds, establish vascular access, administer a vasopressor, and provide rapid transport

A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient's vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should: A) respect her wishes because she is coherent, but leave her with a trusted family member. B) use reasonable force to physically restrain the patient, administer a sedative, and transport. C) remain with the patient, contact medical control, and request law enforcement intervention. D) contact medical control and advise him or her that you will be transporting the patient against her will.

A 45-year-old man presents with severe cramps in his legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95°F and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. His blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The MOST appropriate treatment for this patient involves: A) giving him a salt-containing solution to drink, applying chemical ice packs to the back of his neck, and discouraging further activity for the day. B) administering high-flow oxygen, gently massaging his lower extremities to enhance circulation, administering 1 µg/kg of fentanyl IM, and transporting. C) offering him oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation. D) having him chew salt tablets, starting an IV with D5W at a keep-vein-open rate, administering 12.5 mg of promethazine IV, and transporting to the hospital.

A 66-year-old man with severe left heart failure is receiving an inotropic medication via an infusion pump. He presents with an altered mental status, increased breathing difficulty, and hypotension. You should: A) administer oxygen and discontinue the medication infusion by turning the pump off. B) assist his breathing, slowly increase the dose of his inotropic medication, and transport. C) support his breathing, continue his medication infusion, and contact medical control. D) administer oxygen, discontinue the medication infusion, and establish a peripheral IV.

A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child's pain should involve: A) encouraging the child to breathe high-flow oxygen. B) not allowing the child to visualize his deformed arm. C) providing calm reassurance to both mother and child. D) administering morphine or fentanyl via slow IV push.

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) starting an infusion of epinephrine at 5 µg/min. B) administering up to 50 mg of diphendydramine. C) administering 0.25 mg of epinephrine IM. D) intubating her and administering albuterol via the ET tube.

A child in anaphylactic shock: A) should receive 0.1 mg/kg of epinephrine IM. B) is treated primarily with saline fluid boluses. C) may require a low-dose epinephrine infusion. D) should receive epinephrine 1:1,000 via the IV route.

A fenestrated tracheostomy tube: A) should be used for patients who require constant support from a ventilator. B) is not equipped with an inflatable cuff and is secured in place with sutures. C) allows the patient to speak, breathe, or clear secretions from the upper airway. D) requires a special adapter in order to be compatible with a ventilation device.

A man leaves his 4-year-old child home alone while he plays golf with his friends. This is an example of: A) assault. B) neglect. C) abandonment. D) emotional abuse.

A man who smiles pleasantly when he tells you of the recent death of his wife: A) is thinking circumstantially. B) has a disorder of perception. C) has an inappropriate affect. D) has delusions of persecution.

A metallic taste in the mouth, explosive diarrhea, and a skin rash are MOST indicative of: A) lead poisoning. B) cyanide poisoning. C) arsenic poisoning. D) mercury poisoning.

A newborn with central cyanosis, adequate respirations, and a heart rate of 120 beats/min should initially be treated with: A) continued observation only. B) high-flow oxygen via mask. C) free-flow oxygen at 5 L/min. D) positive-pressure ventilation.

A patient with a long-term vascular access device is in cardiac arrest and requires epinephrine. In order to remove any heparin from the device, the paramedic should: A) follow the epinephrine with a 10-mL saline flush. B) briskly flush the device with 20 mL of saline. C) withdraw up to 10 mL of blood and discard it. D) slowly inject 3 to 5 mL of sodium bicarbonate.

A person taking levothyroxine (Synthroid) is at an increased risk for a heat-related illness secondary to: A) tachycardia. B) hypothalamic suppression. C) an increased metabolic rate. D) lowering of the blood pressure.

A person who is neologistic: A) repeats what he or she hears. B) talks with grossly slurred speech. C) invents words. D) has accelerated or pressured speech.

A person who is taking antibiotic therapy following a positive TB skin test and chest radiograph should not consume alcohol because: A) this increases the risk of active TB. B) alcohol can cause a violent reaction. C) the antibiotics are toxic to the liver. D) alcohol causes immunocompromise.

A person with amblyopia has: A) difficulty visualizing object from afar. B) an area missing from his or her visual field. C) partial or complete vision loss in one eye. D) difficulty visualizing objects that are close.

A psychiatric emergency: A) generally occurs following the use of an illicit drug or excessive consumption of alcohol. B) is caused by a chemical imbalance in the brain but does not interfere with activities of daily living. C) exists when a person's abnormal behavior threatens the safety and well-being of himself or herself or others. D) is generally the result of a short-term emotional crisis that is treated effectively with behavior modification.

A sick or injured child's general appearance is MOST reflective of: A) the etiology of the problem. B) his or her cardiovascular status. C) his or her central nervous system function. D) his or her ability to be consoled.

A typical finding for a foreign body aspiration is: A) a child with recent flu-like symptoms who presents with acute stridor. B) an otherwise healthy child with a progressive increase in work of breathing. C) an afebrile child with a sudden onset of coughing or gagging while playing. D) a temperature less than 102°F with sudden drooling, crowing, and dyspnea.

Abnormal behavior that stems from a psychosocial etiology would MOST likely occur in a patient who: A) is under severe stress caused by work. B) resorts to alcohol to mitigate daily stress. C) experienced emotional trauma as a child. D) recently experienced the death of a loved one.

Adult patients who have a tracheostomy tube in place and are ventilator-dependent should receive: A) cool, dry air through the ventilator circuit. B) deep tracheal suctioning every other day. C) humidification and heating of inspired air. D) ventilation at a rate of 20 to 24 breaths/min.

Adverse drug reactions in elderly people are the result of: A) partial digestion secondary to delayed gastric emptying. B) changes in body composition and an increase in body water. C) changes in drug metabolism due to diminished hepatic function. D) increased drug elimination due to decreased antidiuretic hormone.

After an adult victim is struck by lightning and experiences cardiac arrest: A) 5 minutes of CPR generally restores a pulse. B) perform a compression to ventilation ratio of 15:2. C) his or her heart may resume beating spontaneously. D) the ECG usually shows an organized cardiac rhythm.

After delivering a patient with a high fever and dry cough to the emergency department, you are later informed that the patient was diagnosed with severe acute respiratory syndrome. Reflecting back on the care you provided to the patient, you recall being in close proximity to her because she was hearing impaired, but you do not recall wearing a protective mask. What will MOST likely happen? A) There will be no special precautions taken because you did not receive a significant exposure. B) You will be tested for HIV and hepatitis B, and will be placed on a 7-day trial of antibiotics. C) You may be quarantined for up to 10 days and will be asked to check your temperature daily. D) You will receive an immune globulin injection and will not be allowed to return to work for a week.

Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to all of the following conditions, EXCEPT: A) hyperkalemia. B) hypernatremia. C) profound dehydration. D) acute volume overload.

Alcohol potentiates Valium. This means that: A) Valium makes alcohol a toxic substance. B) alcohol antagonizes the effects of Valium. C) alcohol enhances the effects of Valium. D) the use of alcohol negates the use of Valium.

An 8-year-old child: A) is analytic but is not capable of abstract thought. B) should not be the initial historian regarding an illness. C) is anatomically and physiologically similar to an adult. D) generally requires little reassurance and encouragement.

An acetone breath odor is common following exposure to all of the following toxins, EXCEPT: A) aspirin. B) isopropyl alcohol. C) camphor. D) methyl alcohol.

An immature egg is called a(n): A) ovum. B) zygote. C) oocyte. D) follicle.

An increase in blood pressure that commonly occurs with aging is physiologically exacerbated by: A) a compensatory increase in preload and cardiac ejection fraction. B) a decrease in stroke volume due to age-induced cardiomyopathy. C) an overproduction of collagen and decreased quantities of elastin. D) the patient's noncompliance with his or her antihypertensive drugs.

An increase in maternal cardiac output can cause a benign systolic flow murmur, which results from: A) an increase in afterload and slight mitral valve regurgitation. B) enlargement of the aortic valve due to increased blood volume. C) hypertrophy of the heart and dilation across the tricuspid valve. D) pulmonic valve prolapse due to transient pulmonary hypertension.

An individual's ability to fight off infection is called: A) virulence. B) immunity. C) host resistance. D) communicability.

An infant or small child who falls from a significant height would MOST likely experience: A) lumbar spine fractures. B) lateral thoracic trauma. C) a traumatic brain injury. D) bilateral femur fractures.

An intra-aortic balloon pump functions by: A) deflating a balloon during systole, which pushes blood into the central circulation. B) deflating a balloon during diastole, which creates a vacuum and decreases afterload. C) inflating a balloon during diastole, which pushes blood into the systemic circulation. D) inflating a balloon during systole, which creates a vacuum and decreases afterload.

An oral or nasal airway in an unresponsive infant or child may serve all of the following purposes, EXCEPT: A) facilitating oral suctioning. B) averting the need for intubation. C) replacing manual head positioning. D) helping to maintain an open airway.

Any diver who loses consciousness immediately following a dive should be assumed to have experienced: A) barotrauma. B) nitrogen narcosis. C) an air embolism. D) decompression sickness.

Assessment of a child in a cold environment would MOST likely yield: A) a rapid, weak pulse. B) flushing of the skin. C) delayed capillary refill. D) a slow, irregular pulse.

Cardiac arrest following a narcotic overdose is usually the result of: A) seizures. B) renal failure. C) respiratory arrest. D) a cardiac dysrhythmia.

Causes of delayed fetal transition include all of the following, EXCEPT: A) acidosis. B) hypothermia. C) birth at 41 weeks. D) meconium aspiration.

Choanal atresia is defined as a: A) small chin that causes a posteriorly positioned tongue. B) condition in which high-flow oxygen causes blindness. C) bony or membranous obstruction of the back of the nose. D) condition in which the occipital skull is abnormally large.

Common signs and symptoms of a panic attack include all of the following, EXCEPT: A) trembling and parasthesias. B) a sensation of being smothered. C) a prolonged loss of consciousness. D) nausea and abdominal discomfort.

Common signs and symptoms of a tricyclic antidepressant overdose include: A) excessive salivation and diarrhea. B) tachypnea and severe hypertension. C) altered mental status and tachycardia. D) constricted pupils and AV heart block.

Common signs and symptoms of meningitis include: A) irritability, back pain, headache, and hypertension. B) slow-onset fever, tinnitus, and an occipital headache. C) mental status changes, fever, stiff neck, and headache. D) a dark red rash, combativeness, and a low-grade fever.

Compared to subsequent breaths, the first few positive-pressure breaths delivered to a distressed newborn: A) should provide a volume equal to 40 to 45 mm Hg. B) should make the chest rise significantly. C) may necessitate manual disabling of the pop-off valve. D) generally require a significantly lower volume of air.

Crowning is MOST accurately defined as: A) bulging of the baby's head from the vaginal opening. B) passage of the baby through the fully dilated cervix. C) the presenting of the baby at the vaginal opening. D) the thinning and shortening of the cervix during labor.

Death from acetaminophen overdose is MOST often caused by: A) metabolic alkalosis. B) acute splenic rupture. C) progressive liver failure. D) gastrointestinal bleeding.

Department of Transportation (DOT) Class 8 chemicals are: A) explosive. B) flammable. C) corrosive. D) radioactive.

Disorganization and disorientation: A) are clinical presentations that are most common in younger patients. B) reinforce the fact that the patient's problem is psychiatric in nature. C) are ways that certain psychiatric conditions may present themselves. D) are presentations that represent a relatively small number of EMS calls.

Down syndrome is a condition in which: A) chromosome 23 fails to separate. B) the ovum contains 21 chromosomes. C) a triplication of chromosome 21 occurs. D) the human somatic cell contains 24 chromosomes.

During an incident involving a building collapse, a paramedic is assigned eight rescuers to function under his authority. However, as the incident progresses, the paramedic finds that he is unable to effectively manage the personnel assigned to him. He should: A) send two of the rescuers to the triage section since this is where they will most likely be needed. B) transfer authority to one of the rescuers assigned to him and then follow that person's directions. C) divide tasks and delegate supervision of some tasks to one or more of the rescuers assigned to him. D) release half of the rescuers assigned to him and instruct them to report directly to the incident commander.

During your assessment of a 4-year-old female, you find injury patterns that are highly suggestive of abuse. The child's mother is present; she is apprehensive and is hesitant to allow you to transport her daughter. Your MOST appropriate action should be to: A) ask the mother to leave the room so that you can ask the girl if the injuries that she has were intentionally inflicted by someone else. B) advise the mother that the child's injuries are inconsistent with accidental trauma and let her know that the child needs to be transported. C) ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police. D) act as though you are not suspicious, but call the child's father and inquire about the relationship between the child and her mother.

Early signs and symptoms of hepatitis B infection include all of the following, EXCEPT: A) fatigue. B) anorexia. C) jaundice. D) low-grade fever.

Elderly people are more susceptible to intracranial bleeding because of: A) a marked increase in brain size. B) depletion of cerebrospinal fluid. C) enlargement of the subdural space. D) constriction of the cerebral vessels.

Epiglottitis in children: A) presents with a sudden onset of low-grade fever and dyspnea. B) should be suspected if the child presents with diffuse wheezing. C) is rare now that children are vaccinated against Haemophilus influenza type B. D) should be confirmed by visualizing the larynx and epiglottis with a laryngoscope.

Epinephrine is indicated during newborn resuscitation if: A) the heart rate does not increase above 80 beats/min after 30 to 60 seconds of effective positive-pressure ventilation. B) the newborn is bradycardic and thick secretions are hindering your ability to provide effective positive-pressure ventilations. C) the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions. D) profound central cyanosis persists despite 30 seconds of effective positive-pressure ventilation with 100% supplemental oxygen.

Factors that increase internal heat production include all of the following, EXCEPT: A) response to infection. B) excess caffeine. C) hypothyroidism. D) Parkinson disease.

Following removal of an ostomy device and cleansing the stoma, you should: A) apply the new device over the stoma. B) flush the inside of the stoma with saline. C) place a clean gauze pad over the stoma. D) cover the stoma with the provided wafer.

For evaporation of sweat to be an effective cooling mechanism: A) the relative humidity must be greater than 90%. B) the environmental temperature must be at least 95°F. C) ambient air must be relatively unsaturated with water. D) ambient air must be saturated with a great deal of water.

Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they: A) expand rapidly. B) contain oxygen. C) are compressible. D) do not compress.

Gestational hypertension: A) often requires an antihypertensive. B) is common in underweight women. C) may be an early sign of preeclampsia. D) is benign in the vast majority of cases.

Gonorrhea in females: A) is usually more acute and pronounced than it is in males. B) typically manifests as dysuria within 24 hours of infection. C) often goes unnoticed until signs of acute abdomen appear. D) remains communicable for up to 48 hours after treatment.

Hepatitis A is often described as a benign disease because: A) people with hepatitis A are typically asymptomatic. B) there is an effective vaccination to prevent infection. C) lifelong immunity occurs once the disease is acquired. D) no known method of transmission has been identified.

If a woman who is being treated with the antibiotic metronidazole for bacterial vaginosis consumes alcohol during treatment: A) she is at high risk for sudden cardiac death. B) severe exacerbation of the vaginosis occurs. C) she may develop severe nausea and vomiting. D) the antibiotic may become a toxic substance.

If an initial cardioversion attempt is unsuccessful in a 33-pound child, you should repeat the procedure using ___ joules: A) 10 B) 15 C) 30 D) 50

If you cannot palpate the femoral pulse in an unresponsive infant, you should: A) apply an AED at once. B) palpate the brachial pulse. C) initiate CPR immediately. D) assess for adequate breathing.

If your EMS system protocols permit you to administer oxytocin to the mother following birth to control severe postpartum bleeding, it is MOST important to: A) administer a 500-mL normal saline bolus. B) first massage the uterus for at least 5 minutes. C) ensure that she is not delivering a second baby. D) obtain at least two blood pressure readings first.

Immediately upon gaining access to an unresponsive victim who is in the water, you should: A) assess the victim for signs of adequate breathing. B) compress the chest to remove water from the lungs. C) open the airway, using c-spine precautions if indicated. D) perform the tongue-jaw lift maneuver and look in the mouth.

In a cold environment, the body produces and conserves heat through all of the following mechanisms, EXCEPT: A) shivering. B) vasoconstriction. C) hyperventilation. D) thermogenesis.

In contrast to adults, cardiac arrest in children is usually caused by: A) a dysrhythmia. B) a toxic ingestion. C) respiratory failure. D) congenital anomalies.

In contrast to body substance isolation precautions, standard precautions: A) is a term used to describe infection control practices that reduce the risk of exposure to blood. B) describe a universal approach in which all blood and bodily fluids are assumed to be infectious. C) emphasize protection from moist body substances that may transmit bacterial or viral infections. D) specify that sweat is an effective carrier of infectious diseases, even if the sweat makes contact with intact skin.

In contrast to classic heatstroke, exertional heatstroke: A) causes hyperglycemia. B) presents with hot, dry skin. C) affects young, healthy people. D) is associated with diuretic use.

In contrast to gravida 3 mothers, gravida 1 mothers: A) have delivered at least one baby. B) are at a lower risk for complications. C) will typically take more time to deliver. D) often experience a precipitous delivery.

In contrast to primary apnea, secondary apnea: A) is characterized by profound tachycardia. B) commonly follows a brief period of hypoxia. C) is usually unresponsive to stimulation alone. D) necessitates immediate endotracheal intubation.

In the average female, the menstrual cycle lasts ___ days. A) 21 B) 24 C) 28 D) 35

In young children, air bags pose a particular threat for injuries to the: A) thoracic organs. B) abdominal organs. C) head and neck. D) soft tissues of the face.

Infants and children in shock: A) typically become hypotensive sooner than adults because of a relative decrease in total blood volume. B) generally remain alert for longer periods than adults despite a significant decrease in cerebral perfusion. C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance. D) maintain end-organ perfusion longer than adults, making capillary refill time a less reliable perfusion indicator.

It is important to remember that blood pressure is only one component in the overall assessment of a child because: A) it is an unreliable measurement of perfusion in all children. B) hypotension is seen much earlier in children than in adults. C) blood pressure may remain adequate in compensated shock. D) it generally yields a falsely low reading in agitated children.

Kyphosis is characterized by: A) cartilage degeneration. B) vertebral disc compression. C) a hunchback appearance. D) lateral curvature of the spine.

Luteinizing hormone stimulates the ovarian cells to release all of the following hormones, EXCEPT: A) relaxin. B) estrogen. C) oxytocin. D) progesterone.

Management for an ingested poison focuses mainly on: A) the prompt induction of vomiting. B) administering a counteracting agent. C) neutralizing the poison in the stomach. D) treating the systemic effects that result.

Morbid obesity is defined as a body mass index that is: A) greater than 30 kg/m2. B) between 30 and 39.9 kg/m2. C) between 40 and 49.9 kg/m2. D) greater than 50 kg/m2.

Mortality and morbidity are greatest following the bite of a: A) coral snake. B) copperhead. C) rattlesnake. D) cottonmouth.

Mortality and morbidity are high among infants who are delivered at 24 weeks' gestation, usually because of: A) congenital heart defects. B) infection and hypothermia. C) respiratory and neurologic problems. D) metabolic and immune deficiencies.

Most infectious disease exposures in health care providers occur due to: A) indirect contact. B) blood splatter. C) sharps injuries. D) inhaled droplets.

Most injuries in pediatric patients: A) can be totally eliminated with training. B) involve trauma to the chest and spine. C) are predictable and preventable events. D) occur due to gross caregiver negligence.

Most psychotropic medications exert their therapeutic effects by: A) inhibiting endocrine function. B) suppressing cerebellar function. C) targeting the autonomic nervous system. D) enhancing the effects of the thyroid gland.

Nocturnal itching and the presence of a rash involving the hands are indicative of: A) lice. B) herpes. C) scabies. D) shingles.

Organophosphates exert their effect by: A) destroying the body's acetylcholine. B) agonizing the sympathetic nervous system. C) stimulating the cholinergic nervous system. D) blocking the parasympathetic nervous system.

Patients with a colostomy: A) require a collection bag to collect solid fecal material after a section of large intestine is surgically removed. B) have a stoma that directs the small intestine to the outside of the abdomen where a collection bag is attached. C) have had a surgical procedure that directs the large intestine out through a stoma in the anterior abdominal wall. D) have a temporary surgical opening in the abdomen that collects waste material and allows the bowel to rest and heal.

Patients with heatstroke: A) present initially with hot, dry skin. B) are typically bradypneic and hypotensive. C) have a core temperature greater than 104°F. D) should routinely be given 50% dextrose.

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

Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform: A) intubation. B) cardioversion. C) defibrillation. D) CPR for 5 minutes.

Priority care for an unresponsive patient who has overdosed on phenobarbital includes: A) administering oxygen and giving naloxone. B) administering diazepam to prevent seizures. C) securing the airway and preventing aspiration. D) observing the ECG closely for lethal dysrhythmias.

Pulse oximetry will not provide a true assessment of arterial oxygenation in patients with carbon monoxide toxicity because: A) the device falsely interprets oxyhemoglobin as carboxyhemoglobin. B) carbon monoxide damages the computer chip inside the pulse oximeter. C) the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin. D) carbon monoxide turns the blood dark red, which indicates low oxygen content.

Resting tremor of an extremity and bradykinesia are associated with: A) Vascular dementia. B) Focal motor seizures. C) Parkinson disease. D) Alzheimer disease.

Rheumatoid arthritis: A) is more common in the elderly. B) does not respond to analgesia. C) can affect other body systems. D) occurs secondary to an infection.

Signs of a threatened abortion include all of the following, EXCEPT: A) sporadic contractions. B) menstrual-like cramps. C) severe abdominal pain. D) bleeding in the first trimester.

Signs of hypovolemia in the newborn include all of the following, EXCEPT: A) persistent pallor. B) weak central pulses. C) persistent acrocyanosis. D) persistent bradycardia.

Symptoms of delirium tremens usually begin within ___ to ___ hours after the last alcohol intake. A) 12, 24 B) 24, 48 C) 48, 72 D) 72, 96

The Candida albicans fungus is the causative agent in: A) bacterial vaginosis. B) gardnerella vaginitis. C) vaginal yeast infections. D) gonorrhea and chlamydia.

The MOST appropriate airway management for an actively seizing child whose airway is not maintainable with positioning involves: A) immediate endotracheal intubation. B) insertion of an oropharyngeal airway adjunct. C) nasal airway insertion and suctioning as needed. D) 100% oxygen and a left lateral recumbent position.

The MOST common cause of amenorrhea is: A) stress. B) exercise. C) pregnancy. D) anorexia nervosa.

The MOST common symptom of superficial frostbite is: A) localized edema. B) white, waxy skin. C) an altered sensation. D) cyanosis of the skin.

The MOST effective ways to protect your patients from nosocomial infections include: A) placing gloves on all patients with drug-resistant infections and placing a mask on yourself. B) routinely placing masks on all patients you treat and ensuring that your vaccinations are current. C) not reporting to work when you are sick and keeping the interior of the ambulance clean and disinfected. D) receiving the hepatitis B vaccine, having a titer drawn every 2 years, and wearing gloves on every EMS call.

The MOST important initial treatment for a child in respiratory failure due to suspected croup is: A) prompt intubation before the airway closes. B) a 2.25% concentration of racemic epinephrine. C) ventilatory assistance with a bag-mask device. D) continuous administration of a beta-2 agonist.

The ____________of the uterus is composed of three layers of muscle fibers that contract and help expel the fetus during childbirth. A) cervix B) endometrium C) myometrium D) perimetrium

The dieffenbachia plant is also referred to as "dumb cane" because: A) ingestion typically results in death in less than 5 minutes. B) its leaves are highly toxic to the ears and cause deafness. C) ingestion can result in the patient being unable to speak. D) its toxic effects cause stupor, ataxia, and bizarre behavior.

The dome-shaped top of the uterus is called the: A) os. B) body. C) fundus. D) cervix.

The effects of hypothermia are MOST dramatically apparent in the: A) integumentary system. B) cardiovascular system. C) central nervous system. D) hematopoietic system.

The headache commonly experienced by women during their menstrual cycle is caused by: A) acute stress. B) vasoconstriction. C) hormonal release. D) transient cerebral edema.

The heart hypertrophies with age, MOST likely in response to: A) a progressive increase in preload and chronic myocardial stretching. B) left-sided heart failure that results in chronic pulmonary hypertension. C) a chronically increased afterload caused by arteriosclerotic blood vessels. D) a significant decline in cardiac output due to a reduction in stroke volume.

The hyperpnea and tachypnea associated with methyl alcohol intoxication is secondary to: A) hypoxemia. B) heart failure. C) metabolic acidosis. D) an elevated blood pH.

The leading cause of life-threatening infections in newborns is: A) candidiasis. B) bacterial vaginosis. C) group B streptococcus. D) human immunodeficiency virus.

The length-based resuscitation tape: A) is only reliable in children who weigh less than 20 kg. B) should not be relied upon for determining pediatric drug doses. C) is used to estimate a child's weight based on his or her height. D) is generally more accurate than the weight given by a caregiver.

The majority of acquired hearing loss in children and adults is the result of: A) a tumor on the acoustic nerve. B) frequent middle ear infections. C) excessive exposure to loud noise. D) long-term use of salicylates.

The management for any potentially toxic exposure in children begins by: A) identifying the toxin. B) providing an antidote. C) ensuring a patent airway. D) assessing respiratory effort.

The medical assessment of an elderly patient can be complex because: A) he or she often makes up symptoms that do not exist. B) caregivers typically prefer that you speak with them. C) he or she often has more than one medical condition. D) most elderly patients are hearing or visually impaired.

The outflow catheter of a cerebrospinal fluid shunt is MOST commonly placed into the patient's: A) right atrium. B) pulmonary cavity. C) peritoneal cavity. D) left ventricle.

The pediatric assessment triangle was designed to: A) formulate a working field diagnosis upon first sight of an ill child. B) identify immediate life threats through a rapid hands-on assessment. C) help EMS providers form a hands-off general impression of an ill child. D) provide a means for performing a rapid head-to-toe physical assessment.

The presence of tachycardia in children: A) commonly reflects an underlying cardiac pathology that requires emergent intervention. B) often causes hypotension and is usually associated with a QRS complex greater than 0.08 seconds. C) should be interpreted in the context of the pediatric assessment triangle and the primary assessment. D) necessitates a 20-mL/kg bolus of an isotonic crystalloid solution until the cardiac rhythm is assessed.

The primary infection with syphilis produces: A) numerous small pustules on the genitalia. B) low-grade fever and pain in the genital area. C) an ulcerative chancre at the site of infection. D) dysuria and a purulent discharge in the urine.

The thermolytic tissues in the hypothalamus are mediated by the: A) endocrine system. B) sympathetic nervous system. C) parasympathetic nervous system. D) signals of the adrenergic nervous system.

The work-of-breathing component of the pediatric assessment triangle includes all of the following, EXCEPT: A) listening for grunting or audible wheezing. B) noting the child's position during breathing. C) auscultating the lungs for adventitious sounds. D) looking for substernal or intercostal retractions.

There is a higher incidence of abdominal injuries in association with chest trauma in pregnant women because: A) seat belts are usually not worn. B) the peritoneum is maximally stretched. C) the diaphragm is elevated nearly 2 inches. D) the abdomen is large and protuberant.

To maintain a neutral airway position in an unresponsive infant, you should: A) slightly extend the infant's head. B) pad underneath the infant's occiput. C) place a towel roll under the shoulders. D) insert an appropriate-sized oral airway.

Toxic effects of alcohol on the liver include all of the following, EXCEPT: A) coagulopathy. B) hypoglycemia. C) hyperglycemia. D) gastrointestinal bleeding.

Treatment for cyanide poisoning may include all of the following, EXCEPT: A) amyl nitrite. B) methylene blue. C) calcium gluconate. D) hydroxocobalamin.

Typical signs and symptoms of Meniere disease include all of the following, EXCEPT: A) vertigo. B) tinnitus. C) otorrhea. D) hearing loss.

Unlike a person with bulimia nervosa, a person with anorexia nervosa: A) is less likely to experience problems related to electrolyte imbalance. B) commonly describes his or her eating disorder as "out of control." C) experiences weight loss that may cause poor health or even death. D) compensates for binge eating by using various purging methods.

Unlike other types of shock, a child in cardiogenic shock would MOST likely present with: A) an enlarged spleen. B) unlabored tachypnea. C) increased work of breathing. D) a primary cardiac dysrhythmia.

Untreated depression in people over 65 years of age: A) causes homicidal behavior in as much as 50% of this age group. B) is often recognized by the patient, who subsequently asks for help. C) is associated with a higher suicide rate than in any other age group. D) usually goes unrecognized because it is often mistaken for delirium.

Virulence is defined as the: A) severity of infection once an organism enters the body. B) degree of difficulty that it takes to destroy an organism. C) ability of an organism to invade and create disease in a host. D) amount of time that it takes for an organism to infect the host.

When a child experiences a low cardiac output state, he or she relies MOST on: A) increased tidal volume. B) central vasoconstriction. C) an increase in heart rate. D) increased stroke volume.

When a patient is receiving palliative care, medical care: A) ceases, and the disease process is allowed to continue until the point of death. B) ceases, and efforts focus on relieving pain until the point at which the patient dies. C) continues, although aggressive, invasive, and uncomfortable interventions cease. D) continues, and only minimally invasive procedures are performed to prolong life.

When a person has a personality disorder: A) the disorder most often stems from fear. B) the paramedic can influence the patient easily. C) another psychiatric illness typically is present. D) medication therapy generally is not indicated.

When an atrial septal defect is present: A) blood flow to the lungs is significantly decreased, which leads to severe hypoxemia. B) the heart must push harder to force blood flow past a narrowed aorta, resulting in increased afterload. C) deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood. D) blood is allowed to bypass the right ventricle and lungs due to the fetus's lungs being filled with fluid.

When an infant or child is in respiratory failure: A) tachypnea is usually present despite a marked decrease in heart rate. B) decreased cerebral perfusion leads to restlessness and a weak, rapid pulse. C) he or she can no longer compensate, which causes hypoxia and hypercarbia. D) oxygen via nonrebreathing mask should be given if tidal volume is reduced.

When assessing an older person, you should remember that it is common for him or her to: A) slur his or her words. B) present with hemiparesis. C) respond slowly to questions. D) not understand your questions.

When caring for a patient experiencing a psychotic episode, you should: A) involve people the patient trusts. B) be calm, direct, and straightforward. C) first assess the situation for danger. D) clearly identify yourself to the patient.

When caring for a patient who is experiencing a panic attack: A) beta blockers are typically used to control tachycardia. B) you should move the patient to the ambulance quickly. C) your manner must convey that everything is under control. D) a benzodiazepine should be administered as soon as possible.

When delivering multiple babies, you should clamp and cut the umbilical cord: A) after the placenta has delivered. B) only after the first baby delivers. C) following delivery of each baby. D) after all the babies have delivered.

When disinfecting the ambulance after transporting a patient with rubella, you should: A) use a 1:1 bleach and water mixture. B) clean all surfaces with boiling water. C) use standard disinfection procedures. D) remove all equipment from the ambulance.

When evaluating a patient with a behavioral emergency, virtually all of the diagnostic information you obtain must come from: A) the medical history. B) the patient's family members. C) your conversation with the patient. D) the patient's general mood and affect.

When heroin passes through the liver: A) the liver rapidly metabolizes the drug, removes the toxic ingredients, and excretes it via the renal system. B) it rapidly becomes hepatotoxic, continues to exert narcotic effects, and causes liver failure within 24 to 36 hours. C) it is metabolized into acetyl-morphine, which continues to exert narcotic effects that may outlast the effects of naloxone. D) absorption through the rest of the body decreases markedly, allowing its narcotic effects to be reversed easily with naloxone.

When interviewing an elderly patient with a medical complaint, you should avoid: A) detailed explanations of what you are doing to him or her. B) looking directly at the patient as this may upset him or her. C) speaking to the family member first rather than the patient. D) talking about the patient in the absence of family members.

When suctioning the newborn's oropharynx to clear secretions prior to intubation, it is MOST important to: A) limit suctioning to 15 seconds. B) use a flexible suction catheter. C) monitor the newborn's heart rate. D) assess pulse oximetry and capnography.

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

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male, you should: A) connect the indwelling catheter to the urine drainage system, unclamp the tubing, and allow urine to drain. B) inflate the balloon with the prefilled syringe and gently pull back on the catheter until you feel resistance. C) continue inserting the catheter until the Y between the drainage port and the balloon port is at the tip of the penis. D) insert the catheter approximately 1 inch farther, inflate the balloon, and then pull back on the catheter until you feel resistance.

When ventilating an apneic child with a bag-mask device, it is important for the paramedic to remember that: A) each ventilation should be delivered over a period of 2 to 3 seconds. B) the presence of chest rise is an unreliable indicator of proper ventilation. C) regurgitation and aspiration may occur, even with proper ventilation technique. D) posterior cricoid pressure will virtually eliminate the risk of pulmonary aspiration.

Which of the following anticonvulsant medications would MOST likely be administered to a newborn with seizures in the prehospital setting? A) Dilantin B) Depakote C) Lorazepam D) Phenobarbital

Which of the following antidepressant medications has the HIGHEST safety margin? A) Doxepin B) Imipramine C) Paroxetine D) Nortriptyline

Which of the following clinical findings would you NOT expect to encounter in a patient with heat exhaustion? A) Abdominal cramping B) Mental disorientation C) Hypertension upon standing D) Body temperature of 103°F

Which of the following conditions is the older patient at greatest risk for? A) Chronic hypotension B) Rheumatoid arthritis C) Peripheral vascular disease D) Acute myocardial infarction

Which of the following disorders or conditions is related to decreased glycogen stores in the newborn? A) Large for gestational age B) Hypoxia or hypothermia C) Small for gestational age D) Maternal diabetes mellitus

Which of the following is LEAST characteristic of an apparent life-threatening event in an infant? A) Pallor or cyanosis B) A period of apnea C) Brief loss of a pulse D) Loss of muscle tone

Which of the following is NOT a factor in determining a person's risk of contracting an infectious disease following exposure? A) The organism's mode of entry B) The virulence of the organism C) The age and sex of the patient D) Host resistance of the individual

Which of the following is NOT a form of passive rewarming? A) Removing wet clothing B) Applying warm blankets C) Applying chemical heat packs D) Encouraging ambulation

Which of the following is NOT an identified risk factor for suicide? A) Financial setback or loss of a job B) A sudden improvement in depression C) Hispanic woman older than 55 years of age D) Recent loss of a significant relationship

Which of the following is the MOST common respiratory infection that causes death in the elderly population? A) Pneumocystis carinii B) Respiratory syncytial virus C) Pneumococcus bacteria D) Mycobacterium tuberculosis

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

Which of the following is the first-line treatment for a hemodynamically unstable child with bradycardia? A) Epinephrine IV or IO B) Chest compressions C) Ventilatory support D) Transcutaneous pacing

Which of the following questions is the MOST important to ask when obtaining a patient's gynecologic history? A) "Do you have any abdominal pain?" B) "When was your last sexual encounter?" C) "When was your last menstrual period?" D) "Is there a chance that you are pregnant?"

Which of the following risk factors is associated with the HIGHEST rate of mortality following a burn injury in an elderly person? A) Age over 55 years B) Musculoskeletal injury C) Preexisting medical condition D) Proportional increase in adipose tissue

Which of the following statements regarding chest trauma in children is correct? A) The pliability of children's rib cages predisposes them to sternal fractures. B) Signs of a pneumothorax are often more obvious in children than in adults. C) Children are more prone to intrathoracic trauma due to compression forces. D) Most cases of fatal chest trauma occur in children who fall more than 10 feet.

Which of the following statements regarding critical incident stress management at the scene of a multiple-casualty incident is correct? A) Critical incident stress management should begin only after all patients have been cared for appropriately. B) At a multiple-casualty incident, rescuers are unable to self-heal and they lose their resiliency to cope with the stress. C) Rescuers should be encouraged, but not forced, to report to the rehabilitation sector for a stress debriefing. D) Critical incident stress management is a crucial and mandatory part of any disaster and should be enforced.

Which of the following statements regarding fever in the newborn is correct? A) Fever in newborns is defined as a rectal temperature greater than 99.0°F. B) The ability of the newborn to dissipate heat through sweating is prominent. C) Fever may not always be a presenting feature in newborns with an infection. D) Because of their active immune systems, newborns commonly experience fever.

Which of the following statements regarding freshwater and saltwater drownings is correct? A) Freshwater drowning has a much higher mortality rate. B) Patients with freshwater drowning often require diuresis. C) Both freshwater and saltwater can lead to pulmonary injuries. D) Normal saline should be avoided in saltwater drowning victims.

Which of the following statements regarding methyl alcohol is correct? A) Also referred to as methanol, methyl alcohol is colorless and odorless and requires large amounts to cause toxicity. B) It is not recognized as a poison, although it has many properties of a poison when consumed in sufficient quantities. C) Methyl alcohol is also known as wood alcohol, and is present in paints, paint removers, windshield washer fluid, and varnishes. D) The signs and symptoms of methyl alcohol poisoning typically appear within 15 to 20 minutes following ingestion of as little as 5 to 10 mL.

Which of the following statements regarding nasogastric (NG) and orogastric (OG) insertion in children is correct? A) Gastric decompression with an NG or OG tube is only appropriate for children older than 10 years of age. B) The correct size NG or OG tube for a child should be half the ET tube size that he or she would need. C) Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate his or her trachea. D) Insertion of an orogastric tube is contraindicated in children with severe head trauma or injury to the midface.

Which of the following statements regarding peritoneal dialysis is correct? A) A patient undergoing peritoneal dialysis will have an AV shunt. B) Peritoneal dialysis can only be performed in a hospital setting. C) In peritoneal dialysis, fluid is instilled into the abdominal cavity. D) Peritoneal dialysis involves filtering the blood through a machine.

Which of the following statements regarding poliomyelitis (polio) is correct? A) Any warm-blooded animal can serve as a host for the polio virus. B) Patients with nonparalytic polio usually have permanent neurologic injury. C) Polio initially presents with a headache, sore throat, fever, and vomiting D) Subclinical polio is characterized by symptoms that last less than a month.

Which of the following statements regarding schizophrenia is correct? A) Although schizophrenia is a complex disorder, it is easily treated. B) Social influences have not been shown to contribute to schizophrenia. C) The typical onset of schizophrenia occurs during early adulthood. D) In schizophrenia, dysfunctional symptoms become less prominent over time.

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

Which of the following statements regarding the black widow spider is correct? A) The venom of a black widow spider contains a necrotoxin, which results in local tissue necrosis. B) Because the mortality rate from a black widow spider bite is about 40%, a prehospital antidote is crucial. C) Following a black widow spider bite, the patient's abdomen is often rigid due to severe muscle spasms. D) The male black widow spider, which is the sex that poses a danger to humans, contains a red hourglass on its back.

Which of the following statements regarding the hepatitis D virus (HDV) is MOST correct? A) The typical incubation period for HDV infection ranges from 180 to 360 days. B) The most common route of transmission of HDV is through sexual contact. C) Infection with HDV requires the host to be infected with the hepatitis B virus. D) If a documented exposure occurs, testing begins with the person who was exposed.

Which of the following statements regarding the human papillomavirus (HPV) is correct? A) HPV infection is characterized by fever and a genital chancroid. B) Genital warts caused by HPV are far more common in females. C) HPV has been identified as a causative agent in cervical cancer. D) Only one type of HPV is spread via unprotected sexual contact.

Which of the following statements regarding the mumps is correct? A) Mumps can cause sterility in males past the age of puberty. B) Postexposure vaccination against the mumps is recommended. C) Mumps presents with fever and swelling of the parotid glands. D) A variety of bacteria have been identified as causing the mumps.

Which of the following statements regarding the umbilical cord is correct? A) The placenta receives arteriovenous blood from the umbilical arteries. B) The umbilical cord is composed of two large veins and one small artery. C) The umbilical vein carries oxygenated blood from the placenta to the fetus. D) The fetus receives the majority of its oxygen supply from the umbilical arteries.

Which of the following toxins causes the MOST serious consequences when absorbed through the skin? A) Dry lime B) Poison oak C) Pesticides D) Sulfuric acid

Which of the following types of maltreatment involves isolating the victim from others, resulting in a substantial change in the victim's behavior or cognitive function? A) Neglect B) Abandonment C) Emotional abuse D) Sexual exploitation

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) establishing an IV line and administering 0.5 mg of atropine. B) visualizing her vaginal area to assess for external bleeding. C) maintaining her airway and providing ventilatory assistance. D) elevating her lower extremities to improve her blood pressure.

While preparing equipment for newborn resuscitation, which of the following items is/are NOT considered optional? A) Pulse oximeter B) Cardiac monitor C) Endotracheal tubes D) Laryngeal mask airway

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) apply full spinal motion restriction precautions at once. B) conduct a more in-depth neurologic exam of the patient. C) place a yellow tag on him and move on to the next patient. D) categorize him as an immediate patient and continue triage.

Work restriction guidelines enforced by OSHA require an employee to use sick time for an illness, unless: A) the employee opted to take the hepatitis B vaccine. B) a physician deems that the illness was unavoidable. C) the illness is the result of an occupational exposure. D) the illness occurred after the post-hire probation period.

You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the GREATEST potential for harm? A) Administering high-flow oxygen and obtaining a 12-lead ECG tracing B) Establishing IO access, administering a sedative, and cardioverting at 15 joules C) Starting an IV line and administering amiodarone followed by procainamide D) Establishing vascular access and rapidly administering 3 mg of adenosine

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) The age of the patient B) Bright red vaginal bleeding C) Absence of abdominal pain D) Audible fetal heart tones

You are assessing a 7-month-old infant who presents with listlessness, pallor, and increased work of breathing. The infant's mother tells you that the child was born 2 months premature and was in the neonatal intensive care unit for 3 weeks. She denies any recent vomiting, diarrhea, or fever. The infant's oxygen saturation is 89% and does not improve with supplemental oxygen. Her heart rate is rapid and weak and does not vary with activity. When you apply the cardiac monitor, you will MOST likely encounter a: A) wide QRS complex rhythm with occasional P waves and a rate greater than 150 beats/min. B) rhythm with QRS complexes greater than 0.08 seconds in duration and a heart rate greater than 180 beats/min. C) narrow QRS complex rhythm with absent P waves and a heart rate greater than 220 beats/min. D) rhythm with QRS complexes less than 0.08 seconds in duration and a heart rate less than 220 beats/min.

You are assisting in the delivery of a baby. After the baby's head emerges from the vagina, you should quickly assess for the presence of a nuchal cord and then: A) assess for facial cyanosis. B) administer free-flow oxygen. C) suction its mouth and nose. D) dry its face to stimulate breathing.

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) elevate the mother's hips with pillows, administer high-flow oxygen, and transport immediately. B) support the baby's body, carefully turn the mother on her left side, and transport expeditiously. C) place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall. D) elevate the mother's hips and apply gentle traction to the baby's body until the head has delivered.

You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient lying on her side in the manager's office. She is confused, is diaphoretic, and appears to be bleeding from her vagina. Her blood pressure is low, and her pulse and respiratory rates are elevated. You should: A) administer 100% oxygen, elevate her legs 12 to 18 inches, keep her warm, establish vascular access and give a 500-mL fluid bolus, reassess her blood pressure, and transport at once with continuous monitoring en route to the hospital. B) immediately place her in a supine position, firmly massage her uterine fundus to control the bleeding, establish two large-bore IV lines and run them wide open, transport at once, and apply high-flow oxygen en route to the hospital. C) apply high-flow oxygen, visually inspect her vagina and cover it with sterile dressings, keep her warm, begin transport, establish at least one large-bore IV en route, and administer enough crystalloid fluid to maintain radial pulses. D) assist her ventilations with a bag-mask device, carefully place a trauma dressing inside her vagina to control the bleeding, begin rapid transport, establish two large-bore IV lines en route, and administer 20-mL/kg fluid boluses as needed.

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. This patient MOST likely has: A) syphilis. B) chlamydia. C) gonorrhea. D) pelvic inflammatory disease.

You are dispatched to an apartment complex for a suicide attempt. While you are en route, an on-scene law enforcement officer advises you that the patient, who is unresponsive, ingested an unknown quantity of an unknown drug. Upon arriving at the scene, you should: A) identify what the patient took before providing treatment. B) gain rapid access to the patient and begin your assessment. C) safely gain access to the patient while looking for an egress route. D) ask the police officer to bring the patient to the ambulance.

You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is MOST correct? A) You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg. B) Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure. C) This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking. D) This patient's vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.

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) There is a high potential that the patient will suddenly become violent. B) The patient will require immediate intubation if his respirations decrease. C) The patient may deteriorate and require further naloxone administration. D) Low doses of naloxone often precipitate seizures in chronic heroin abusers.

You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant's abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The MOST appropriate intervention involves: A) intubating immediately. B) suctioning the oropharynx. C) inserting an orogastric tube. D) manual gastric decompression.

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) applying high-flow oxygen via pediatric nonrebreathing mask, assessing his blood glucose level, elevating his legs 12 inches, and transporting at once. B) establishing IV access and administering a 20-mL/kg normal saline bolus, applying high-flow oxygen, administering 25% dextrose, and transporting. C) administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route. 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.

You receive a call to an apartment complex for a patient with an unknown behavioral problem. The scene has been secured by law enforcement prior to your arrival. The patient, a 39-year-old man, appears very anxious and worried. He tells you that he has obsessive-compulsive disorder and stopped taking his prescribed medication a week ago because he did not like its side effects. He tells you that he has had fleeting thoughts of suicide, but denies homicidal thoughts. You should: A) tell him that stopping his medications abruptly could result in death. B) transport him to the hospital and ask a police officer to accompany you. C) safely transport him to the hospital and monitor his behavior en route. D) make contact with his psychiatrist to apprise him or her of the situation.

You respond to a local motel for a young woman who was sexually assaulted. Upon your arrival, you find the patient sitting on the bed talking to a police officer. The last thing she remembers is meeting "some guy" at a nightclub the evening before and then having a few drinks with him. She is conscious, but sleepy. Her respirations are 12 breaths/min and regular, pulse rate is 56 beats/min and strong, and blood pressure is 102/58 mm Hg. The cardiac monitor reveals sinus bradycardia at 50 to 60 beats/min. You should: A) assist her ventilations with a bag-mask device, start an IV line, administer 0.5 mg of atropine, and transport. B) give her supplemental oxygen, conduct a secondary assessment at the scene to collect evidence, and transport her. C) administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital. D) conclude that she was unknowingly administered a narcotic analgesic, start an IV line, and give her 2 mg of naloxone.

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) recall that do not resuscitate orders are invalid in the prehospital setting and be prepared to provide full ACLS. C) provide supportive care, administer narcotic analgesia as indicated, and transport the patient to the hospital. D) accept the stipulations of the do not resuscitate order, obtain a signed refusal from the wife, and return to service.

You would MOST likely encounter a child with a tracheostomy tube breathing spontaneously on room air if: A) he or she has a brainstem abnormality that affects the respiratory drive. B) the tracheostomy tube was placed because of a congenital airway anomaly. C) the purpose of the tube is to bypass a mechanical upper airway obstruction. D) a self-limiting condition necessitated placement of the tracheostomy tube.

You would MOST likely encounter the presence of a ventricular assist device in a patient who: A) has severe emphysema. B) has pulmonary hypertension. C) is awaiting a heart transplant. D) has transient right heart failure.

You would expect a person to be hypertensive and tachycardic following exposure to all of the following, EXCEPT: A) cocaine. B) parathion. C) phenobarbital. D) pseudoephedrine.

Your FIRST priority when dealing with a patient who may have overdosed is to: A) ascertain what the patient took. B) enter the scene carefully. C) request law enforcement. D) assess the patient's airway.

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 98/58 mm Hg, pulse rate is 108 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to bringing the fetus to the hospital for inspection, the MOST appropriate treatment for this patient involves: A) 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. 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) 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. D) 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.

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) ask your partner to insert an IO catheter and administer epinephrine 1:10,000. B) attempt immediate transcutaneous pacing while continuing ventilation assistance. C) establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate. D) initiate one-rescuer CPR while your partner attempts to establish vascular access.

A 50-year-old woman called 9-1-1 after she was suddenly awakened in the middle of the night with the feeling that she was being smothered. Your assessment reveals that she is clearly anxious, is trembling, and complains of chest pain and numbness and tingling to her face and hands. Her blood pressure is 168/96 mm Hg, pulse rate is 140 beats/min, and respirations are 30 breaths/min. Her medications include Xanax, Lipitor, and Vasotec. The MOST appropriate treatment for this patient includes: A) applying a nonrebreathing mask with the flow rate set at 2 L/min, assessing her blood glucose level, administering diazepam for sedation, and transporting her without lights and siren. B) attempting to regulate her breathing by asking her to hold her breath, assessing her end-tidal carbon dioxide level, administering 1 µg/kg of fentanyl IM for sedation, and transporting. C) applying a cardiac monitor, establishing vascular access and administering adenosine, administering oxygen via nasal cannula, considering a beta adrenergic antagonist to lower her blood pressure, and transporting. D) coaching her to slow her breathing, monitoring her oxygen saturation and end-tidal carbon dioxide levels, administering supplemental oxygen, assessing her cardiac rhythm, establishing vascular access, and transporting.

A young child with marked respiratory distress who is agitated and thrashing about should receive oxygen via: A) nonrebreathing mask because agitation indicates cerebral ischemia. B) the blow-by technique while he or she sits on the lap of a caregiver. C) positive-pressure ventilation after he or she has been properly sedated. D) a method that minimizes metabolic demand and oxygen consumption.

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should be MOST suspicious that this patient has a(n): A) poorly healed diabetic ulcer. B) local reaction to an ant bite. C) infection caused by a tick. D) brown recluse spider bite.

A 69-year-old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he has an odd odor on his breath; however, he denies being diabetic. You should: A) start an IV line of normal saline and administer 10 mL of a 10% solution of calcium chloride. B) administer 1 to 2 g of pralidoxime infused with normal saline solution over a 5- to 10-minute period. C) start an IV line, sedate and chemically paralyze the patient, and then perform endotracheal intubation. D) have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

A child who is disinterested in your presence and has a blank stare and poor muscle tone: A) is likely hypoglycemic or in septic shock. B) should be ventilated with a bag-mask device. C) will most likely require pharmacologic support. D) requires immediate intervention and transport.

A common cause of hearing loss in the elderly is presbycusis, which is defined as: A) a progressive loss of hearing, particularly in the low frequencies, which explains why their television is turned up. B) an acute hearing impairment caused by idiopathic rupture of the tympanic membrane in the middle part of the ear. C) a degenerative condition in which the person experiences difficulty hearing both low and high frequency sounds. D) loss of high-frequency sounds and the inability to differentiate a particular sound from background noise.

A deeply frostbitten extremity: A) is typically bright red and painful. B) usually heals well with rewarming. C) requires amputation due to gangrene. D) is cold, hard, and without sensation.

A delay in clamping the umbilical cord and keeping the baby below the level of the placenta can result in fetal: A) anemia. B) hypovolemia. C) exsanguination. D) polycythemia.

A dialysis patient requires pharmacologically assisted intubation. Which of the following medications should be avoided? A) Midazolam B) Etomidate C) Vecuronium D) Succinylcholine

A hallmark sign of mania is: A) speech retardation. B) persistent insomnia. C) memory distortion. D) marked hyperactivity.

A health care worker's fear of contracting a communicable disease is MOST often the result of: A) obsessive-compulsive disorder. B) statistics published by the media. C) a prior history of disease exposure. D) a lack of proper education and training.

A man stormed into a daycare center and opened fire with a semiautomatic rifle. The scene has been secured by law enforcement, and you are in the process of triaging the injured children. The first child you assess, a 4-year-old boy, is unresponsive and apneic but has a pulse. After manually opening his airway, he remains apneic. You should: A) consider him nonsalvageable and place a black tag on him. B) assist his ventilations while closely monitoring his pulse rate. C) categorize him as an immediate patient and continue triaging. D) provide five rescue breaths and reassess his respiratory status.

A newborn is at GREATEST risk for meconium aspiration if he or she: A) is large for his or her gestational age. B) requires positive-pressure ventilations. C) has respiratory depression at the time of birth. D) is born at more than 42 weeks' gestation.

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

A patient who is confused: A) cannot recall the events that preceded his or her illness. B) should be given 50% dextrose to rule out hypoglycemia. C) can usually be redirected by providing emotional support. D) has an impaired understanding of his or her surroundings.

A patient with diabetes would MOST likely experience heat loss secondary to: A) insulin use. B) ketoacidosis. C) acute hyperglycemia. D) peripheral neuropathy.

A person is able to hear, but is unable to interpret speech when other background noises are present. This is consistent with: A) auditory neuropathy. B) conductive hearing loss. C) sensorineural hearing loss. D) central auditory processing disorder.

A person with TB infection: A) poses a significant health risk to others. B) has active TB and is highly contagious. C) usually has a negative chest radiograph. D) has tested positive for exposure to TB.

A pregnant woman with a past history of a cesarean section is at GREATEST risk for: A) breech birth. B) preeclampsia. C) prolapsed cord. D) uterine rupture.

A primagravida woman: A) has had one abortion. B) has delivered one baby. C) will deliver her second baby. D) is pregnant for the first time.

A therapeutic dose of Valium simply relaxes one person, but causes severe central nervous system depression in another patient. This is an example of: A) synergism. B) potentiation. C) hypersensitivity. D) an idiosyncrasy.

A young man is found unresponsive by his girlfriend. Your assessment reveals marked respiratory depression; a slow, weak pulse; and pinpoint pupils. There are numerous medication bottles found in his home. Of these, he has MOST likely ingested: A) Valium. B) Sudafed. C) Benadryl. D) Percodan.

A(n) ___ orogastric or nasogastric tube would the MOST appropriate size for a 4-year-old child. A) 4F B) 6F C) 8F D) 10F

Accelerated thinking in which the mind skips very rapidly from one thought to the next is called: A) confabulation. B) circumstantial thinking. C) perseveration. D) flight of ideas.

According to Part G of the Ryan White Comprehensive AIDS Resources Emergency Act, medical facilities are required to notify emergency responders of potentially infectious diseases involving patients they transported no longer than ___ hours from the time they have a suspect case. A) 6 B) 12 C) 24 D) 48

Acquired immunodeficiency syndrome: A) occurs in as many as 85% of HIV-infected individuals. B) exists when T-helper lymphocytes are dangerously high. C) most often occurs within 5 to 10 years of HIV infection. D) is characterized by the presence of opportunistic infections.

After delivering a baby and clamping and cutting the umbilical cord, you note that the end of the umbilical cord attached to the baby is bleeding. You should: A) cannulate the baby's umbilical vein and infuse normal saline. B) cut the cord proximal to the first clamp and apply another clamp. C) pinch the distal end of the cord with your finger and assess the baby. D) tie or clamp the cord proximal to the first clamp and reexamine it.

After falls, _______________ is/are the second leading cause of accidental death among elderly people. A) thermal burns B) drug interactions C) submersion injury D) motor vehicle accidents

After inserting an orogastric tube in a newborn, you should: A) leave the 20-mL syringe attached. B) perform intubation within 2 minutes. C) connect the tube to continuous suction. D) leave the tube open to allow air to vent.

An acute dystonic reaction is characterized by: A) a sudden catatonic state that results from oversedation with drugs such as Zyprexa and Mellaril. B) intermittent explosive behavior after a person suddenly stops taking medications for schizophrenia. C) dry mouth, blurred vision, and cardiac dysrhythmias following treatment with a neuroleptic drug. D) muscle spasms of the neck, face, and back within a few days of starting treatment with an antipsychotic drug.

An alteration in one's perception of reality is MOST characteristic of: A) depersonalization. B) posttraumatic stress. C) a histrionic personality. D) a dissociative disorder.

An elderly person is at increased risk for aspiration, primarily from: A) atrophy of the epiglottis. B) a decreased ability to swallow. C) slowing of the ciliary mechanisms. D) decreased cough and gag reflexes.

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.

An unresponsive middle-aged man ingested a half-full bottle of Valium approximately 20 minutes ago. His respirations are slow and shallow, his pulse is slow and weak, and his blood pressure is significantly low. The cardiac monitor reveals sinus bradycardia. You should: A) insert a Combitube, establish vascular access, administer up to 4 liters of normal saline, and give him 0.1 mg/kg of naloxone. B) administer oxygen via nonrebreathing mask, start an IV line, and give 150 mg of amiodarone to prevent lethal ventricular dysrhythmias. C) immediately intubate his trachea, hyperventilate him to minimize acidosis, establish vascular access, and administer up to 10 mg of flumazenil. D) assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

An unresponsive woman with diabetes is wearing an insulin pump. Her blood glucose level is 24 mg/dL. You should: A) give a 20-mL/kg crystalloid bolus. B) administer 0.1 mg of glucagon IM. C) give her half the usual dose of dextrose. D) ensure that the insulin pump is turned off.

Any patient who is experiencing a panic attack: A) should rebreathe his or her carbon dioxide from a paper bag. B) must be given high-flow oxygen with a nonrebreathing mask. C) should be presumed to have experienced a recent stressful event. D) should be evaluated to rule out an underlying medical condition.

Appropriate bag-mask ventilation for an apneic 3-year-old child involves: A) ensuring a consistently delivered tidal volume of 400 mL. B) providing hyperventilation to ensure carbon dioxide elimination. C) hyperextending the head to ensure an adequate mask-to-face seal. D) delivering each breath over 1 second until the chest rises visibly.

Appropriate care for postpartum bleeding in the prehospital setting includes all of the following, EXCEPT: A) infusing oxytocin at a rate of 0.2-0.3 units/min. B) massaging the uterus in a clockwise fashion. C) administering IV fluids to maintain perfusion. D) carefully placing sanitary pads in the vagina.

Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for: A) nitrogen narcosis. B) a tension pneumothorax. C) decompression sickness. D) an arterial gas embolism.

Approximately 70% of all child abuse or neglect cases involve: A) females over 8 years of age. B) an otherwise healthy child. C) males under 6 years of age. D) substance abuse by the perpetrator.

Assumptions by the paramedic based on stereotypes of a particular communicable disease: A) will maximize the paramedic's safety. B) are a violation of the patient's privacy. C) will expose the paramedic to legal action. D) serve only to undermine patient care efforts.

At a minimum, you should be able to assess an emotionally disturbed patient's: A) ability to recall. B) blood pressure. C) blood sugar level. D) general appearance.

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

By the end of week ____ of gestation, a woman's diastolic blood pressure should return to its prepregnancy level. A) 30 B) 32 C) 34 D) 36

Carboxyhemoglobin: A) is a combination of oxygen and hemoglobin. B) effectively carries oxygen to the body's cells. C) is the chemical by-product of cyanide poisoning. D) is hemoglobin combined with carbon monoxide.

Cardiopulmonary arrest in the pediatric patient: A) usually presents with pulseless electrical activity. B) requires high epinephrine doses. C) typically requires defibrillation. D) is most often a secondary event.

Children between 1 and 3 years of age: A) are capable of basic reasoning. B) have a well-developed sense of cause and effect. C) generally explore the world exclusively by crawling. D) may have negative associations with health care providers.

Classic heatstroke: A) is also called active heatstroke and is usually seen in diabetics. B) presents with a high core body temperature and profuse sweating. C) affects young people and is often accompanied by hypoglycemia. D) typically affects older people and is not associated with exertion.

Clinical signs and symptoms following exposure to a toxin will manifest MOST rapidly if the patient: A) is older than 70 years of age. B) ingests a large quantity of toxin. C) breathes in the toxic chemical. D) is exposed by the injection route.

Common complications associated with cerebral palsy include all of the following, EXCEPT: A) seizures. B) visual impairment. C) mental retardation. D) cardiovascular disease.

Common signs and symptoms of gardnerella vaginitis include: A) high fever, polymenorrhea, dysuria, and pain during sex. B) a thick vaginal discharge, abdominal pain, and vaginal irritation. C) low-grade fever, itching, vaginal bleeding, and abdominal pain. D) a "fishy" vaginal odor, itching, irritation, and vaginal discharge.

Compared to adults, the smaller diameter of a child's airway makes it more vulnerable to: A) laryngospasm. B) inhalation injury. C) oropharyngeal secretions. D) obstruction by the tongue.

Components of the environmental assessment of an elderly patient include all of the following, EXCEPT: A) assessing for the odor of urine or feces. B) looking for rotted floors or faulty wiring. C) ensuring that food is adequate and unspoiled. D) inquiring about any delays in obtaining food.

Cyanide blocks the utilization of oxygen at the cellular level by: A) binding to monoamine oxidase. B) directly destroying red blood cells. C) binding to the hemoglobin molecule. D) combining with cytochrome oxidase.

Dilated cardiomyopathy is a condition in which the heart is: A) deprived of oxygen due to sudden coronary vasospasm. B) unusually thick and must pump harder to eject blood. C) temporarily impaired by an isolated bacterial infection. D) weakened and enlarged, making it a less efficient pump.

Ductal-dependent congenital heart defects typically present with __________ in the neonatal period. A) hypertension B) low-grade fever C) hyperirritability D) respiratory distress

During an incident involving an explosion, you determine that two critically injured patients should be transported to a trauma center by air. After stabilizing the patients' conditions to the best of your ability, you should: A) call the receiving trauma center and update them on the patients' conditions. B) contact the incident commander and request permission to utilize air transport. C) request air transport immediately and determine where you will land the helicopter. D) notify the transportation supervisor and request that he or she establish a landing zone.

During saturation diving: A) the diver uses no equipment except a snorkel. B) a self-contained underwater breathing apparatus is used. C) air is piped to the diver through a tube from the surface. D) the diver remains at depth for prolonged periods of time.

During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment of the newborn reveals that it is active, has a strong cry, and has a heart rate of 110 beats/min. You should: A) deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator. B) avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an ET tube. C) preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation. D) ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

During the second stage of labor: A) amniotic fluid typically gushes out of the vagina. B) the baby's head begins to bulge through the cervix. C) delivery in a multiparous woman occurs in a few hours. D) contractions become more intense and more frequent.

During transport of a newborn, timely intervention of acute deterioration is MOST effectively achieved by: A) ensuring placement of at least one IV line. B) reassessing vital signs every 5 to 10 minutes. C) cardiac monitoring and the use of capnography. D) ongoing observation and frequent reassessment.

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) avoid any form of positive-pressure ventilation, as this may cause barotrauma and a pneumothorax. B) stabilize her fractured ribs with bulky dressings and administer high-flow oxygen via nonrebreathing mask. C) immediately secure her airway with an endotracheal tube because she is at increased risk for aspiration. D) assist her ventilations with a bag-mask device, delivering just enough volume to produce visible chest rise.

During your assessment of a patient with paraplegia, you touch the patient's leg and he screams in pain. This is an example of: A) parasthesias. B) hypoplasia. C) hyperplasia. D) hyperasthesia.

During your assessment of an unresponsive 70-year-old man, the patient's wife tells you that he takes Luvox and BuSpar, among other medications. From this limited information, you should conclude that the patient suffers from: A) bipolar disorder. B) paranoid schizophrenia. C) chronic manic behavior. D) depression and anxiety.

Dysmenorrhea that occurs before, during, and after menstrual flow: A) affects about 80% of women. B) is called primary dysmenorrhea. C) is generally hormonal in nature. D) may signal an underlying illness.

Early signs of MAOI overdose include all of the following, EXCEPT: A) nystagmus. B) tachycardia. C) hyperactivity. D) hypoventilation.

Etomidate should be avoided as an induction agent in pediatric intubation in the presence of: A) hypovolemia. B) tachycardia. C) hypotension. D) septic shock.

Exposure to sarin or tabun would result in: A) hyperthermia. B) pupillary dilation. C) severe tachycardia. D) excessive lacrimation.

Failure of the heart's primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in: A) junctional rhythms. B) atrioventricular block. C) ventricular ectopy. D) atrial fibrillation.

Fertilization of an egg usually occurs in the: A) ovary. B) uterus. C) infundibulum. D) fallopian tube.

Following a significant exposure, the source patient is routinely tested for all of the following, EXCEPT: A) HIV. B) HCV antibody. C) HBV antigen. D) HBV antibody.

Following retirement, many older people: A) experience a rapid decline in their underlying health and become incapacitated within 12 months. B) often experience an improvement in their overall health because the stress of working has been eliminated. C) return to work within 6 months because their retirement pension does not support them adequately. D) commonly experience decreased self-esteem because they no longer feel useful or productive in society.

Gamma-hydroxybutyrate is MOST commonly used to: A) induce euphoria. B) enhance the senses. C) treat chronic coughing. D) facilitate sexual assault.

Hepatitis B is also referred to as: A) CSF hepatitis. B) fecal hepatitis. C) enteral hepatitis. D) serum hepatitis.

Herbal preparations would MOST likely cause an induced abortion by: A) precipitating premature labor and the delivery of a nonviable fetus. B) causing premature separation of the placenta from the uterine wall. C) causing a fetal intracranial hemorrhage due to severe vasoconstriction. D) making the uterus and bloodstream too toxic for the fetus to survive.

Hydramnios is a condition in which: A) the amniotic fluid is infected. B) there is too little amniotic fluid. C) the amniotic sac has not ruptured. D) there is too much amniotic fluid.

Identified risk factors associated with sudden infant death syndrome include all of the following, EXCEPT: A) low birth weight. B) young maternal age. C) exposure to tobacco smoke. D) sleeping in a supine position.

If a 17-year-old woman with a gynecologic problem answers your question, "Is there any possibility that you are pregnant?" with a firm "No way!" you should: A) document the response and continue your assessment. B) assume that she is pregnant and document this thoroughly. C) ask her mother or father about the possibility of pregnancy. D) ask the patient why she is sure that she is not pregnant.

If a child who is wearing a helmet strikes a fixed object on his or her bicycle and flies over the handlebars, you would MOST likely encounter: A) facial fractures with associated brain injury. B) stretching or tearing injuries to the kidneys. C) open or closed fractures of the lower extremities. D) compression injuries to the intra-abdominal organs.

If a pregnant woman is injured and is bleeding severely: A) signs of shock will appear earlier than expected. B) her body will automatically shunt blood to the fetus. C) her blood pressure will fall after a 70% loss of blood. D) blood flow will be diverted away from the uterus.

If a psychotic person's level of consciousness is fluctuating, you should: A) administer 25 g of dextrose. B) immediately assess blood pressure. C) consider administering haloperidol. D) suspect an organic brain syndrome.

If a woman is gravida 3 and para 2: A) she has been pregnant two times. B) she has delivered three babies. C) she has been pregnant five times. D) she has delivered two babies.

If a young female with a known history of gonorrhea presents with abdominal pain, nausea and vomiting, and bleeding between periods: A) you should suspect disseminated gonococcemia. B) one of her ovaries is probably grossly enlarged. C) it is likely that she has an ectopic pregnancy. D) she most likely has pelvic inflammatory disease.

If an infant or small child swallowed a rigid foreign body, he or she would MOST likely experience respiratory distress because: A) a foreign body in the esophagus would cause reflux and aspiration. B) when an infant or child is stressed, he or she tends to swallow a lot of air. C) the feeling of a foreign body in the throat would cause severe anxiety. D) the esophageal foreign body can compress the relatively pliable trachea.

If you are unsure if a patient became hypothermic prior to developing cardiac arrest, you should: A) withhold resuscitation. B) contact medical control. C) transport with BLS only. D) begin resuscitative efforts.

If you feel 13 pulsations in a 6-second time frame, the newborn's heart rate is approximately: A) 30 beats/min. B) 60 beats/min. C) 90 beats/min. D) 130 beats/min.

In addition to an IV dextrose bolus, the MOST important treatment for newborn hypoglycemia is: A) IV fluid boluses. B) assisted ventilation. C) a 25% dextrose infusion. D) proper thermal management.

In anxiety disorders, the dominant moods are: A) anger and agitation. B) confusion and apathy. C) euphoria and elation. D) fear and apprehension.

In contrast to a 30-year-old man, if a 70-year-old were to consume an excessive amount of alcohol: A) he would experience a lower blood alcohol concentration secondary to a decrease in total body water. B) the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug. C) it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver. D) he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

In contrast to an AV fistula, an AV graft: A) is used for patients who are undergoing peritoneal dialysis. B) can be palpated as a pulsating bulge on an upper extremity. C) is typically found on the lower extremity of a dialysis patient. D) creates a raised area beneath the skin that resembles a large vessel.

In contrast to an abruptio placenta, a placenta previa: A) typically presents with tearing abdominal pain. B) is usually caused by maternal abdominal trauma. C) is associated with an absence of fetal heart tones. D) usually presents with painless vaginal bleeding.

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

In contrast to the SAMPLE history of a child with an illness, the SAMPLE history of an injured child should include a specific inquiry regarding: A) routine medication use. B) any known drug allergies. C) any prior hospitalizations. D) his or her last tetanus shot.

In contrast to upper airway emergencies, lower airway emergencies: A) often present with more prominent retractions. B) are generally associated with high-grade fever. C) include laryngotracheobronchitis and diphtheria. D) involve restriction of airflow during exhalation.

In contrast to younger patients, elderly patients: A) present with multiple imaginary complaints when they are ill. B) typically overdramatize their medical problems to get attention. C) are the patient population with the highest rate of hypochondriasis. D) tend not to complain, even when they have legitimate symptoms.

In trauma patients with shock, hypothermia: A) decreases internal hemorrhage. B) enhances the shivering response. C) facilitates the process of hemostasis. D) interferes with the coagulation of blood.

In which of the following situations would a newborn MOST likely experience a seizure? A) Hyperglycemia B) Post-term gestation C) Maternal aspirin use D) 33 weeks' gestation

Initial signs and symptoms of toxic shock syndrome include all of the following, EXCEPT: A) myalgia. B) scleral injection. C) headache and fever. D) cardiac dysrhythmias.

It is MOST pertinent to determine if the symptoms of a diving-related emergency began: A) at the time of water entry. B) before entering the water. C) after the diver surfaced. D) during ascent or descent.

Lithium is MOST commonly used to treat patients with: A) depression. B) schizophrenia. C) chronic anxiety. D) bipolar disorder.

Mental retardation is MOST accurately defined as: A) the inability to provide adequate self-care because of intense emotional abuse during childhood. B) a substandard intelligence quotient secondary to a congenital infection or complications at birth. C) a genetic condition in which the patient is unable to interact normally and acts younger than his or her peers. D) insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate.

Most ingested poisons will cause: A) headache and seizures. B) tremors and weakness. C) salivation and coma. D) nausea and vomiting.

Muscular dystrophy can be defined as a(n): A) autoimmune disease in which the skeletal muscles are rapidly destroyed. B) nonprogressive neuromuscular disorder caused by fetal brain hypoxia. C) birth defect caused by improper development of the fetal neural tube. D) genetic disease that causes a slow, progressive degeneration of muscle fibers.

Occupationally acquired hepatitis C virus infection: A) is not possible because an effective one-series vaccine is available. B) is most commonly contracted via blood exposure to nonintact skin. C) occurs by ingestion of food that is contaminated with infected feces. D) is related to a contaminated needlestick with visible blood on the sharp.

Of the many factors that affect the basil metabolic rate, the MOST important factor is: A) the person's age. B) the person's sex. C) the person's level of activity. D) the person's body surface area.

On the ECG, an Osborne wave can be recognized as: A) a negative deflection that produces a biphasic P wave. B) acute widening of the QRS complex during the R wave. C) an upward slurring at the beginning of the QRS complex. D) a positive deflection immediately after the QRS complex.

Once you suspect that a child may have been abused, you should: A) apprise the caregiver of your suspicions. B) transport the child to the hospital at once. C) question the child in front of the caregiver. D) carefully document what you see and hear.

Organic brain syndrome is a term used to describe a condition in which a person's abnormal behavior is: A) irreversible and cannot be linked to a physical abnormality or the influence of illicit substances. B) caused by premature brain cell deterioration that is progressive and cannot be reversed. C) directly related to an endocrine disturbance that results in the underproduction of key hormones. D) caused by a physical illness or the influence of a substance that interferes with normal cerebral function.

Poisoning with ________________ is MOST often the result of improper food storage or canning. A) Listeria B) Salmonella C) Toxoplasma D) Clostridium botulinum

Postmenopausal women: A) often experience hot flashes and bradycardia. B) tend to experience fewer urinary tract infections. C) are usually over 35 years of age and tend to be obese. D) are more susceptible to atherosclerosis and osteoporosis.

Prehospital treatment for a patient who overdosed on aspirin may include: A) flumazenil. B) an antipyretic. C) calcium chloride. D) sodium bicarbonate.

Prior to replacing an ostomy device in a patient, it is MOST important to: A) ensure that the patient is in a comfortable position. B) wash the area around the stoma with soap and water. C) use sterile technique when opening the new ostomy kit. D) wash your hands and apply personal protective equipment.

Psychomotor abnormalities associated with depression include: A) a flat affect. B) distractibility. C) fatigue and insomnia. D) agitation and pacing.

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

Severely hypothermic newborns may present with sclerema, which is defined as: A) a yellow or orange tint to the white portion of the eyes. B) spontaneous bleeding due to blood-clotting abnormalities. C) an inability to shiver due to an immature immune system. D) hardening of the skin associated with reddening and edema.

Shallow water blackout occurs when: A) voluntary hypoventilation causes a drop in the PaO2. B) cerebral vasodilation causes syncope during ascent. C) a decreasing PaO2 during descent results in syncope. D) a swimmer hyperventilates prior to entering the water.

Side effects of MAOI antidepressants include: A) hypersomnia. B) acute bradycardia. C) suicidal behavior. D) orthostatic hypotension.

Signs and symptoms of HIV infection may include all of the following, EXCEPT: A) acute febrile illness. B) swollen lymph glands. C) malaise and a headache. D) right upper quadrant pain.

Signs and symptoms of depression that last for at least 2 years: A) are typical of major depressive disorder. B) require long-term hospitalization to treat. C) are typically not associated with anxiety. D) are highly suggestive of dysthymic disorder.

Signs and symptoms of marijuana use include all of the following, EXCEPT: A) euphoria. B) drowsiness. C) bloodshot eyes. D) decreased appetite.

Tetralogy of Fallot is a combination of four heart defects, including: A) atrial septal defect. B) coarctation of the aorta. C) tricuspid atresia. D) right ventricular hypertrophy.

The FIRST step in treating a patient with a heat emergency is to: A) ensure that the airway is patent. B) assess the core body temperature. C) employ active cooling measures. D) move the patient to a cooler area.

The MOST appropriate ET tube for a 6-year-old child is: A) 4.0 mm, cuffed. B) 4.5 mm, cuffed. C) 5.0 mm, uncuffed. D) 5.5 mm, uncuffed.

The MOST common and reliable sign of pit viper envenomation is: A) tachycardia within 30 seconds of the bite. B) patient anxiety and a slow, bounding pulse. C) swelling of the tongue and marked hypertension. D) rapidly developing edema around the bite area.

When the outside temperature approaches or exceeds skin surface temperature, heat loss by _________ and _________ diminishes and eventually ceases. A) convection, conduction B) conduction, evaporation C) evaporation, radiation D) radiation, convection

The MOST common risk factor for the development of type 2 diabetes in people over 65 years of age is: A) poor dietary habits and a sedentary lifestyle. B) frequent infections that do not heal properly. C) hypertension of longer than 5 years' duration. D) the presence of more than one chronic disease.

The MOST important aspect in the care of a woman with severe vaginal bleeding is: A) controlling the vaginal bleeding. B) administering crystalloid fluid boluses. C) giving oxygen via nonrebreathing mask. D) treating for shock and transporting rapidly.

The MOST important prehospital intervention for a footling breech or transverse presentation of the baby is: A) maternal vascular access. B) keeping the mother warm. C) delivery of high-flow oxygen. D) rapid transport to the hospital.

The MOST important treatment for a patient experiencing heatstroke involves: A) antipyretic administration and high-flow oxygen. B) rehydration with IV fluids and ice water submersion. C) rapid transport and cooling to the point of shivering. D) removal from the hot environment and rapid cooling.

The correct positive-pressure ventilation rate for an apneic newborn is: A) 12 to 20 breaths/min. B) 20 to 30 breaths/min. C) 30 to 40 breaths/min. D) 40 to 60 breaths/min.

The egg is referred to as a blastocyst when: A) it becomes fertilized with sperm in the lower part of the fallopian tube. B) the placenta has fully formed and has attached to the superior part of the uterus. C) the amniotic sac and placenta begin to differentiate into their specialized duties. D) it has been fertilized and enters the uterus and begins absorbing uterine fluid through the cell membrane.

The emotional state of craving a drug to maintain a feeling of well-being is called: A) addiction. B) habituation. C) physical dependence. D) psychological dependence.

The leading cause of lower respiratory tract infections in infants, older people, and immunocompromised individuals is the: A) rotovirus. B) influenza virus. C) parainfluenza virus. D) respiratory syncytial virus.

The majority of current hemodynamic monitoring involves placement of different types of catheters into areas within the: A) central nervous system. B) brain and spinal cord. C) pulmonary circulation. D) cardiovascular system.

The onset of eclampsia is marked by the presence of: A) hypertension. B) protein in the urine. C) thrombocytopenia. D) generalized seizures.

The onset of fever commonly occurs as early as ___ days following exposure to the measles. A) 2 B) 3 C) 5 D) 7

The poisonous part of the apricot plant is/are the _______, which contain(s) _______. A) leaves, iron B) root, tyramine C) bulb, oxalic acid D) seed, cyanide

The primary source of heat production in the newborn is: A) shivering. B) hyperventilation. C) peripheral vasoconstriction. D) nonshivering thermogenesis.

The recommended IV dose and concentration of epinephrine for the newborn is: A) 0.01 mg/kg, 1:1,000. B) 0.3 to 1 mL/kg, 1:10,000. C) 0.01 to 0.03 mg/kg, 1:1,000. D) 0.1 to 0.3 mL/kg, 1:10,000.

The recommended dose and method for administering naloxone to a patient who overdosed on a narcotic and is unresponsive and hypoventilating is: A) 0.1 mg/kg rapidly until the patient's respirations improve. B) 0.4 to 2 mg rapidly until the patient regains consciousness. C) 5 to 10 mg via the endotracheal tube until the pupils dilate. D) 2 mg injected slowly until the patient's respirations improve.

The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to: A) constipation. B) cholelithiasis. C) mesenteric ischemia. D) peptic ulcer disease.

The risk of newborn complications is HIGHEST if the amniotic sac: A) encases the baby's face at birth. B) is still intact at the time of birth. C) contains thin, brown amniotic fluid. D) ruptured more than 18 hours before birth.

The use of lorazepam for seizures in the prehospital setting is limited by its: A) short half-life. B) slow onset of action. C) long duration of action. D) refrigeration requirement.

Triple lumen central catheters are usually placed in the: A) external jugular vein. B) internal carotid artery. C) antecubital vein in the arm. D) subclavian or femoral vein.

Unlike the prenatal period, the gestational period: A) begins at conception. B) only last about 2 weeks. C) usually takes 40 weeks. D) is 38 weeks in duration.

Upon arriving at the scene of a 4-year-old boy with respiratory distress, you enter the residence and see the child, who is conscious, sitting on his father's lap. The father is aware of your presence, but the child is not. Your initial action should be to: A) make physical contact with the child as soon as possible in order to identify any life threats. B) allow the father to carry his son to the ambulance, where you can perform an initial assessment. C) quickly build good rapport with the child by picking him up and asking him what his name is. D) visually assess the child from across the room for any signs of increased work of breathing.

Upon arriving at the scene of a major incident, you can clearly see that there are numerous patients, some of whom are receiving care and others of whom are walking around unattended. Your MOST appropriate action should be to: A) immediately triage the unattended patients. B) move the walking patients to a separate area. C) notify dispatch and request air medical transport. D) report to the staging area for further instructions.

Ventricular shunts are typically placed in children who: A) are born with a congenital condition in which the ventricles of the brain produce excessive amounts of cerebrospinal fluid. B) have experienced a severe traumatic brain injury that results in chronic cerebral edema and increased intracranial pressure. C) are born with an abnormally small brain, which results in a relative increase in the amount of circulating cerebrospinal fluid. D) have impaired circulation and absorption of cerebrospinal fluid, leading to increased size of the ventricles of the brain and increased intracranial pressure.

What is a lethal dose of ethylene glycol in a 190-pound man? A) 50 mL B) 120 mL C) 150 mL D) 175 mL

What is the corpus luteum? A) The by-product of the release of progesterone B) The thickened inner lining of the uterine wall C) A hormone that is excreted throughout the ovarian cycle D) Remnants of the follicle after the egg has been released

What should you do prior to inserting an indwelling urinary catheter if a home health care patient has sensation in the penile area? A) Inject 10 mL of lidocaine into the urethra. B) Administer a mild sedative prior to catheterization. C) Minimize any pain by allowing the patient to sit up. D) Coat the end of the catheter with an anesthetic gel.

When a disease infects large numbers of people and spreads all over the world, it is considered a(n): A) endemic. B) epidemic. C) outbreak. D) pandemic.

When asking an emotionally disturbed patient a series of questions, you should: A) keep your questions as indirect as you possibly can. B) simplify the process by asking closed-ended questions. C) try to ask questions that can be answered with a yes or no. D) use words such as "how" and "what" whenever possible.

When assessing and caring for a 17-year-old gang member, it is MOST important to remember that he or she: A) must be separated from other gang members. B) generally desires the presence of a caregiver. C) typically boasts about the use of illicit drugs. D) may have a weapon and a reputation to earn.

When caring for a patient with suspected abuse or neglect, your FIRST priority should be to: A) summon law enforcement personnel to the scene. B) provide an immediate assessment of the patient. C) remove the patient from the abusive environment. D) take deliberate action to ensure your own safety.

When caring for an infant or child who is in compensated shock, you should: A) intubate at the earliest sign of altered mentation. B) administer a 10-mL/kg normal saline fluid bolus. C) assist ventilations to improve tissue oxygenation. D) establish IV or IO access en route to the hospital.

When caring for an unresponsive patient with a toxicologic emergency, you should: A) intubate at once, obtain baseline vital signs, transport immediately, and perform all other interventions en route to the hospital. B) administer high-flow oxygen, perform a detailed secondary assessment, obtain vital signs, and transport to the closest 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.

When chlorine gas comes in contact with the body's mucous membranes, it forms: A) boric acid. B) a strong alkali. C) sulfuric acid. D) hydrochloric acid.

When dispatched to a residence for an injury involving a pregnant woman, you should: A) contact medical control. B) quickly access the patient. C) request a backup ambulance. D) be alert for evidence of abuse.

When frozen tissues thaw slowly: A) the risk of gangrene and subsequent amputation is much lower. B) the resultant ice crystals are smaller in size and cause less damage. C) the injured area becomes flushed or pale, but is relatively painless. D) partial refreezing of melted water may cause greater tissue damage.

When preparing to intubate a small child, it is important to remember that: A) the small child's epiglottis is very rigid. B) prolonged attempts often cause tachycardia. C) you should hyperventilate before intubating. D) small children have a relatively large occiput.

Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity? A) Narrowing of the PR interval B) Marked flattening of the T wave C) Narrowing of the QRS complex D) Prolongation of the QT interval

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

Which of the following behaviors or actions should make you the MOST suspicious that a caregiver has abused his or her child? A) Asking other siblings to leave the room while the child is examined B) Demanding that you take the child to the hospital as soon as possible C) Difficulty recalling the last time the child was seen by a physician D) Offering unsolicited explanations for abnormal physical exam findings

Which of the following cardiac dysrhythmias is associated with the highest risk of stroke? A) AV heart block B) Sinus tachycardia C) Junctional rhythm D) Atrial fibrillation

Which of the following central nervous system functions does NOT change as a person ages? A) Postural stability B) Cognitive speed C) Memory retrieval D) Intelligence level

Which of the following clinical presentations is MOST consistent with cocaine ingestion in a child? A) Diaphoresis, miosis, tachycardia, and bronchospasm B) Miosis, bradycardia, hypoventilation, and hypotension C) Mydriasis, diarrhea, hypothermia, and hallucinations D) Hypertension, tachycardia, diaphoresis, and mydriasis

Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia? A) Pulse rate B) P wave presence C) Systolic blood pressure D) QRS complex width

Which of the following conditions, if it remains undetected until puberty, can result in acute pain, severe constipation, and low back pain at the onset of menses? A) Ovarian cyst B) Endometriosis C) Ectopic pregnancy D) Imperforate hymen

Which of the following diseases is bacterial in nature, has an insidious onset, and is characterized by an irritating cough that may become paroxysmal in about 1 to 2 weeks? A) Tetanus B) Bronchitis C) Diphtheria D) Pertussis

Which of the following interventions generally is preferred for a patient who overdosed on a barbiturate more than 1 hour ago? A) Gastric lavage B) Syrup of ipecac C) Urine alkalinization D) Activated charcoal

Which of the following interventions is influenced strongly by the amount of time that has elapsed since a patient ingested a toxic substance? A) Transport B) IV therapy C) Intubation D) Gastric lavage

Which of the following is an extrinsic cause of falls in the elderly? A) Postural hypotension B) Dizziness or syncope C) A pathologic fracture D) An uneven sidewalk

Which of the following is atypical of an alcoholic? A) Drinking early in the day B) Green tongue syndrome C) Memory loss or blackouts D) Chronically pale face and palms

Which of the following is often not acquired during the SAMPLE history of an adult, but should be routinely acquired in an infant or child? A) Prescribed medications B) Nature of symptoms C) Preceding events D) Immunizations

Which of the following is the MOST appropriate dose of activated charcoal for a 45-pound child? A) 5 g B) 10 g C) 15 g D) 20 g

Which of the following locations would provide the BEST protection from a lightning strike? A) An open shed or lean-to B) A spot at least 5 miles away from the storm C) Curled up in a ball in an open area D) A car with the windows rolled up

Which of the following medical procedures would pose the LEAST risk of exposure to an infectious disease? A) Administering a subcutaneous injection B) Covering a wound that is bleeding minimally C) Delivering the baby of an HIV-negative mother D) Assessing a patient's temperature by the oral route

Which of the following medications would be the LEAST likely to increase a person's risk for a heat-related illness? A) Diuretics B) Beta blockers C) Antihistamines D) Alpha antagonists

Which of the following questions would be the MOST appropriate initial question to ask when broaching the subject of suicide with a depressed patient? A) "Did you ever feel that you'd be better off dead?" B) "Have you ever thought of causing harm to yourself?" C) "Do you have the means to carry out a suicide attempt?" D) "Have you ever thought that life wasn't worth living?"

Which of the following statements regarding Rh disease during pregnancy is correct? A) Isoimmunization occurs when an Rh-positive woman becomes pregnant by an Rh-negative man. B) Rh disease is a problem during the first pregnancy and occurs when the mother's blood is Rh positive. C) If the fetus inherits Rh-positive blood, it will create antibodies that can result in maternal hemolysis. D) During subsequent pregnancies, the Rh antibody will cross the placental barrier and attack the fetal red blood cells.

Which of the following statements regarding West Nile virus (WNV) is correct? A) It is estimated that approximately 20% to 30% of mosquitoes carry WNV. B) The incubation period for WNV is 3 to 14 days following the bite of an infected tick. C) Up to 80% of people infected with WNV experience a severe headache, body rash, and fever. D) There is no period of communicability because WNV is not transmitted from person to person.

Which of the following statements regarding acrocyanosis is correct? A) Acrocyanosis is seen in the skin and mucous membranes and is a late finding if respiratory failure or shock is present. B) Acrocyanosis is only considered to be a normal finding in newborns and usually resolves within 12 hours following birth. C) Acrocyanosis is a bluish discoloration of the chest, abdomen, and face and is the most extreme visual indicator of poor perfusion. D) Acrocyanosis is cyanosis of the hands and feet, and is a normal finding in infants younger than 2 months of age who are cold.

Which of the following statements regarding bronchiolitis is correct? A) Infants who were born past 42 weeks are at highest risk for respiratory failure and arrest secondary to bronchiolitis. B) The pathophysiology of bronchiolitis is acute bronchospasm secondary to a bacterium that enters the lower respiratory tract. C) Bronchiolitis is usually caused by the metapneumovirus and occurs with greatest frequency during late spring and early summer. D) Bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age.

Which of the following statements regarding croup is correct? A) Croup is also referred to as acute bacterial subglottic stenosis. B) Hallmark signs of croup include high fever and a sore throat. C) Most cases of croup result in severe hypoxia and hypercarbia. D) Croup is a viral upper airway infection that may cause stridor.

Which of the following statements regarding ectopic pregnancy is MOST correct? A) Ectopic pregnancy occurs when a fertilized egg implants in a fallopian tube. B) Most ectopic pregnancies present with symptoms during the second trimester. C) Use of an intrauterine device is the most common cause of an ectopic pregnancy. D) In ectopic pregnancy, a fertilized egg implants somewhere other than the uterus.

Which of the following statements regarding genital herpes is MOST correct? A) The lesions of genital herpes remain infectious for 12 to 24 days. 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) Acyclovir is used to reduce a herpetic outbreak, but there is no cure.

Which of the following statements regarding thermoregulation is correct? A) Thermogenesis is how the human body eliminates excess heat in order to maintain homeostasis. B) At a constant temperature of 97.6°F, the metabolic reactions of the body proceed at their optimal level. C) Temperature of the brain and thoracoabdominal organs varies widely, depending on the body's needs. D) Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation.

Which of the following steps of caring for a patient with a psychiatric emergency would MOST likely give the patient the feeling that something is being done to help? A) Asking direct questions B) Encouraging the patient to talk C) Remaining calm and confident D) Developing a definite plan

While assessing a 59-year-old man with an acute onset of crushing chest pain and diaphoresis, the patient tells you that he recently tested positive to a tuberculin skin test. His vital signs reveal hypertension and tachycardia. You should be MOST concerned with: A) applying a mask to the patient to reduce your chance of exposure. B) reporting this to your supervisor and receiving a tuberculin skin test. C) establishing vascular access and rapidly transporting to the hospital. D) the fact that he may be experiencing an acute myocardial infarction.

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) begin bag-mask ventilations to improve her low tidal volume. C) provide free-flow oxygen as you nasotracheally intubate her. D) manually maneuver her head and reassess her breathing status.

With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once: A) he or she reaches the age of 8 to 10 years. B) resting vital signs are consistent with an adult. C) his or her body weight is estimated at 55 pounds. D) secondary sexual characteristics have developed.

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) cannulate the umbilical vein and give 0.5 mL of epinephrine. B) try tactile stimulation as you continue bag-mask ventilations. C) start a peripheral IV line and give 4 mEq of sodium bicarbonate. D) continue bag-mask ventilations and initiate chest compressions.

You and your partner are transferring a 76-year-old woman from a local nursing facility to the emergency department for evaluation of an acute onset of fever. While reviewing the transfer record, you note that the patient was recently treated with daptomycin. This patient MOST likely has: A) vancomycin-resistant enterococci. B) hemorrhagic fever caused by hantavirus. C) an infection caused by the hepatitis A virus. D) methicillin-resistant staphylococcus aureus.

You and your partner arrive at the scene shortly after a 2-year-old child experienced an apparent seizure. The child's father tells you that his son's entire body began shaking and that the episode lasted less than 5 minutes. Your assessment of the child reveals that he is conscious, is crying, and has hot, moist skin. His heart rate is 160 beats/min, and his respirations are 40 breaths/min. You should: A) advise the father to take his son to see a pediatrician the following day. B) cool the child with tepid water, administer high-flow oxygen, and transport. C) establish vascular access, give a 20-mL/kg saline bolus, and transport him. D) keep the child cool and transport him to the hospital for physician evaluation.

You are assessing a patient and discover that he has a ventricular assist device because of severe left heart failure. In this case, the device is MOST likely connected to the: A) left atrium. B) right atrium. C) right ventricle. D) left ventricle.

You are assessing an 80-year-old man who complains of generalized weakness. He denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days. His medical history is significant for two prior heart attacks, hypertension, chronic renal insufficiency, and atrial fibrillation. His blood pressure is 108/60 mm Hg, pulse rate is 94 beats/min and irregular, and respirations are 20 breaths/min and unlabored. Auscultation of his lungs reveals scattered crackles, and the ECG reveals atrial fibrillation. In addition to administering supplemental oxygen, you should: A) start an IV with D5W, assess his blood glucose level, and administer half the usual dose of diltiazem to lower the rate of his atrial fibrillation. B) obtain a 12-lead ECG tracing, start an IV line with normal saline and give a 250-mL fluid bolus, reassess his blood pressure, and transport him. C) establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport. D) obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport to the hospital.

You are called to a residence for a ventilator-dependent child with respiratory distress. Upon your arrival, the child's mother tells you that the child was doing fine, but then suddenly began experiencing labored breathing. She further tells you that the child's home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. Your FIRST action should be to: A) suction the child's tracheostomy tube to rule out secretions as the problem. B) assess the patency of the tracheostomy tube to determine if it is dislodged. C) remove the tracheostomy tube and replace it with a similar-sized ET tube. D) disconnect the child from the ventilator and begin bag-mask ventilations.

You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and a patent IV line is in place. During transport, you reassess her and note that she has become diaphoretic, tachycardic, and tachypneic. You should: A) reassess her blood pressure. B) administer a rapid fluid bolus. C) cover her with warm blankets. D) tilt the backboard to the left side.

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) IV fluid boluses B) Thermal management C) Cardiac monitoring D) Narcotic analgesia

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) apply oxygen via pediatric nonrebreathing mask and attach a pulse oximeter. 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) begin assisting her ventilations with a bag-mask device and assess her pulse rate.

You are dispatched to a residence for an "ill person." Upon arrival, you enter the residence and find the patient, a 72-year-old woman, lying on the couch; she is responsive to pain only. Her son, who arrived shortly before you, tells you that her air conditioner went out, and that he came over to her house to pick her up and found her in her present condition. He further tells you that his mother has diabetes, hypertension, and congestive heart failure. Assessment of the patient reveals that her skin is flushed, hot, and dry; her pulse is rapid and weak; and her blood pressure is low. After moving the patient to the ambulance and applying high-flow oxygen, you should next: A) remove any bulky clothing, assess her temperature, begin active cooling if her temperature is greater than 105°F, and start a large-bore IV with normal saline. B) intubate her to protect her airway, apply chemical ice packs to her trunk area only, start an IV and give a normal saline bolus, and assess her axillary temperature. C) cover her with sheets that are soaked with water, start a large-bore IV and give a 20-mL/kg fluid bolus, and administer 50% dextrose for presumed hypoglycemia. D) strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level.

You arrive at the scene of an unknown drug-related emergency. Law enforcement is present and has ensured scene security. The patient, a young male, is found sitting at the kitchen table. He is laughing uncontrollably and tells you, "Life sure is good!" Your partner finds a basin of water and an empty box of baking soda on the counter. You should be MOST suspicious that this patient: A) is speedballing. B) has injected heroin. C) was snorting cocaine. D) has smoked crack cocaine.

You have just delivered a little girl 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, she remains acrocyanotic and is not crying. You should: A) determine the newborn's Apgar score. B) begin assisting her ventilations at once. C) resuction her mouth for up to 10 seconds. D) open her airway and assess respirations

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) administer high-flow oxygen via pediatric nonrebreathing mask, keep him calm, and transport. B) establish vascular access, give an appropriate dose of methylprednisolone, and transport. C) administer 0.5 mL of racemic epinephrine via nebulizer, apply the cardiac monitor, and transport. D) allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital.

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) overdosed on his Xanax. B) underdosed on his Toprol. C) underdosed on his digoxin. D) overdosed on his warfarin.

You should be MOST suspicious for cardiogenic shock in an infant or child if: A) he or she appears listless or lethargic. B) his or her heart rate varies with activity. C) his or her heart rate is greater than 150 beats/min. D) perfusion decreases following a fluid bolus.

You should be MOST suspicious that a patient has systemic iron toxicity if he or she presents with: A) bradypnea. B) hypertension. C) severe nausea. D) hematemesis.

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

The severity with which a hazardous material interferes with the body's internal processes is LEAST affected by the: A) part of the body exposed. B) route of chemical exposure. C) presence of an underlying illness. D) chemical's dose and concentration.

The ______________ has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. A) logistics chief B) rescue officer C) triage officer D) safety officer

A commercial truck was involved in a wreck and is spilling anhydrous ammonia on the roadway. The incident commander has already established the hot, warm, and cold zones as dictated by the chemical involved. As one of the paramedics at the scene, you should anticipate that your role will MOST likely involve: A) performing triage and treatment in the cold zone. B) assisting with decontamination in the warm zone. C) removing only critical patients from the hot zone. D) evacuating residents who live near the incident.

According to the dose effect principle: A) the greater the length of time or the greater the concentration of the material, the greater the effect will be on the body. B) biotransformation and elimination of a chemical is not possible if the exposure involved a large or concentrated dose. C) the effects of a hazardous material will be more severe if it is ingested rather than inhaled or absorbed through the skin. D) an extremely toxic hazardous material will have the same effect on the body, regardless of the length of the exposure.

After ensuring your own safety, which of the following is your next priority at the scene of a hazardous materials incident? A) Identify the hazardous material involved. B) Immediately move patients to a safe place. C) Evacuate residents within a 3-mile radius. D) Begin decontaminating all involved patients.

As soon as the treatment officer receives patients from the triage section, he or she should: A) perform secondary triage and begin treatment. B) immediately tend to the most critically injured. C) obtain the names and addresses of each patient. D) make radio contact with the transportation officer.

Because extrication and rescue are medically complex: A) the officers responsible for these functions usually function under the EMS branch of the incident command system. B) no lengthy extrication or rescue operation should commence until an emergency physician is present at the scene. C) the position of extrication or rescue officer should always be assumed by an experienced EMT or paramedic. D) anyone who requires extrication or rescue should be triaged and receive basic lifesaving care before being extricated or rescued.

Broadly speaking, the finance section chief is responsible for: A) documenting all expenditures at an incident and seeking reimbursement. B) tracking all personnel overtime and ensuring that they are compensated. C) determining what impact the incident will have on the economy of the affected area. D) predetermining how much a major incident would affect the system's finances.

Command functions include all of the following, EXCEPT the: A) triage officer. B) safety officer. C) liaison officer. D) public information officer.

Cyanide is a chemical asphyxiant, which means that it: A) interferes with the utilization of oxygen at the cellular level. B) impairs pulmonary respiration by causing pulmonary edema. C) destroys red blood cells and prevents red blood cell production. D) binds to hemoglobin and prevents oxygen transport to the cells.

For the purposes of hazardous materials, vapor pressure pertains to: A) any liquids held inside any type of enclosed container. B) any liquid that evaporates quickly when not contained. C) where a vapor might go once released from a container. D) the speed at which a liquid evaporates when not contained.

If a sufficient concentration of a hazardous material mixes with air and reaches its lower flammable limit: A) the material can burn in the air or explode. B) the vapors will begin to burn, but will not explode. C) the chemical is said to have reached its flash point. D) there will not be enough oxygen to support combustion.

If responders at a major incident require additional medical equipment and supplies, they should notify the: A) logistics section. B) planning section. C) operations section. D) liaison officer.

If you are trained in hazardous materials at the awareness level, you should be able to: A) recognize potential hazards and the need for additional resources. B) perform patient care activities in the command and support center. C) coordinate activities at the scene of a hazardous materials incident. D) care for patients who may present a risk of secondary contamination.

If you discover that a seemingly ordinary EMS call is actually a hazardous materials incident, you should: A) immediately notify the dispatcher and request the appropriate resources. B) isolate the incident as much as possible to avoid the risk of harm to others. C) immediately establish a hot zone and cordon it off with red or yellow tape. D) size up the scene, assessing factors such as wind direction and terrain features.

If your unit is the first to arrive at an incident, you should keep yourself safe, size up the scene, and then: A) notify dispatch, identify your unit, apprise dispatch of the situation, and assume command. B) request additional help and then begin triaging patients, treating the most critically injured first. C) immediately contact medical control and request authorization to function as the medical officer. D) quickly categorize all patients according to the severity of their injuries and request additional resources.

Prior to implementing any plans or operations at the scene of a multiple-casualty incident, you should FIRST: A) notify your supervisor or the incident commander. B) make sure the assigned safety officer is present. C) move any unnecessary personnel away from the area. D) acquire the assistance of at least seven other rescuers.

The FIRST step in the START triage system involves: A) directing all the walking wounded to an easily identifiable landmark. B) quickly removing the obviously dead victims to a predesignated area. C) identifying the nonambulatory patients and assessing their breathing. D) obtaining an estimate of the total number of critically injured victims.

The National Incident Management System is designed to: A) prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. B) provide a consistent template to enable state, federal, and local governments to respond safely to any act of terrorism. C) educate state, federal, and local governments, as well as private-sector organizations, to effectively prevent a domestic incident. D) maximize the capabilities of each state in the United States to manage a large-scale disaster effectively, regardless of the cause.

Which of the following events would MOST likely cause an open, or uncontained, multiple-casualty incident? A) Tornado B) Bus wreck C) Small explosion D) Two-car collision

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) CHEMTREC C) Bill of lading D) Emergency Response Guidebook

You should be particularly suspicious that a hazardous materials incident is the result of a terrorist attack when it occurs at a/an: A) government building. B) manufacturing facility. C) agricultural operation. D) educational institution.

_____________ is the process in which individual units or different organizations make independent decisions about the next appropriate action. A) Freelancing B) Sole command C) Unified command D) Effort duplication

A blue placard specifically indicates that a chemical is a _________ hazard. A) fire B) health C) reactivity D) explosive

A single command system is one in which: A) the incident commander assumes all functional roles. B) one person is in charge, even if multiple agencies respond. C) one person is in charge, unless multiple agencies respond. D) one person from each responding agency assumes command.

According to the JumpSTART triage system for pediatric patients, infants or children not developed enough to walk or follow commands should be: A) quickly moved to a designated area of the triage section and monitored closely. B) taken to the treatment sector as soon as possible for immediate secondary triage. C) labeled with a red tag and transported immediately to a pediatric trauma center. D) assigned the same triage category as the walking wounded and evaluated later.

According to the START triage system, if a patient has a strong radial pulse, you should: A) place him or her in the delayed category. B) control bleeding and assess mental status. C) assess his or her ability to follow commands. D) determine whether the pulse rate is slow or fast.

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.

At the scene of a hazardous materials incident, the paramedic would MOST likely be called upon to: A) provide initial decontamination in the warm zone. B) support hazardous materials teams through medical monitoring. C) don a breathing apparatus and rescue contaminated patients. D) provide emergency medical care in the incident's hot zone.

Department of Transportation (DOT) Class 1 chemicals are: A) corrosive. B) explosive. C) combustible. D) radioactive.

During a small-scale incident, the incident commander: A) will likely not respond to the scene. B) may perform all the command functions. C) primarily assumes the role of safety officer. D) delegates all authority to the senior paramedic.

Following exposure to an industrial pesticide, a patient is responsive to pain only, is coughing up copious secretions, and has a heart rate of 40 beats/min. Priority treatment for this patient includes: A) pralidoxime. B) oral suctioning. C) atropine sulfate. D) tracheal intubation.

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

If you are the first unit to arrive at a scene and observe any signs suggesting that a hazardous materials incident has occurred, you should: A) place yellow or red police tape around the danger zone and begin moving bystanders away from the scene. B) remain upwind from the scene if possible and immediately call the hazardous materials response team. C) don gloves, a mask, and a gown and begin moving injured patients away from the area surrounding the incident. D) immediately move any patients to a designated area and begin decontaminating them by dousing them with water.

In contrast to primary triage, secondary triage: A) requires a more rapid assessment. B) is performed in the treatment area. C) is typically performed by a physician. D) involves initial placement of triage tags.

Level A personal protective equipment: A) is designed to protect the rescuer against a known agent and is worn with an air-purifying respirator. B) fully encapsulates the hazardous materials technician, including his or her self-contained breathing apparatus. C) is required when a technician needs protection from splashes and inhaled toxins but does not need to be fully encapsulated. D) provides the same degree of protection as a fire fighter's turnout gear, and is typically worn in the cold zone.

Occlusive dressings and large-bore IV catheters for thoracic decompression are supplies used to address ____________ issues at a multiple-casualty incident. A) disability B) breathing C) circulation D) airway control

Patients showing signs of pulmonary edema secondary to inhalation exposure to a corrosive chemical may need to be treated with: A) glucagon. B) a diuretic. C) an inotrope. D) sodium bicarbonate.

Preparedness in a given area should involve decisions and planning about: A) major disasters, such as tornadoes and earthquakes. B) the most likely disasters for the area, among other disasters. C) international terrorist attacks and catastrophic natural disasters. D) the most common disasters encountered throughout the world.

Systemic effects following exposure to a hazardous material: A) primarily affect the hepatic system. B) may be delayed for hours or even years. C) are typically seen immediately in the field. D) are characterized by erythema and blisters.

The local effects of a hazardous material may present with: A) restlessness. B) blister formation. C) nausea and vomiting. D) blood in the urine.

The primary duty of the triage officer is to: A) quickly remove the deceased from the triage area. B) ensure that every patient receives a primary assessment. C) immediately identify the most critically injured patients. D) evacuate patients to the most appropriate treatment area.

The threshold limit value/ceiling of a chemical is the concentration that: A) a person can be exposed to for 1 hour. B) a person should never be exposed to. C) is only toxic if inhaled into the lungs. D) is nontoxic during short-term exposure.

Triage and emergency medical treatment should be performed: A) in the hot zone. B) in the cold zone. C) in the warm zone. D) at least 100 feet from the incident.

Two MOST important underlying principles of National Incident Management System are: A) compliance and funding. B) flexibility and standardization. C) personnel training and certification. D) interoperability and public awareness.

Using the incident command system provides a modular organizational structure that: A) is overseen by the most experienced paramedic. B) depends on the size and complexity of the incident. C) requires a uniform approach to any major incident. D) remains static in all incidents involving mass casualties.

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

When functioning at the scene of a major incident, communication should: A) incorporate signals for privacy purposes. B) be face to face to minimize radio traffic. C) involve the use of codes to limit air time. D) occur via radio to keep everyone updated.

Where would you MOST likely find a material safety data sheet that provides information about a hazardous material? A) At a tanker truck's destination location B) At a permanent manufacturing or storage facility C) Affixed to the roof of a commercial tanker truck D) In a steel box in the conductor's cabin of a train

Which of the following injuries or conditions should be assigned the HIGHEST triage priority? A) Full-thickness burns B) Respiratory distress C) Cardiopulmonary arrest D) Multiple long bone fractures

Which of the following statements regarding the rehabilitation section is correct? A) Ideally, the rehabilitation section should be located within view of the scene so that responders can return to the incident quickly if they are requested to do so by a section officer. B) In addition to meeting the responders' needs for rest, fluids, and food, the rehabilitation officer must be prepared to conduct a defusing session if a responder shows signs of stress. C) The primary purpose of the rehabilitation section is to conduct brief physical examinations on all responders before they actively engage in functions that are required by the incident. D) Victims of a major incident who are not physically injured should report to the rehabilitation section for food, water, rest, protection from the elements, and psychological support.

Which of the following statements regarding the transport of a hazardous material is correct? A) Federal law requires a truck to display a placard if it contains small amounts of several materials that become highly toxic when combined. B) Even if the law does not require a truck to display a placard, the driver of the truck is required to carry documentation of the chemical being transported. C) A tanker truck that displays a "Please drive carefully" placard is likely not carrying a hazardous material and should be considered safe to approach. D) Any tanker truck or train that carries a hazardous material is required by federal law to display a warning placard, regardless of the quantity it is carrying.

Which of the following statements regarding the unified command system is correct? A) A unified command system is difficult to establish before an incident and is activated when the resources of one agency are significantly overwhelmed. B) In a unified command system, multiple agencies from multiple jurisdictions work together to develop a plan that involves shared responsibilities. C) A unified command system functions optimally if one incident commander from each agency is identified before a multiple-casualty incident actually occurs. D) The response plan developed by a unified command system should focus only on major events such as building collapses, plane crashes, and terrorist attacks.

While en route to a motor vehicle accident, the dispatcher advises you that law enforcement is at the scene and is reporting that numerous bystanders are suddenly becoming ill. After receiving this information, you should: A) ascertain approximately how many patients are involved. B) keep a safe distance from the scene and view it with binoculars. C) advise all law enforcement personnel to evacuate immediately. D) alert area hospitals to prepare them to care for numerous patients.

A multiple-casualty incident is MOST accurately defined as an event in which: A) mutual aid from other agencies is required to care for numerous patients. B) there are at least 25 patients, more than half of whom are critically injured. C) the number of patients exceeds the resources available to the initial responders. D) there are more patients who require advanced life support than patients who do not.

A single command system: A) involves multiple agencies that share the responsibility for management of the incident. B) generally increases an individual's span of control to include as many as 10 to 15 people. C) is one in which a single person is in charge, even if multiple agencies respond to the incident. D) is ideally used for long-duration, complex incidents that require the services of a single agency.

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

After ensuring your own safety, you should consider the safety of, in order: A) your partner, the patient, other rescuers, and any bystanders. B) the patient, other rescuers, any bystanders, and your partner. C) your partner, other rescuers, the patient, and any bystanders. D) the patient, your partner, any bystanders, and other rescuers.

An individual's span of control: A) should be self-assigned and dependent on the incident size. B) is the degree of responsibility assigned by a higher authority. C) represents the number of personnel who report to him or her. D) limits his or her autonomy to delegate tasks to another person.

Decontaminating a patient with copious amounts of water: A) should not include the eyes, as this often causes further injury. B) should involve the use of a brush to maximize decontamination. C) decreases the dose effect of the hazardous material on the patient. D) is generally discouraged, as this may cause runoff of the material.

If a disaster situation requires a morgue officer, it is MOST important for the person who is assigned the function of morgue officer to: A) work directly with law enforcement officials to positively identify the deceased as soon as possible. B) leave all of the dead victims in their original locations until a coroner or mortician is at the scene. C) be aware that some multiple-casualty incidents involving numerous fatalities may be crime scenes. D) quickly remove the bodies from the scene, even if a storage and removal plan has not been established.

In contrast to the lethal concentration of a chemical, the lethal dose is: A) a single dose that causes death when exposure occurs exclusively via the inhalation route. B) the dose expected to cause death when administered over a specified period of time. C) a single dose that causes death when exposure occurs by any route other than inhalation. D) the dose expected to cause death when administered by any route other than absorption.

Initial command of an incident should be assumed by the: A) police chief or his or her designee. B) first paramedic to arrive at the scene. C) most experienced public safety official. D) highest-ranking individual at the scene.

Knowledge of the specific hazardous material involved in an incident is MOST important because: A) this information will determine how many hazardous materials vehicles will be required. B) knowledge of the material involved dictates the square mileage of evacuation. C) you will have an understanding of how the material will affect a patient's health. D) many hazardous material exposures require treatment at a hyperbaric chamber.

Level ___ personal protective equipment would MOST likely be worn during transport of patients with the potential of secondary contamination. A) A B) B C) C D) D

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

Multiple-casualty equipment and supplies needed for airway control include all of the following, EXCEPT: A) gloves, face shields, and a HEPA or N-95 mask. B) oral and nasal airways, ET tubes, and Combitubes. C) large-bore IV catheters for thoracic decompression. D) rigid and flexible suction catheters and suction devices.

The National Incident Management System standard incident command structures are based on: A) a unified command system, multijurisdictional cooperation, and continuous public education. B) U.S. military oversight, coordination among multiple public and private agencies, and a warning system. C) an incident command system, multiagency coordination systems, and public information systems. D) a single command system, cooperation between state and local governments, and a mechanism to warn the public.

The goal of doing the greatest good for the greatest number of people mandates that: A) life-threatening injuries should be treated during the triage phase. B) there should be one triage officer for every 10 victims of a disaster. C) triage assessment is brief and patient condition categories are basic. D) every victim should receive a detailed physical exam during triage.

The primary function of the treatment section is to: A) expediently move patients to the transportation area. B) rapidly assess each patient to determine injury severity. C) separate and treat patients based on their triage category. D) treat each patient in the order in which he or she presents.

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) flash point. B) vapor density. C) flammable range. D) ignition temperature.

When approaching an overturned tanker truck that is not displaying a warning placard, it is MOST important for the paramedic to maintain a high index of suspicion because: A) all tanker trucks carry some type of hazardous material, regardless of whether a placard is displayed. B) many companies that transport hazardous materials do not abide by federal law and do not display warning placards. C) tankers carrying small amounts of a hazardous material may not be required by law to display a warning placard. D) warning placards are only displayed on one side of tanker trucks, and that side may not be visible due to the crash.

When assessing a potential hazardous materials incident from a distance: A) your unit should be positioned such that you can feel a breeze on your face. B) the entire scene should be covered by your hand held out at arm's length. C) you should use binoculars to obtain a clearer picture of the entire incident. D) the unit should be in a low-lying area since most hazardous materials rise.

You and another paramedic are transporting an unresponsive, apneic patient from a hazardous materials incident to the hospital. Because of his condition, he was only partially decontaminated at the scene. You will arrive at the hospital in approximately 10 minutes. The MOST appropriate treatment for this patient involves: A) flushing the patient's entire body with copious amounts of water while your partner intubates him. B) hyperventilating the patient with a bag-mask device and 100% oxygen at 20 breaths per minute. C) avoiding intubation if possible, as this may expose the patient's airway to contamination. D) establishing vascular access in case emergency drug therapy is required before you arrive at the hospital.

A Computer-Aided Management of Emergency Operations (CAMEO) device is used by hazardous materials teams to: A) determine a hazardous material's explosive limits by monitoring wind speed and environmental temperature. B) monitor the levels of hydrogen sulfide and carbon monoxide contained in a wide variety of hazardous materials. C) determine the pH of the hazardous material, which will assist in identifying the most appropriate neutralizing agent to use. D) help predict downwind concentrations of hazardous materials based on the input of environmental factors into a computer model.

A closed, or contained, multiple-casualty incident is a situation that: A) does not have the potential to grow in size or complexity. B) involves no more than 10 patients who are critically injured. C) does not require mutual aid assistance from other agencies. D) is not expected to produce more patients than initially present.

According to the JumpSTART triage system, if an infant or child is not breathing, you should: A) deliver five rescue breaths. B) manually open the patient's airway. C) categorize the patient as expectant. D) immediately assess for a pulse.

An individual trained at the hazardous materials technician level is trained to: A) provide medical support for hazardous materials teams. B) perform patient care activities in an incident's warm zone. C) care for patients contaminated with a hazardous material. D) perform patient care activities in an incident's cold zone.

Communicating with area hospitals to determine their capabilities and resources is a responsibility of the: A) treatment officer. B) individual paramedic. C) chief medical officer. D) transportation officer.

Following decontamination, a patient is presented to you by rescue personnel for transport. The patient is conscious and alert, and is in no obvious respiratory distress. The patient is emitting a pungent odor and has an orange chemical on his clothing. You should: A) apply standard precautions and douse the patient with sterile water or saline. B) isolate the patient by wrapping him with a plastic blanket and then transport. C) document the time that you received the patient and begin your assessment. D) advise the rescuers that the patient has not been adequately decontaminated.

If an incident is such that it warrants evacuation of people, the incident commander would MOST likely request that the _______________ disseminate that information as well as evacuation directions. A) safety officer B) liaison officer C) operations chief D) public information officer

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) hazardous chemicals that turn to gas rarely have a vapor density that is heavier than the air, regardless of the amount of chemical. D) 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.

Prior to accepting a patient who has been decontaminated by the hazardous materials team, the paramedic must: A) make contact with the receiving medical facility. B) be informed about the degree of decontamination. C) receive a verbal report about the material involved. D) don the appropriate personal protective equipment.

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

The direct exposure of a patient to a hazardous material is called: A) acute infection. B) chemical transference. C) systemic intoxication. D) primary contamination.

The staging supervisor is responsible for: A) tracking the number of vehicles transporting patients. B) supervising all responders who are providing treatment. C) requesting additional medical supplies as they are needed. D) coordinating with all incoming and outgoing ambulances.

The transfer of incident command should occur: A) when the most experienced paramedic arrives. B) over the radio so all involved personnel can hear. C) at least every hour throughout the entire incident. D) face to face, if possible, and in an orderly manner.

Triage tags that have tear-off receipts are MOST useful to the: A) triage supervisor. B) treatment supervisor. C) incident commander. D) transportation supervisor.

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) any type of fluid is leaking from the overturned tanker or railroad car. B) the truck driver or train conductor is unconscious and still in the vehicle. C) a visible cloud or dark smoke is escaping from the tanker or railroad car. D) multiple patients are unconscious or are experiencing respiratory distress.

When a base substance is placed on a burn caused by an acid: A) the burn will be confined to the epidermis. B) an exothermic reaction is less likely to occur. C) the toxicity of the acid is effectively neutralized. D) heat is generated as a by-product of the reaction.

When sizing up the scene of a multiple-casualty incident, the LEAST of your initial concerns should be: A) the nature of the incident. B) requesting additional help. C) how you will react initially. D) why the incident occurred.

When staging at an appropriate distance from the scene until the hazardous materials team arrives to investigate the chemical leaking from an overturned tanker, you should: A) be able to read the vehicle's safety placard with the naked eye. B) stay in a location that is upwind and downhill from the incident. C) notify area hospitals and tell them to prepare for mass casualties. D) check the wind direction periodically and be prepared to relocate.

Which of the following duties is NOT a responsibility of the incident commander? A) Assessing the entire incident scene B) Developing a plan to manage the incident C) Establishing strategic objectives and priorities D) Authorizing medical treatment interventions

Which of the following is the MOST difficult aspect of being a triage supervisor? A) Communicating with the EMS branch on your progress B) Ensuring the movement of all patients to a treatment area C) Documenting all the activities that occur in the triage area D) Not initiating treatment until all patients have been triaged

Which of the following statements regarding the warm zone at a hazardous materials incident is correct? A) Patients who are brought to the warm zone by trained rescuers should already have been decontaminated. B) A standard-size warm zone is generally 50 feet in all directions, but may be smaller depending on the incident. C) The warm zone is also known as the contamination zone and is only accessible by properly trained rescuers. D) It may be necessary to perform urgent lifesaving care in the warm zone before a patient is fully decontaminated.

Which of the following statements regarding triage during a multiple-casualty incident is correct? A) Unless hypotension is present, patients with other signs of shock should be given a yellow tag. B) Any patient with burns should be assigned a higher priority than patients with severe medical problems. C) A patient with a back injury with spinal cord involvement should be placed in the immediate category. D) If your resources are limited, apneic patients with a pulse may be placed in the expectant category.

While preparing to receive patients at the scene of a hazardous material spill, you see a middle-aged man approaching your ambulance. He is covered with a green liquid, is dyspneic, and states that he "barely got out of there alive!" You should: A) advise the man to proceed back to the incident site so that he can be properly decontaminated. B) quickly don standard precautions, assist the patient to the ambulance, and apply high-flow oxygen. C) get close enough to the man so that you can visually triage him, and decontaminate him if he is stable. D) tell him to stop immediately and inform the incident commander that the patient has not been decontaminated.

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) administer oxygen via nasal cannula, take his blood pressure, and offer him cold water to drink. B) administer oxygen, start an IV line, administer 2 L of cold normal saline rapidly, and prepare for transport. C) first contact the incident commander and confirm that the patient has indeed been decontaminated. D) suspect that he is suffering from heatstroke, administer high-flow oxygen, and begin rapid cooling measures.

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