Chapter 40

Which of the following volume expanders has been shown to interfere with platelet function and cause clotting problems? Dextran Hespan Plasmanate Lactated Ringer solution

Dextran

Which of the following premorbid conditions would MOST likely occur in an otherwise healthy adult? Renal failure Congestive heart failure Coronary artery disease Drug toxicity

Drug toxicity

Which of the following substances or elements reinforces red blood cells, creating the final step in the formation of a blood clot? Fibrin Plasminogen Fibrinogen Platelets

Fibrinogen

By which of the following mechanisms do patients with septic shock become hypovolemic? Sustained systemic vascular dilation Fluid leakage out of the vascular space Spontaneous destruction of red blood cells Frequent and severe vomiting and diarrhea

Fluid leakage out of the vascular space

What effect would the restoration of normotension have on a patient with internal bleeding and a blood pressure of 70/54 mm Hg? Increased hemostasis and improved cerebral perfusion Acute pulmonary edema secondary to volume overload Facilitation of the clotting mechanisms that stop bleeding Formed clot dislodgement and worsened internal bleeding

Formed clot dislodgement and worsened internal bleeding

Which of the following would MOST likely allow you to reach the status of entry-level competence? Functioning for at least 2 years in the field Passing the state or national paramedic exam Interning with an experienced preceptor Studying didactic material at least 2 hours per week

Interning with an experienced preceptor

You and your team are treating an unresponsive trauma patient. Which of the following questions would be the MOST relevant to ask your team when evaluating for the presence of a tension pneumothorax? What is the patient's systolic blood pressure? Are the patient's heart tones becoming muffled? Is the patient becoming difficult to ventilate? Does the patient's pulse weaken during inhalation?

Is the patient becoming difficult to ventilate?

Which of the following solutions is preferred for fluid resuscitation of a patient in shock in the prehospital setting? Fresh frozen plasma Isotonic crystalloid Hypertonic saline Dextrose in water

Isotonic crystalloid

Which of the following is the BEST indicator of tissue perfusion during compensated shock? Systolic blood pressure Pulse rate and quality Skin color and condition Level of responsiveness

Level of responsiveness

Which of the following hemodynamic parameters decreases, regardless of the etiology of the shock? Pulse rate Mean arterial pressure Central venous pressure Peripheral vascular resistance

Mean arterial pressure

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

Oxygen molecules move from the alveoli into the blood by diffusion.

Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock? They cause platelets to clump together. They do not expand the circulating volume. They do not have oxygen-carrying capacity. They increase the viscosity of the blood.

They do not have oxygen-carrying capacity.

Which of the following is an example of a peri-arrest condition? Ventricular tachycardia and a systolic blood pressure of 60 mm Hg Sinus tachycardia secondary to fever and a mild infection Ventricular fibrillation that has persisted for 6 minutes Bradycardia in the absence of chest pain or other symptoms

Ventricular tachycardia and a systolic blood pressure of 60 mm Hg

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

Widespread dilation of the resistance and capacitance vessels

A 40-year-old man had a syncopal episode after receiving news of the death of a loved one. He complains of a headache and is unable to walk without becoming dizzy. You should be the MOST suspicious for: hypoglycemia. a dysrhythmia. hypovolemia. a head injury.

a head injury.

Parasympathetic nervous system stimulation results in: a negative dromotropic effect. increased myocardial contractility. a decreased inotropic effect. decreased gastrointestinal motility.

a negative dromotropic effect.

Infection, hypertensive crisis, and medication noncompliance are differential diagnoses that should be considered when treating a patient who presents with: acute chest pain. unilateral weakness. altered mental status. vomiting and diarrhea.

altered mental status.

A characteristic sign of neurogenic shock caused by a spinal injury is: pink, warm, dry skin above the level of the injury. an absence of sweating below the level of the injury. a reflex tachycardia secondary to vascular dilation. irregular breathing secondary to brainstem insult.

an absence of sweating below the level of the injury.

In addition to IV fluids, treatment for a patient in neurogenic shock may include: atropine. amiodarone. epinephrine 1:1,000. low-dose dopamine.

atropine.

During multiple-organ dysfunction syndrome, the release of __________, a potent vasodilator, leads to tissue hypoperfusion and may contribute to hypotension. renin epinephrine bradykinin angiotensin

bradykinin

Intrinsic causes of cardiogenic shock include: pleural effusion. cardiomyopathy. pulmonary embolus. tension pneumothorax.

cardiomyopathy

When an adult patient with hemorrhagic shock loses more than 40% of his or her blood volume: blood flow is diverted away from the skin to the liver, kidneys, and lungs. cardiovascular deterioration cannot be reversed by compensatory mechanisms. vital organ damage can be repaired if a blood transfusion is started promptly. immediate IV fluid replacement can rapidly restore adequate tissue perfusion.

cardiovascular deterioration cannot be reversed by compensatory mechanisms.

Tissue perfusion is primarily a function of the: endocrine system. cardiovascular system. respiratory system. peripheral nervous system.

cardiovascular system.

The MOST immediate treatment for the patient with a tension pneumothorax is to: establish a large-bore IV line. ventilate with a bag-mask device. evacuate air from the pleural space. apply high-flow supplemental oxygen.

evacuate air from the pleural space.

Shock in the trauma patient should be considered _____________ until proven otherwise. hemorrhagic distributive obstructive neurogenic

hemorrhagic

Systemic effects of epinephrine include: bronchoconstriction. decreased preload. increased afterload. diffuse vasodilation.

increased afterload.

Anaerobic metabolism is the process in which: the cells produce carbon dioxide and water. adequate amounts of oxygen reach the cell level. the adrenal glands fail to release catecholamines. inefficient cellular metabolism produces lactic acid.

inefficient cellular metabolism produces lactic acid.

The MOST common cause of cardiogenic shock is: myocardial infarction. ventricular aneurysm. a sudden dysrhythmia. papillary muscle rupture.

myocardial infarction.

When communicating an intuitive decision and obtaining feedback to your team, you should FIRST advise your team: of what you think should be done next. of what you think the patient's problem is. of what led you to a particular diagnosis. to ask any questions or voice any concerns.

of what you think the patient's problem is.

Disseminated intravascular coagulation is defined as a(n): decrease in white blood cell count, which results in decreased resistance to infection. pathophysiologic reaction that occurs when cellular ischemia leads to anaerobic metabolism. abnormal process in which disease or injury causes hemostasis due to platelet aggregation. pathological condition in which the proteins that normally control blood clotting become inappropriately active

pathological condition in which the proteins that normally control blood clotting become inappropriately active.

Paramedic intuition is BEST described as: pattern recognition and matching based on past experience. the quick formulation of a field diagnosis based on assessment. the field diagnosis arrived at based on the general impression. instinct or a "gut feeling" based on past reading or studying.

pattern recognition and matching based on past experience.

The capillary "washout" phase occurs when: anaerobic metabolism causes the postcapillary sphincters to remain constricted, causing capillary fluid engorgement. postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells. cellular ischemia causes the postcapillary sphincters to remain constricted, causing the capillaries to become engorged with fluid. precapillary sphincters constrict in response to the buildup of lactic acid, vasomotor failure, and increased carbon dioxide.

postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells.

Premorbid conditions are those that: are a direct cause of death. precede the onset of a disease. are caused by an acute illness. have no effect on patient outcome.

precede the onset of a disease.

A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of _____________ shock. neurogenic obstructive psychogenic hypovolemic

psychogenic

Incomplete glucose breakdown leads to an accumulation of: lactic acid. pyruvic acid. bicarbonate. carbonic acid.

pyruvic acid.

During anaerobic metabolism, the precapillary sphincters __________ in response to __________. relax, lactic acid buildup constrict, capillary engorgement relax, systemic vasoconstriction constrict, decreased carbon dioxide

relax, lactic acid buildup

Relative bradycardia during neurogenic shock occurs because: systemic venous pooling of the blood overstimulates the vagus nerve. the parasympathetic nervous system does not release acetylcholine. the sympathetic nervous system is not stimulated to release catecholamines. the brainstem does not receive messages to increase the heart rate.

the sympathetic nervous system is not stimulated to release catecholamines.

The recommended fluid resuscitation of a patient in shock and no evidence of traumatic brain injury is: 20 mL/kg, repeat as needed; maintain a systolic BP of 100 mm Hg. 500 mL, up to 4 times; maintain a systolic BP of 70 to 80 mm Hg. 250 mL, up to 4 times; maintain a systolic BP of 80 to 90 mm Hg. 1 liter, repeated 1 time; maintain a systolic BP of 100 mm Hg.

250 mL, up to 4 times; maintain a systolic BP of 80 to 90 mm Hg.

Adequately perfused kidneys put out at least ___ to ___ mL of urine per hour. 30, 50 50, 70 70, 100 100, 110

30, 50

You have given an 800-mL normal saline bolus to a patient in shock. How much of this fluid will remain in the intravascular space after 20 minutes? 320 mL 380 mL 480 mL 600 mL

320 mL

The blood pressure of an infant or child can be maintained with blood loss of up to: 35% to 40%. 40% to 45%. 45% to 50%. 50% to 55%.

35% to 40%.

The mean arterial pressure must be greater than or equal to ____ mm Hg to ensure that the brain, coronary arteries, and kidneys remained perfused. 50 60 70 80

60

If the left ventricle fills with 85 mL of blood and ejects 60 mL during a contraction, the ejection fraction is approximately ___%. 55 60 65 70

70

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

90/70 mm Hg

Which of the following is an element of the Fick principle? Adequate production of pyruvic acid A relatively constant end-tidal CO2 An adequate number of red blood cells Consistent white blood cell production

An adequate number of red blood cells

Which of the following vital signs values are MOST consistent with neurogenic shock? Blood pressure, 120/70; pulse, 70; respirations, 14 Blood pressure, 160/100; pulse, 40; respirations, 8 Blood pressure, 80/60; pulse, 50; respirations, 24 Blood pressure, 70/40; pulse, 120; respirations, 26

Blood pressure, 80/60; pulse, 50; respirations, 24

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

"Does this patient undergo dialysis?"

What is formed when carbon monoxide binds to the hemoglobin molecule? Myoglobin Oxyhemoglobin Methemoglobin Carboxyhemoglobin

Carboxyhemoglobin

Which of the following is the MOST accurate definition of multiple-organ dysfunction syndrome? Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness Sequential failure of two or more organs or organ systems caused by an acute injury or illness affecting any part of the patient's central nervous system Acute and predictable failure of the kidneys, liver, lungs, and heart that resulted from any disorder or injury that directly affected these organs Progressive failure of two or more organs or organ systems that were directly affected by the acute disorder or injury that caused the patient's initial illness

Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness

Which of the following will be of MOST help to the paramedic when formulating a field diagnosis? Receiving input from family members Considering or ruling out various conditions Identifying and treating immediate life threats Trending the vital signs over a period of time

Considering or ruling out various conditions