Chapter 37 Special Challenges
An important aspect in the assessment of a patient who experienced a previous brain injury involves: A) speaking with the patient and family to establish what is considered normal for the patient B) recalling that most patients with a brain injury have other organ dysfunction C) presuming that he or she has cognitive impairment until proven otherwise D) contacting the patient's physician to determine the extent of the brain injury
A
Autism is defined as a: A. psychiatric condition related to an imbalance of serotonin in the brain. B. mental disability caused by insufficient cognitive development of the brain. C. congenital condition caused by factors such as malnutrition or birth complications. D. pervasive developmental disorder characterized by impairment of social interaction.
A
If suctioning of the tracheostomy tube is necessary, the EMT should: A) attempt to use the patient's suction device first because it is probably already sized correctly B) instill 20 mL of saline into the tracheostomy tube and suction for no longer than 20 seconds C) attach a bag valve mask to the tracheostomy tube and hyperventilate the patient for 2 minutes D) insert the suction catheter to a depth of no more than 15 cm and set the suction unit to 140mm Hg
A
The purpose of a ventricular peritoneum shunt is to: A) prevent excess cerebrospinal fluid from accumulating in the brain B) monitor pressure within the skull in patients with a head injury C) divert excess cerebrospinal fluid to the ventricles of the brain D) remove fluid from the abdomen of patients with right sided heart failure
A
an obese person is _____ over ideal weight. A) 30% or more B) 50% or more C) 15% or more D) 10% or more
A
which of the following conditions would most likely be encountered in a patient with cerebral palsy? A) seizure disorder B) paralysis C) type 2 diabetes D) brain tumors
A
which of the following statements regarding gastrostomy (gastric) tube is correct? A) patients with a gastrostomy tube might still be at risk for aspiration B) most gastrostomy tubes are temporary and are not sutured in place C) gastrostomy tubes are used for patients who cannot digest food D) gastrostomy tubes are placed directly into the small intestines
A
you receive a call to a residence for an apneic 2 month old male. When you arrive at the scene, the infant's mother tells you that her son was born prematurely and that his apnea monitor has alarmed four times in the past 30 minutes. Your assessment of the infant reveals that he is conscious and active. His skin is pink and dry, and he is breathing at an adequate rate and with adequate tidal depth. His oxygen saturation reads 98% on room air. You should: A) transport the infant to the hospital and bring the apnea monitor with you B) administer high flow oxygen and observe for a drop in oxygen saturation C) advise the mother to observe her son and call 911 again if necessary D) request an ALS ambulance to transport the infant to the hospital
A
Airway management can be challenging in patients with Down syndrome because their: A) occiput is round, which causes flexion of the neck B) teeth are misaligned, and they have a large tongue C) mandible is large, which inhibits a mask to face seal D) tongue is relatively small and falls back in the throat
B
As many as 40% of patients with Down syndrome have: A) unilateral paralysis B) a heart condition C) diabetes mellitus D) intracranial bleeding
B
Because a tracheostomy tube bypasses the nose and mouth: Select one: A. severe swelling of the trachea and bronchi can occur. B. secretions can build up in and around the tube. C. the risk of a local infection is significantly high. D. bleeding or air leakage may occur around the tube.
B
Because hearing-impaired patients typically have more difficulty hearing high-frequency sounds, it is important for you to: A) increase the pitch of your voice B) lower the pitch of your voice C) try basic sign language first D) speak in a monotone voice
B
Common complications associated with central venous catheters include all of the following, EXCEPT: A) clotting of the line B) rupture of a central vein C) bleeding around the line D) a local infection
B
Down syndrome is a genetic defect that occurs as the result of: A) a separation of chromosome 21 B) a triplication of chromosome 21 C) an extra pair of chromosomes D) a sperm that contains 24 chromosomes
B
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) an intracranial hemorrhage B) a cervical spine injury C) a seizure D) hydrocephalus
B
General techniques for communicating with hearing-impaired patients include: A) removing any hearing aids and using pen and paper to ask questions B) positioning yourself approximately 18 inches directly in front of the patient C) exaggerating your lip movements to ensure the patient understands D) speaking directly into the patients ear with an increased voice pitch
B
In contrast to an automated implanted cardioverter/defibrillator, an internal cardiac pacemaker: A) is implanted under the skin in the left upper abdominal quadrant B) regulates the patient's heart rate if it galls below a preset value C) will only activate if it detects rhythms such as ventricular fibrillation D) delivers a shock to the heart if the rate becomes exceedingly fast
B
Under what circumstances is a left ventricular assist device used? A) to ensure that the ventricles contract at an adequate and consistent rate B) as a bridge to heart transplantation while a donor heart is being located C) to permanently replace the function of one or both of the ventricles D) to reduce ventricular pumping force in patients with aortic aneurysms
B
When enlisting the help of an interpreter who signs, it is important for you to ask the interpreter to: 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
`According to the Emergency Medical Treatment and Active Labor Act (EMTALA): A) a healthcare facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical B) all healthcare facilities must provide a medical assessment and required treatment, regardless of the patients ability to pay C) a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing to the emergency department D) all healthcare facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured
B
cerebral palsy is a condition that results from damage or injury to the: A) voluntary muscles B) brain C) spinal cord D) peripheral nervous system
B
characteristic anatomic features of Down Syndrome include: A) bulging eyes and a large face B) a round head with a flat occiput C) long hands with wide fingers D) a proportionately small tongue
B
the tip of a central venous catheter rests in the: 51. Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct? A) 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 B) communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition C) before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition D) in most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver
B
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) tell him or her what is happening, identify noises, and describe the situation and surroundings C) leave items such as canes and walkers at the residence if the patient will be carried on a gurney D) allow a service dog to remain with the patient at all times, even if the patient is critically ill
B
which of the following statements regarding patients with intellectual disabilities is correct? A) speaking with the patients 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) most patients with intellectual disabilities have normal cognitive function but abnormal physical features D) An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality
B
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) intestinal shunt B) gastrostomy C) colostomy D) gastric stoma
C
EMTs are dispatched for a patient whose central venous catheter is malfunctioning. When they arrive and assess the patient, they find bleeding from the tubing attached to the line. The EMTs should: A) request an ALS ambulance to clamp the tubing B) carefully remove the catheter and transport C) apply direct pressure to the tubing and transport D) gently manipulate the catheter to reduce the bleeding
C
For which of the following conditions would you most likely encounter a ventricular peritoneum shunt? A) subdural hematoma B) cerebral palsy C) hydrocephalus D) epidural hematoma
C
In contrast to conductive hearing loss, sensorineural hearing loss is caused by: A) earwax accumulation B) eardrum perforation C) nerve damage D) barotrauma
C
Spina bifida is defined as: A) congenital inflammation of the spinal cord, usually in the neck B) a birth defect in which the child is born without spinal vertebrae C) a birth defect caused by incomplete closure of the spinal column D) chronic pressure on the brain caused by excess cerebrospinal fluid
C
Vagus nerve stimulators may be an alternative treatment to medication for patients with: A) inherently slow heart rates B) certain psychiatric conditions C) chronic seizure disorders D) chronic muscle pain and fatigue
C
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) place a call to the home health agency treating this patient C) disconnect the ventilator and apply a tracheostomy collar D) reset the ventilator by unplugging it for 30 to 60 seconds
C
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
C
cerebral palsy is characterized by poorly controlled _______ movement. A) eye B) extremity C) body D) neck
C
the rate of autism in the US population is about 1 in: A) 27 B) 5 C) 40 D) 100
C
which of the following statements regarding cerebral palsy is correct? A) a key clinical feature of cerebral palsy is paralysis of the respiratory muscles, which confines the patient to a ventilator B) approximately 25% of patients with cerebral palsy posses some varying degrees of developmental delay C) conditions such as brain injury at birth, postpartum infections, and fetal hypoxia can cause cerebral palsy D) most cases of cerebral palsy develop within the first 10 years of life and are typically caused by meningitis
C
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) contacting dispatch and requesting a sign language interpreter B) attempting to use body language to determine the problem C) using a piece of paper and writing utensil to ask questions D) using a high pitched voice while speaking directly into the ear
C
By placing one hand on top of your head and the other hand over your abdomen, you are asking a hearing-impaired patient if he or she: A) needs help B) is hurt C) is nauseated D) is sick
D
Common associated conditions in patients with spina bifida include all of the following, EXCEPT: A) hydrocephalus B) loss of bladder control C) extreme latex allergy D) spastic limb movement
D
EMS personnel would MOST likely be called to the residence of a patient receiving home health care when the home care provider: A) has a question that is specific to the patient's condition B) needs simple assistance in providing patient care C) must confirm that a specific intervention is required D) has recognized a change in the patient's health status
D
EMTs are dispatched for a patient in cardiac arrest. When they arrive, they find that the patient is pulseless, apneic, and wearing an external defibrillator vest. In this situation, the EMTs should: A) quickly remove the vest and perform CPR B) wait 5 minutes prior to using the AED C) apply the AED pads over the vests' pads D) perform CPR and leave the vest in place
D
General care for a patient with a tracheostomy tube includes all of the following, EXCEPT: A) suctioning the tube as needed to clear a thick mucous plug B) maintaining the patient in a position of comfort when possible C) ensuring adequate oxygenation and ventilation at all times D) removing the tube if the area around it appears infected
D
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) remove his hearing aids, turn up the volume, and replace them in his ears B) recognize that the batteries in his hearing aids are probably depleted C) remove both of his hearing aids and use pencil and paper to communicate D) try repositioning the hearing aid or remove it and turn down the volume
D
a tube from the brain to the abdomen that drains excessive cerebrospinal fluid is called a: A) CS tube B) G-tube C) cerebral bypass D) shunt
D
patients with autism: A) prefer to maintain eye contact with whomever is talking with them B) often speak with speech patterns that alternate in tone and speed C) use and understand nonverbal means of communicating messages D) have extreme difficulty with complex tasks that require many steps
D
when caring for a morbidly obese patient, you should: A) leave him or her in a supine position, as this often facilitates breathing B) call for ALS backup because obese patients are at high risk for heart attack C) ask the patient if he or she knows what led to his or her obesity problem D) establish his or her chief complain and then communicate your plan to help
D
which of the following does not usually contribute to or cause obesity? A) genetic predisposition B) low metabolic rate C) high caloric intake D) rapid metabolism
D
which of the following statements regarding hearing aids is correct? A) over time, hearing aids can restore normal hearing B) a whistling sound indicates correct hearing aid placement C) in the canal hearing aids fit in the outer part of the ear D) hearing aids cannot restore hearing to normal levels
D
you are assessing a 440lb man who complains of shortness of breath and lower back pain. The patient is conscious and alert, his blood pressure is 148/98mm Hg, and his heart rate is 120 bpm. Your most immediate action should be to: A) perform a secondary assessment, focusing on his respiratory system and back B) notify the receiving facility and advise them of the patient's weight and status C) ask a member of your team to locate the best route to move him to the ambulance D) avoid placing him in a supine position if possible and administer oxygen
D
you respond to a residence for a 9 year old female with down syndrome who is sick. When you arrive at the scene and assess the patient, you determine that she is unresponsive and has gurgling respirations. You should: A) immediately apply high flow oxygen via a nonrebreathing mask and then assess her pulse rate B) open her airway with the jaw thrust maneuver and assess the rate and depth of her breathing C) insert an oropharyngeal airway and begin assisting her ventilations with a bag valve mask D) open her airway with a manual maneuver, suction her oropharynx, and insert a simple airway adjunct
D
