Chapter 36: Patients with Special Challenges

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

A. As a bridge to heart transplantation while donor heart is being located.

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

A. Rapid metabolism.

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

A. 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? Select one: A. Using a piece of paper and writing utensil to ask questions B. Attempting to use body language to determine the problem C. Contacting dispatch and requesting a sign language interpreter D. Using a high-pitched voice while speaking directly into the ear

A. Using a piece of paper and writing utensil to ask questions

According to the Emergency Medical Treatment and Active Labor Act (EMTALA): A. all health care facilities must provide a medical assessment and required treatment, regardless of the patient's ability to pay. B. all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured. C. a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department. D. 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.

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

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

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

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

A. right atrium of the heart.

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

A. rupture of a central vein.

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

A. their limbs are often underdeveloped and are prone to injury.

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. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's 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. Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.

B. Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.

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

B. Most cases of autism are diagnosed by 3 years of age.

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. a cervical spine injury. C. hydrocephalus. D. an intracranial hemorrhage.

B. a cervical spine injury.

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

B. begin ventilations with a bag-valve mask.

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: Select one: 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.

B. disconnect the ventilator and apply a tracheostomy collar.

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

B. lower the pitch of your voice.

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

B. positioning yourself approximately 18 inches directly in front of the patient.

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

B. to report exactly what the patient signs and not to add any commentary.

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? Select one: A. Listen to breath sounds to assess for a pneumothorax. B. Look for blood or other secretions in the tube. C. Check the mechanical ventilator for malfunction. D. Attempt to pass a suction catheter into the tube.

C. Check the mechanical ventilator for malfunction.

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. An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality. C. Patients with intellectual disabilities are susceptible to the same disease processes as other patients. D. Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.

C. Patients with intellectual disabilities are susceptible to the same disease processes as other patients.

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

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

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. perform a secondary assessment, focusing on his respiratory system and back. B. ask a member of your team to locate the best route to move him to the ambulance. C. avoid placing him in a supine position if possible and administer oxygen. D. notify the receiving facility and advise them of the patient's weight and status.

C. avoid placing him in a supine position if possible and administer oxygen.

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

C. brain

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: Select one: A. recognize that the batteries in his hearing aids are probably depleted. B. remove both of his hearing aids and use pencil and paper to communicate. C. try repositioning the hearing aid or remove it and turn down the volume. D. 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.

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

D. 30% or more

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

D. Respiratory complications

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

D. Seizure disorder

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

D. a birth defect caused by incomplete closure of the spinal column.

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

D. a triplication of chromosome 21

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

D. ask your team members to wait until you can establish a rapport with the patient.

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

D. be observant for signs of fear or reluctance from the patient.

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. gastrostomy. B. intestinal shunt. C. gastric stoma. D. colostomy.

D. colostomy

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 nauseated. B. is hurt. C. needs help. D. is sick.

D. is sick.

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

D. prevent excess cerebrospinal fluid from accumulating in the brain.

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. suctioning the tube as needed to clear a thick mucous plug. C. maintaining the patient in a position of comfort when possible. D. removing the tube if the area around it appears to be infected.

D. removing the tube if the area around it appears to be infected.

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

D. 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. cerebral bypass. B. CS tube. C. G-tube. D. shunt.

D. shunt

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

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

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

D. watch the patient for signs of anxiety.

Cerebral palsy is characterized by poorly controlled ________ movement.

body

A(n) _________ is a special piece of medical equipment that takes over the function of either one or both heart ventricles.

left ventricular assist device

Comfort care, or _________ , improves the patient's quality of life before the patient dies.

palliative care

You may allow a patient with a visual impairment to rest his or her hand on your________, because this may help with balance and security while moving.

shoulder