Ch. 36 - Patients with Special Challenges

You are assessing a 440-lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98 mm Hg, and his heart rate is 120 beats/min. Your MOST immediate action should be to: A) avoid placing him in a supine position if possible and administer oxygen. B) notify the receiving facility and advise them of the patient's weight and status. C) perform a secondary assessment, focusing on his respiratory system and back. D) ask a member of your team to locate the best route to move him to the ambulance.

Correct Answer A) avoid placing him in a supine position if possible and administer oxygen.

When assessing or providing care to a patient with an intellectual disability, you should: A) explain procedures while in the process of performing them. B) be observant for signs of fear or reluctance from the patient. C) move swiftly and deliberately to quickly accomplish the task. D) frequently reassure him or her that everything will be okay.

Correct Answer B) be observant for signs of fear or reluctance from the patient.

General care for a patient with a tracheostomy tube includes all of the following, EXCEPT: A) ensuring adequate oxygenation and ventilation at all times. B) removing the tube if the area around it appears to be infected. C) suctioning the tube as needed to clear a thick mucous plug. D) maintaining the patient in a position of comfort when possible.

Correct Answer B) removing the tube if the area around it appears to be infected.

When caring for patients with cerebral palsy, it is important to remember that: A) they are unable to walk and are totally dependent upon you. B) their limbs are often underdeveloped and are prone to injury. C) hearing aids are usually ineffective for patients with hearing loss. D) most patients have the ability to walk, but have an unsteady gait.

Correct Answer B) their limbs are often underdeveloped and are prone to injury.

A person is said to be obese when he or she is ________ over his or her ideal weight. A) 10% or more B) 20% or more C) 30% or more D) 40% or more

Correct Answer C) 30% or more

When interacting with an intellectually disabled patient, the best approach is to: A) speak primarily with the patient's family to establish the degree of disability. B) approach the patient as a team to reassure him or her that you are there to help. C) ask your team members to wait until you can establish a rapport with the patient. D) position yourself slightly above the patient's level to reduce his or her anxiety.

Correct Answer C) ask your team members to wait until you can establish a rapport with the patient.

Cerebral palsy is characterized by poorly controlled ________ movement. A) eye B) neck C) body D) extremity

Correct Answer C) body

Which of the following conditions would MOST likely be encountered in a patient with cerebral palsy? A) Paralysis B) Brain tumors C) Type 2 diabetes D) Seizure disorder

Correct Answer D) Seizure disorder

Which of the following does NOT usually contribute to or cause obesity? A) Rapid metabolism B) High caloric intake C) Low metabolic rate D) Genetic predisposition

Correct Response A) Rapid metabolism

Down syndrome patients are at an increased risk for medical complications. Which of the following is NOT one of those potential complications? A) Respiratory complications B) Cardiovascular complications C) Gastrointestinal complications D) Endocrine complications

Correct Response A) Respiratory complications

Cerebral palsy is a condition that results from damage or injury to the: A) brain. B) spinal cord. C) voluntary muscles. D) peripheral nervous system.

Correct Response A) brain.

A surgical procedure that creates an opening between the intestine and the surface of the body that allows for elimination of waste products is called a(n): A) colostomy. B) gastrostomy. C) gastric stoma. D) intestinal shunt.

Correct Response A) colostomy.

When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to: A) report exactly what the patient signs and not to add any commentary. B) voice what he or she is signing while communicating with the patient. C) document the answers to the questions that the patient has responded to. D) avoid any kind of lip movement while he or she is signing with the patient.

Correct Response A) report exactly what the patient signs and not to add any commentary.

A ventricular atrium shunt drains excess fluid from the ventricles of the brain into the: A) right atrium of the heart. B) left atrium of the heart. C) right ventricle of the heart. D) left ventricle of the heart.

Correct Response A) right atrium of the heart.

Because a tracheostomy tube bypasses the nose and mouth: A) secretions can build up in and around the tube. B) the risk of a local infection is significantly high. C) bleeding or air leakage may occur around the tube. D) severe swelling of the trachea and bronchi can occur.

Correct Response A) secretions can build up in and around the tube.

A tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a: A) shunt. B) G-tube. C) CS tube. D) cerebral bypass.

Correct Response A) shunt.

Airway management can be challenging in patients with Down syndrome because their: A) teeth are misaligned and they have a large tongue. B) occiput is round, which causes flexion of the neck. C) tongue is relatively small and falls back in the throat. D) mandible is large, which inhibits a mask-to-face seal.

Correct Response A) teeth are misaligned and they have a large tongue.

Under what circumstances is a left ventricular assist device used? A) To permanently replace the function of one or both of the ventricles B) As a bridge to heart transplantation while a donor heart is being located C) To reduce ventricular pumping force in patients with aortic aneurysms D) To ensure that the ventricles contract at an adequate and consistent rate

Correct Response B) As a bridge to heart transplantation while a donor heart is being located

Which of the following statements regarding patients with intellectual disabilities is correct? A) Speaking with the patient's family is the least effective way to determine how much the patient understands. B) Patients with intellectual disabilities are susceptible to the same disease processes as other patients. C) An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality. D) Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.

Correct Response B) Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

Which of the following statements is NOT true regarding patients with autism? A) They fail to use or understand nonverbal communication. B) They will talk with normal tone and speech patterns. C) They may have extreme difficulty with complex tasks that require many steps. D) They have difficulty making eye-to-eye contact.

Correct Response B) They will talk with normal tone and speech patterns.

Which of the following would be the MOST practical method of communicating with a hearing-impaired patient until his or her hearing aids can be located? A) Attempting to use body language to determine the problem B) Using a piece of paper and writing utensil to ask questions C) Using a high-pitched voice while speaking directly into the ear D) Contacting dispatch and requesting a sign language interpreter

Correct Response B) Using a piece of paper and writing utensil to ask questions

Spina bifida is defined as: A) congenital inflammation of the spinal cord, usually in the neck. B) a birth defect caused by incomplete closure of the spinal column. C) a birth defect in which the child is born without spinal vertebrae. D) chronic pressure on the brain caused by excess cerebrospinal fluid.

Correct Response B) a birth defect caused by incomplete closure of the spinal column.

According to the Emergency Medical Treatment and Active Labor Act (EMTALA): A) all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured. B) all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay. C) a health care facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical. D) a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.

Correct Response B) all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay.

A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress. You should: A) attempt to troubleshoot the mechanical ventilator problem. B) disconnect the ventilator and apply a tracheostomy collar. C) place a call to the home health agency treating this patient. D) reset the ventilator by unplugging it for 30 to 60 seconds.

Correct Response B) disconnect the ventilator and apply a tracheostomy collar.

By placing one hand on your head and the other hand over your abdomen, you are asking a hearing-impaired patient if he or she: A) is hurt. B) is sick. C) needs help. D) is nauseated.

Correct Response B) is sick.

According to the "E" in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube? A) Look for blood or other secretions in the tube. B) Attempt to pass a suction catheter into the tube. C) Check the mechanical ventilator for malfunction. D) Listen to breath sounds to assess for a pneumothorax.

Correct Response C) Check the mechanical ventilator for malfunction.

Which of the following statements regarding autism is correct? A) Autism affects females four times greater than males. B) The majority of patients with autism do not speak at all. C) Most cases of autism are diagnosed by 3 years of age. D) Impairment of motor activity is a classic sign of autism.

Correct Response C) Most cases of autism are diagnosed by 3 years of age.

Which of the following statements is NOT true regarding the care of a patient with cerebral palsy? A) Do not assume these patients are mentally disabled. B) Limbs are often underdeveloped and are prone to injury. C) Walkers or wheelchairs should not be taken in the ambulance. D) Be prepared to care for a seizure if one occurs.

Correct Response C) Walkers or wheelchairs should not be taken in the ambulance.

EMTs are dispatched for a fall. The patient, a 16-year-old female with Down syndrome, is experiencing difficulty walking and says that her fingers "feel like needles." The EMTs should suspect: A) a seizure. B) an intracranial hemorrhage. C) a cervical spine injury. D) hydrocephalus.

Correct Response C) a cervical spine injury.

Down syndrome is a genetic defect that occurs as the result of: A) an extra pair of chromosomes. B) a separation of chromosome 21. C) a triplication of chromosome 21. D) a sperm that contains 24 chromosomes.

Correct Response C) a triplication of chromosome 21

If a patient's mechanical ventilator malfunctions, you should remove the patient from the ventilator and: A) place the patient on a nasal cannula. B) place the patient on a nonrebreathing mask. C) begin ventilations with a bag-valve mask. D) contact medical control.

Correct Response C) begin ventilations with a bag-valve mask.

Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to: A) try basic sign language first. B) speak in a monotone voice. C) lower the pitch of your voice. D) increase the pitch of your voice.

Correct Response C) lower the pitch of your voice.

A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids. You should: A) recognize that the batteries in his hearing aids are probably depleted. B) remove his hearing aids, turn up the volume, and replace them in his ears. C) try repositioning the hearing aid or remove it and turn down the volume. D) remove both of his hearing aids and use pencil and paper to communicate.

Correct Response C) try repositioning the hearing aid or remove it and turn down the volume.

When caring for a patient with a previous head injury, you should: A) speak in a loud, commanding tone. B) expect the patient to be able to walk. C) watch the patient for signs of anxiety. D) never consider restraining the patient.

Correct Response C) watch the patient for signs of anxiety.

Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct? A) In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver. B) Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition. C) In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness. D) Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

Correct Response D) Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

General techniques for communicating with hearing-impaired patients include: A) exaggerating your lip movements to ensure the patient understands. B) speaking directly into the patient's ear with an increased voice pitch. C) removing any hearing aids and using pen and paper to ask questions. D) positioning yourself approximately 18 inches directly in front of the patient.

Correct Response D) positioning yourself approximately 18 inches directly in front of the patient.

The purpose of a ventricular peritoneum shunt is to: A) divert excess cerebrospinal fluid to the ventricles of the brain. B) monitor pressure within the skull in patients with a head injury. C) remove fluid from the abdomen of patients with right-sided heart failure. D) prevent excess cerebrospinal fluid from accumulating in the brain.

Correct Response D) prevent excess cerebrospinal fluid from accumulating in the brain.

Common complications associated with central venous catheters include all of the following, EXCEPT: A) a local infection. B) clotting of the line. C) bleeding around the line. D) rupture of a central vein.

Correct Response D) rupture of a central vein.

When caring for a patient who is visually impaired, it is important to: A) allow a service dog to remain with the patient at all times, even if the patient is critically ill. B) stand to the side of the patient when speaking if his or her peripheral vision is impaired. C) leave items such as canes and walkers at the residence if the patient will be carried on a gurney. D) tell him or her what is happening, identify noises, and describe the situation and surroundings.

Correct Response D) tell him or her what is happening, identify noises, and describe the situation and surroundings.

Patients with autism: A) have extreme difficulty with complex tasks that require many steps. B) prefer to maintain eye contact with whomever is talking with them. C) often speak with speech patterns that alternate in tone and speed. D) use and understand nonverbal means of communicating messages.

Correct Response A) have extreme difficulty with complex tasks that require many steps.