Chapter 38
An 83-year-old male has fallen down five stairs to the floor below. He hit his head and is complaining of a headache. When getting a history from this patient, what question should you ask first?
"What caused you to fall?"
Your partner informs you that the 3-year-old boy you have been called to care for is breathing 28 times per minute. As a knowledgeable EMT, you would recognize:
Correct a normal rate.
Which one of the following is the fundamental danger associated with a pulmonary embolism?
Hypoxia
When suctioning a 46-year-old male with a tracheostomy tube, which of the following is appropriate?
Insert the suction cannula until resistance is met.
Which of the following correctly identifies a stoma?
The opening in the neck for a tracheostomy tube
The EMT recognizes that dementia is typically observed as:
a chronic and irreversible condition.
To find an implanted port on a patient, the EMT should:
palpate the anterior chest.
You must assess the pupils of a 5-year-old who fell off a bed while playing. Which of the following statements would be most appropriate prior to performing this assessment?
"I am going to use this light to look into your eyes."
A patient with postural hypotension would most likely make what statement?
"I get so dizzy when I get up off of the couch."
You are assessing a 5-year-old boy who is complaining of arm pain after falling down three steps. As you physically assess the patient, he tries to bite your hands. His mother is at his side. Which of the following statements is appropriate to make regarding the behavior of biting?
"I know that you do not feel good, but biting is not okay."
The EMT would recognize a sensory impairment when he encounters which of the following?
49-year-old male who is hearing impaired in one ear
Which one of the following statements about peritoneal dialysis is true?
A catheter is inserted into the abdomen.
A 1-year-old male is in respiratory distress and wheezing. His pulse is 156, respirations 32, and SpO2 95% on 5 liters of blow-by oxygen. His mother denies a medical history for him, but states that she suffers from asthma and uses an albuterol inhaler. Of the following, what would be appropriate in the care of this child?
Add humidity to the oxygen.
When he is assessing a 3-year-old child for possible injuries after the child fell down a flight of stairs, which of the following would raise the EMT's suspicion that the child may be a victim of physical abuse?
Bruises are found on his chest and abdomen.
Which of the following statements regarding traumatic injuries and the elderly is true?
Injuries are most commonly caused by falls.
You have been called to an assisted living facility to transport a patient who has been vomiting continuously for 6 hours. She is responsive to verbal stimuli. The patient suffers from arthritis and severe kyphosis. How should you transport this patient on the stretcher?
Left lateral recumbent position
What is the best location for assessing breath sounds in the pediatric patient?
Midaxillary region of the lungs
You have been called for a 2-week-old baby who is sick. Assessment reveals him to have a fever and rhonchi in the lungs. Which of the additional assessment findings would be most concerning to you given the age of this patient?
Nasal passages occluded by mucus
You have been called to a residence for an unknown medical problem. As you enter the house, what scene clue would most likely suggest the use of home medical oxygen?
No smoking sign located on the front door
You are immobilizing a 4-year-old-boy on a long spine board. Which of the following would be appropriate when performing this intervention?
Place padding between his shoulders and the spine board.
Which one of the following best describes an oxygen concentrator?
Portable oxygen device that extracts oxygen from the air
You have been called for a 77-year-old female with altered mental status. On scene you note the patient's inability to speak and vomitus in her airway. Her breathing is labored and inadequate, and radial pulse rapid and weak. She is not moving her right arm or right leg. Which one of the following should be your first priority?
Suction the airway and determine adequate breathing.
When assessing a 91-year-old female who fell, what assessment finding should concern the EMT most?
Sudden onset of confusion
When assessing a patient, which finding should raise the EMT's suspicion that the patient may be suffering from a pulmonary embolism?
Sudden onset of shortness of breath
A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. You find him sitting on the floor with his wife next to him. His wife states that he did not lose consciousness and that this has happened several times over the past few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?
Take manual in-line spinal stabilization and begin assessment.
When assessing a geriatric patient for pneumonia, the EMT must remember that:
a normal body temperature may be observed.
At a long-term care facility, a nurse informs you that the patient you will be transporting has a peripherally inserted central catheter (PICC) in place. To find this catheter, you should look at the patient's:
antecubital fossa.
A 2-month-old presents with labored breathing, fever, and coughing. Auscultation of the lungs reveals significant wheezing bilaterally. Based on this presentation, an EMT would recognize that the patient is most likely suffering from:
bronchiolitis
The increased pliability of the child's ribs makes him more prone to:
bruising of the lung.
Assessment of an alert and oriented 9-year-old child with a history of asthma reveals him to be breathing 20 times a minute with adequate chest rise and fall. You also note that he exhibits nasal flaring and has slight retractions of the intercostal muscles. His heart rate is 100 beats per minute and his blood pressure is 102/64 mmHg. On room air, he has a pulse oximeter reading of 98%. The EMT would recognize:
compensated respiratory distress.
A 7-year-old child was riding a bike downhill and struck a parked car. He was thrown from the bike, impacting his head and back on the roadway. Presently, he is alert, oriented, and complaining of a headache. His airway is open and his breathing is adequate. A radial pulse is easily palpated and his skin is warm and dry. After taking manual in-line spinal immobilization, the EMT would:
consider the need for supplemental oxygen.
A 92-year-old female informs you that she suffers from diabetic retinopathy. Subsequently, you recognize that this condition has occurred in relation to:
damage to blood vessels in the eye.
Croup is recognized as an illness that involves:
edema beneath the glottis.
A terminally ill female with ovarian cancer is receiving palliative care when she:
has a morphine pump implanted in her abdomen.
You have arrived on the scene to help a child who is short of breath. The mother is screaming hysterically that her 3-year-old boy cannot breathe, making assessment of the patient very difficult. Your initial action in the management of this situation would be to:
have your partner talk to the mother while you assess the child.
A patient with cataracts would most likely complain of:
intermittent blindness.
A malnourished child would be an example of:
neglect
You are called to a home for a 7-year-old female with a suspected upper respiratory infection. As you assess the patient, you note a bruise to her right upper arm. As you care for this child, it is essential that you:
perform a head to toe assessment.
As you assess a very sick 3-year-old with a fever, rash, and sore neck, you suddenly suspect he might have meningitis. Your immediate action would be to:
put on a mask and gown.
A mother asks you what causes her son to get bronchiolitis. You would inform her that it is caused by:
the respiratory syncytial virus.
When assessing a 65-year-old male patient, you note a tube-like device inserted into the lower portion of his trachea. You recognize that the device has most likely been placed to:
to permit the exchange of O2 and CO2.
You are concerned that a sick 5-year-old with lower abdominal pain and a temperature of 100.3°F has appendicitis. He describes the pain as generalized and crampy and although complaining of nausea, he is not vomiting. His pulse, respirations, blood pressure, and SpO2 are normal and there are no immediate life-threatening conditions. Based on these assessment findings, his father informs you that he does not wish his son to be transported, and will call the pediatrician in the morning. How would you respond?
"I have to tell you, if he has appendicitis, it will only get worse and become a major situation."
You have been called for an 84-year-old female who fell and hit her head. The patient is confused and has a laceration on her forehead. When getting the history from family members, which statement suggests that the patient is suffering from delirium?
"She could not remember her name yesterday."
An Emergency Medical Responder asks you why you should not overextend the airway on a pediatric patient when performing a head-tilt, chin-lift. Your reply would be:
"The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far."
While attempting resuscitation on a baby with a probable case of SIDS, which of the following questions would be appropriate for the EMT to ask the mother?
"Were there any problems with the pregnancy or his birth?"
The friend of an impoverished 50-year-old male called 911 because his friend had chest pain. On scene, the patient informs you that he does have a cardiac history and has not seen his cardiologist in over a year since he lost his job. Additionally, he does not want treatment or transport since he knows that both are expensive and will be unable to pay for it. In this situation your best response would be:
"You may be eligible for free or reduced-cost medical care."
An elderly female fell down three steps and is complaining of back pain. After performing the primary assessment, what question would be most important to ask first?
"Did you become dizzy before you fell?"
The father of a 45-year-old male with mental retardation summoned EMS because his son was not acting right. The patient is awake, but is nonverbal, which is not typical per the father. Your assessment reveals no abnormalities, and vital signs are normal. When calling the chief complaint into the hospital you would state that the patient:
"is not acting himself per his father."
A 15-year-old male with a history of seizures presents as lethargic but oriented. He takes the anticonvulsant Keppra and has no other medical history according to his mother. Of the following, what action would you take first?
Obtain a full set of vital signs.
You have been called to an apartment for a child who is sick. As you approach the 4-year-old boy, you note that he is sitting upright in his mother's arms with his chin thrust forward. He has a sickly appearance and is drooling. His airway appears open and his breathing is adequate. His radial pulse is strong and his skin is hot to the touch. Which of the following interventions would be most appropriate in the care of this patient?
Provision of blow-by oxygen
An 89-year-old female is short of breath and has a fever. Her SpO2 is low and she has crackles and coarse breath sounds to both lungs. When getting history from her family caregivers, which of the following would make you suspicious that the patient has aspiration pneumonia?
She was fine until just after eating lunch.
You are treating a 6-month-old patient who was accidentally dropped down a flight of steps, when her mother stumbled at the top of the stairway. The infant will only open her eyes and moan to deep painful stimuli, and tries to withdraw from the pain. Given these findings, you calculate her Glasgow Coma Score to be:
8.
What would be the minimally acceptable blood pressure for a 9-year-old girl who is suffering from a significant bleed from broken glass?
88 mmHg
You have been summoned for a diabetic patient with altered mental status. What sign would cause you to suspect that the patient is suffering from hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
Complaint of thirst and dry mouth
Your partner believes the 90-year-old male you are caring for is dehydrated. What sign best reinforces his suspicion?
Dry mouth and tongue
The mother of a 2-year-old has called EMS because her son has an axillary temperature of 103.2°F. On scene, your assessment reveals the boy to be confused and lethargic with a rectal temperature of 104.1°F. When caring for this child, you would:
remove the child's clothes and sponge with tepid water.
Poor position of an obese patient on the stretcher would most likely result in:
respiratory distress.
Assessment of a 4-year-old reveals him to be unresponsive with no spontaneous respirations or pulse. Your immediate action would be to:
start chest compressions.
Family members tell you that 3 hours ago, their 76-year-old mother suddenly became confused and had great difficulty speaking. However, within 15 minutes she returned to normal. Based on this description, the EMT should be suspicious of:
transient ischemic attack.
You are preparing to transport an 86-year-old female complaining of altered mental status and nausea and vomiting. Aspiration pneumonia would be best prevented by:
transporting in a semi-Fowler's position.
A 5-year-old male is drooling with stridorous respirations and has a fever of 104°F. What statement would concern the EMT most?
"It hurts to swallow."
A coworker is telling you about a recent run in which he provided care to a preschooler. Based on this description, you know that age of the patient would have been:
3-6 years.
A 77-year-old male who is blind and has a guide dog called 911 for chest pain. On scene you note no immediate life threats and now must move him to the stretcher, located in another room. Which one of the following is most appropriate, given his impairment of sight?
Carry him to the stretcher.
You have been called to a residence for a patient who is sick and not feeling well. The patient has multiple medical problems and is bed confined, with care provided by family members. The patient has a gastric tube and indwelling urinary catheter. What assessment finding should raise your suspicion that the patient has a urinary tract infection?
Cloudy urine in the bag of the urinary catheter
When assessing a 32-year-old male with a history of mental retardation, you note the protrusion of a clamped tube from her back in the area of her right kidney. The best method of determining what the tube is and why it is in place would be to:
Correct
When assessing a dialysis patient and his AV graft, which one of the following is of most concern?
Red and hot skin at the graft site
A central intravenous catheter is typically placed for what reason?
Repeated administration of medications
When assessing a 3-year-old who is in respiratory distress, which assessment finding would be most concerning?
Retractions observed above the clavicles
An 82-year-old female with nausea and vomiting has called 911. When obtaining her past medical history, she informs you that she suffered a transient ischemic attack (TIA) two months ago. Based on this, what should the EMT expect to find?
The absence of any neurological deficits
A 92-year-old male states that he "passed out" and fell down. He regained consciousness a few moments later, but had shortness of breath and sharp chest pain. Which one of the following in the patient's history is of greatest concern?
The patient states his left calf is tender and painful.
You have been summoned to a grocery store for a 6-year-old girl who has collapsed. On scene, you find the girl lying unresponsive on the floor. Quickly you open the airway and determine that she is not breathing. When you try to ventilate her with the bag-valve mask, you are unable to do so. Repositioning the head and reattempting ventilation is not successful in passing air into the lungs. Your next action would be to:
administer 30 chest compressions.
When providing care to the pediatric patient who has been injured or ill, the EMT must recognize that the most important aspect of care normally revolves around:
airway and respiratory support.
An infant is short of breath and has rhonchi in both lungs. He is alert with adequate respirations at a rate of 38 per minute. His skin color is pink but cool to the touch. When EMRs place a pediatric mask on his face, he becomes very upset and physically struggles to remove it. In this situation you would:
allow the mother to hold the infant and provide blow-by oxygen.
A patient with advanced dementia cannot provide an accurate medical history. In this situation, the EMT's best course of action would be to:
ask family members about the patient's past medical history.
Family has called you after the apnea alarm for their 1-month-old baby sounded. They state that the settings seem too high and the alarm goes off frequently. They would like the home health nurse to readjust the settings, so this scenario can be avoided in the future. They do not want the patient transported to the hospital and are prepared to sign a refusal. Assessment reveals no life threats to the airway, breathing, or circulation. Given the situation, you would:
contact medical direction.
The EMT is properly assessing the breathing of a 3-year-old when he:
counts the respiratory rate for 30 seconds and multiplies by 2.
You are by the side of a 2-year-old whose mother states he has had a cough for the past three days. His airway is patent and respirations labored. Intercostal retractions are accompanied by stridorous respirations. His skin is warm to hot and vital signs are as follows: pulse 152, respirations 28, SpO2 97%, and temperature 100.3°F. Breath sounds are clear and equal. Based on this presentation, you would suspect and treat the patient for:
croup
A new EMT asks you why the elderly are at a higher risk for developing pneumonia, as compared to those of a younger age. You inform him that the elderly are more susceptible to respiratory infections because of a(n):
decreased cough reflex.
The son of an 88-year-old patient states that he told his mother to double the dose of her antibiotic so she would "get better faster." This represents a problem given that the elderly have a(n):
decreased liver and kidney function.
On scene at a school cafeteria, you are presented with a 9-year-old boy who attempted to eat a small plum whole. He is conscious with stridorous respirations and unable to cough when instructed to do so. His skin color is gray and cyanotic. Your immediate action would be to:
deliver five abdominal thrusts.
A patient on a ventilator presents as cyanotic and listless. Alarms are sounding. Your immediate action would be to:
disconnect the ventilator and start positive pressure ventilation.
You have been called for a 2-year-old girl who has been sick for two days. In preparing to assess the patient, it is important that you recognize that patients in this age group generally:
do not like having clothing removed.
Ageism would occur when the EMT:
does not attempt to assess combative elderly patients with dementia.
When evaluating capillary refill time in a pediatric patient, the EMT must remember that:
it is considered very reliable.
You have been called to a skilled nursing home to transport a patient with fever and pneumonia to the hospital for further care and treatment. As such, you realize that the primary focus of your care will be:
oxygen therapy.
The mother of a 3-year-old boy has called 911 because her son has a low-grade fever and difficulty breathing. On scene, you are suspicious that the boy is suffering from croup. Which of the following statements made by the mother would reinforce this suspicion?
"At night, he seems to get a barking-like cough."
Which of the following would be the most appropriate instructions to give to another EMT concerning the ventilation of an unresponsive and apneic 3-year-old boy?
"Deliver one breath every 3 seconds."
Which statement indicates an accurate understanding of administering positive pressure ventilation (PPV) to a geriatric patient?
"Gentle ventilations that make the chest rise are adequate to provide oxygen into lungs."
Which of the following instructions would you provide to an EMT who is preparing to assess a stable 9-month-old boy who has a rash?
"Have the mother hold him as you do the assessment."
You suspect a very sick child to be in shock. His skin is dry, radial pulse weak, and blood pressure low. What statement made by the parents would reinforce this suspicion?
"He has had diarrhea for three days."
After a 29-year-old male with chest pain is removed from the house by stretcher, the man's 7-year-old son throws a temper tantrum. His mother is embarrassed and states that he has not done this since he was 2 years old. Given the situation, your response would be:
"I would not be concerned. This is a stressful event he doesn't understand, and he may just be having trouble coping with it."
Another EMT tells you that he had a call the previous shift in which he thinks a 5-year-old boy may be the victim of abuse since he had bruises on both upper legs. However, he did not communicate this to anyone nor transport the patient. Your best response would be:
"If you do not take steps to report this, you can be punished in a court of law."
You have been called to a nursing home for a 39-year-old male with shortness of breath. On scene you discover that the patient unsuccessfully attempted suicide several years ago by shooting himself in the head. The patient is belligerent and swearing at you as you assess him. Of the following questions, which one should you ask the nurse first?
"Is this his normal mental status?"
Which of the following statements made by another EMT regarding treatment of the pediatric patient in the prehospital setting would you agree with?
"It is critical that the EMT be able to determine the respiratory status of the patient as this commonly is the reason for acute deterioration."
You have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you what temperature would cause a child to seize. Your response would be:
"It is not the specific temperature that is of concern, but the rate at which the body temperature rises."
You have been called for a 79-year-old female complaining of shortness of breath. Due to the increased respiratory rate, cough, and production of discolored sputum, you are suspicious of pneumonia. A family member asks you how she can have pneumonia, when her temperature is only 97.9°F. Your best response is:
"It is not uncommon for the elderly to have pneumonia without the signs of high fever or chills."
A 5-year-old boy who is drooling has suspected epiglottitis. His pulse rate is 144, respirations 156, and blood pressure 110/52. He is noncompliant with the pulse oximeter, but his skin is normal colored. Which statement indicates proper care of this patient?
"Let's give him high-concentration oxygen through a mask."
While performing the reassessment of a 2-year-old male who is severely dyspneic, you note that he is now unresponsive and not breathing. He has a heart rate of 32 beats per minute and his skin is cool and diaphoretic. What instruction would you provide to another EMT who is helping you transport the patient?
"Let's start chest compressions and positive pressure ventilations."
A 9-year-old with a history of congenital heart disease is in cardiac arrest. What instruction would you give other EMTs on scene?
"Let's use the adult pads and adult settings for the AED."
The EMT would recognize potential elder neglect when the patient makes what statement?
"They do not give me my high blood pressure medications."
At the scene of an MVC, you must remove an injured child from his car seat and fully immobilize him prior to transport to the hospital. What statement made by the lead EMT indicates that this procedure is being performed correctly?
"To get her on the long board, let's tilt the car seat backwards, and carefully slide her out headfirst."
You are assessing a 12-year-old female in respiratory distress and a history of asthma. What statement, made by her mother, would be most concerning?
"Two years ago she needed to have a breathing tube in her throat."
You are assessing a 2½-year-old who was involved in a minor car accident. She is currently alert and oriented. While you are assessing her for possible injuries, which of the following would be considered appropriate?
Allow the child to hold a favorite toy during the assessment.
The mother of a 4-month-old boy awoke to find him in his crib and not breathing. On scene, you are providing resuscitative care while the parents watch on in disbelief. Which of the following would be most appropriate regarding their presence in the room?
Allow them to observe the resuscitation if they wish.
You have been called for a 6-year-old girl who has vomited once and is complaining of abdominal pain. When you are performing the secondary assessment and obtaining a medical history, which action by you would be considered most appropriate?
Allowing the child to play with the stethoscope before listening to her lungs
You are assessing a 6-year-old girl with possible pneumonia. She has labored breathing and a fever of 102°F. When you are assessing and classifying her respiratory status, which of the following signs would provide the strongest evidence that she is in decompensated or late respiratory failure?
Altered mental status
A skilled nursing facility has called you for a patient who has a problem with his intraventricular shunt. The patient is a 21-year-old man who was born with hydrocephalus and had the shunt placed shortly after. When assessing the patient, which sign would raise your suspicion that the shunt is occluded?
Blood pressure of 210/126 mmHg
A 77-year-old male got out of bed, became dizzy, and fell onto the floor, hitting the right side of his face. You find him sitting on the floor with his wife next to him. His wife states that he did not lose consciousness and that this has happened several times over the past few days, ever since the doctor put him on a new blood pressure medication. Presently, the patient is alert and oriented and complaining of dizziness and a headache. He has a history of coronary artery disease, emphysema, and hypertension. Which one of the following should you do first?
Correct Take manual in-line spinal stabilization and begin assessment.
Which of the following behaviors would the EMT recognize as uncharacteristic of a conscious and stable 2-year-old boy who fell and hurt his hand?
Does not cry or protest when taken from his mother
A patient with quadriplegia most likely suffered an injury to his:
cervical spine.
You have arrived at the emergency department with a young child whom you believe is the victim of child abuse. To which person would it be best to report your suspicion?
Emergency physician
What disease or illness would you suspect when confronted with a pediatric patient exhibiting respiratory distress and audible inspiratory stridor but no cough?
Epiglottitis
You have just arrived by the side of an elderly patient who took excessive amounts of his daily medications after becoming confused about what to take and when. Which one of the following is the immediate priority in caring for this patient?
Evaluate and support the patient's airway and breathing.
You are treating a short of breath 9-year-old male with a history of asthma. On scene he presents in severe respiratory distress with noted intercostal retraction, lethargy, and expiratory wheezing. His pulse is 136, respirations 32, and SpO2 95%. You have assisted him with his albuterol MDI and are transporting emergently to the hospital. As you reassess the patient, what finding is most concerning?
Heart rate 88
An 86-year-old female fell while walking to her bathroom. She is on the floor with severe pain to her right hip. Her airway is patent and breathing adequate. Family members tell you that she takes medication for high blood pressure, high cholesterol, and depression. When assessing the patient, what assessment finding is most concerning?
Heart rate of 120 beats per minute
A concerned parent asks you which vaccine will decrease the risk of her child getting epiglottitis. Which vaccine would you tell her?
Hib vaccine
On scene you are presented with a 21-year-old female with multiple disfigurements from birth defects. She is nonverbal and according to her home health nurse, has a fever, which requires transport to the emergency department. Your partner is familiar with her since he transported her last week for the same condition. When obtaining the patient's past medical history, which source should be tried first?
Nurse
You have been called to a residence for a 63-year-old female with a history of COPD who is short of breath. The patient is moderately dyspneic with the following vital signs: pulse 124, respirations 20, blood pressure 162/56, and SpO2 at 86%. She is using an oxygen concentrator set at 5 lpm. What is your best course of action?
Remove the oxygen concentrator and administer high-concentration oxygen to the patient.
Which of the following would be true regarding a 42-year-old female with traumatic paraplegia?
She would require a wheelchair.
An 8-year-old child was chasing his dog when he ran out into the street and was struck by a car. He is responsive to verbal stimuli and has an unstable pelvis and a bruise to the side of his face. His airway is open and his breathing is rapid and shallow. His radial pulse is rapid and weak and his skin is cool, moist, and diaphoretic. He also has burns and abrasions to his back after being thrown by the car onto the hot pavement. Based on these assessment findings, the EMT would treat the patient for what condition?
Shock
On the scene of a medical emergency, you are directed to a 5-month-old baby in his crib. He responds to painful stimuli by whimpering and he is breathing at a rate of 50 breaths per minute. His airway is open and his brachial pulse is fast, weak, and difficult to locate. Assessment of his skin reveals it to be cool and pale in color. According to the mother, he has had vomiting and diarrhea for four days. She also reports that the father of the baby is a diabetic. Based on this information, the EMT would recognize what condition?
Shock
While in an apartment to provide care for a 52-year-old female with shortness of breath, you note a baby sleeping in a nearby crib. Which of the following observations related to the baby would prompt you to intervene and speak to the family?
The baby is sleeping on her abdomen.
You are on scene of an MVC in which a 3-year-old was in a car seat in the backseat. The child appears not to be injured, but the mother would like her taken to the hospital for an evaluation. Since she will need a car seat for transport, what criteria would indicate that the car seat she is in cannot be used to safely transport the patient?
The car seat appears to have only been dented by the door handle.
A 66-year-old male has summoned your assistance because he is short of breath and his home pulse oximeter is reading 89%, despite 3 lpm of home medical oxygen. Assessment reveals an intact airway and adequate breathing. His radial pulse is normal and skin hot and dry. Vital signs are: pulse 84, respirations 18, and blood pressure 166/86 mmHg. Breath sounds are clear bilaterally. His pulse oximeter is fluctuating between 88% and 90%. In this situation you would first:
check his SpO2 with your pulse oximeter.
While assessing a patient on a home mechanical ventilator, the low pressure alarm sounds. Your immediate action would be to:
check the connection between the tubing and tracheostomy.
The EMT understands that vision disturbances caused by glaucoma occur secondary to:
damage to the optic nerve.
The family of an 87-year-old female has called 911. She is confused and exhibiting improper and out of character behavior. They inform you that she is a diabetic, but takes pills and not insulin. They also state that he has been complaining of dizziness and has been drinking water nonstop as well as urinating. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. Based on this history, you should be suspicious of and treat her for:
elevated blood sugar.
A hearing-impaired patient with a hearing aid is having a difficult time hearing your questions. Your initial action would be to:
ensure that his hearing aid is turned on.
When assessing a patient at an extended care facility, you note the presence of an ostomy bag. As such, you realize that the patient has impaired function of:
fecal elimination.
You have been called to a local day care for a sick child. On scene, panicked day care workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals her to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch with no signs of cyanosis. You are told that she has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to:
fever
You have been called to the side of a confused geriatric patient complaining of abdominal pain. Before palpating the patient's abdomen, you would first:
inform the patient that you will be pressing on her abdomen.
You have been called for a 4-year-old female who is short of breath. Her mother informs you that she has had a fever and runny nose for two days and today began to have difficulty breathing. Furthermore, she is having a difficult time waking her up. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times a minute with minimal chest and abdominal rise and fall. Her skin is warm to the touch with cyanosis around the lips. Your partner informs you that her heart rate is 124 beats per minute. You find the girl lying in bed with snoring respirations despite use of the head tilt,-chin lift airway maneuver. Your immediate action in caring for this child next is:
insertion of a nasal airway.
The fundamental reason a patient uses BiPAP when sleeping is to:
keep the small airways open.
You have been called for a conscious and alert 83-year-old male complaining of a fever for three days. He has a history of peripheral vascular disease. When assessing the patient's circulation, you have a difficult time feeling his radial pulse. Your next action would be to:
locate the patient's carotid pulse.
A frantic mother has contacted EMS because she believes that her 4-year-old daughter got into her blood pressure medications and ate three or four pills. She presents as awake and confused with pale skin that is cool and diaphoretic. Her pulse is rapid and respirations adequate. Vital signs are pulse 116, respirations 22, blood pressure 82/44, and SpO2 99%. After completing the primary assessment, your immediate action would be to:
obtain the name and dosage of the medication.
You have just arrived by the side of a nonverbal patient with snoring respirations. The caregiver states that they were eating lunch when she suddenly collapsed face first onto the table. She also states that she has a history of a stroke, high blood pressure, and colon cancer. Your priority in caring for this patient at this time would be:
open and look into the patient's mouth.
You have arrived at a residence to find a 6-month-old girl in her crib in cardiac arrest. Quick assessment reveals no rigor mortis or lividity. The mother states that she put the baby to bed at 9 P.M. last night and awoke at 3 A.M. to find her in her present state. Your first action would be to:
open the airway and provide 2 ventilations.
A 6-year-old male has a decreased level of consciousness. His mother states that they do not have health insurance so they did not take him to the hospital last week when he started vomiting and had copious amounts of diarrhea. She continues by stating that he has not had anything to eat or drink since then. He has snoring respirations that are rapid and inadequate. His radial pulse cannot be located, and his carotid pulse is rapid and weak. His capillary refill is 5 seconds and his skin is cool to the touch. Your first intervention in caring for this child would be:
opening the airway using the head-tilt, chin-lift.
A patient with kyphosis has fallen and is complaining of numbness in both arms. Regarding immobilization, you should:
place pillows in voids between the patient and the long board.
On scene, you must lead a patient's visually impaired wife from the house to the ambulance. This is best accomplished by:
placing her hand on your shoulder.
An 84-year-old male complains of generalized weakness and an ache in his left shoulder. He also reports mild shortness of breath, but has clear lung sounds and an SpO2 of 93%. When asked, he claims that the discomfort started after getting out of bed 2 hours ago. He denies any known injury to his shoulder or back. He has a history of coronary artery disease, hypertension, TIA, and irritable bowel syndrome. Family members state that he has early dementia. There are no obvious life threats and his vital signs are normal for his age. The appropriate treatment for this patient would include:
provide oxygen and treat as a cardiac patient.
You have been called for an unknown medical emergency. On scene you are presented with an 84-year-old patient who is confused and does not obey commands. The best means of determining the patient's normal mental status would be to:
question family members.
You have been called for a 91-year-old female who fell. Since your assessment reveals bruises to her body in various stages of healing and inconsistencies in information provided by her family, you are suspicious of geriatric abuse. Your best action would be to:
quietly transport and inform the emergency department physician.
An 81-year-old female called 911 when she suddenly lost vision in her right eye. Based on this description, the EMT should be suspicious of:
retinal detachment.
After placing a small rock in her mouth, a 7-month-old girl begins to choke. You are on scene within minutes and find her unresponsive in her mother's arms. You attempt to provide ventilation with the bag-valve mask, but are unsuccessful. Your next action would be to:
start cardiopulmonary resuscitation.
A 6-year-old female is in severe respiratory distress with inspiratory stridor and pale moist skin with cyanosis noted around his mouth. He is very lethargic and cannot hold his head up. His mother is panicked and reports that he has a history of asthma. Breath sounds are diminished and his vital signs are: pulse 162, respirations 40, blood pressure 122/66, and SpO2 81%. Your immediate action would be to:
start positive pressure ventilation.
Narrowing of the valves within the heart is best described as:
stenosis
A patient with a history of arteriosclerosis suffers from:
stiffened arteries.
You are responding to a patient with a tracheostomy tube who is weak and has a fever. In this situation, you can assume:
the tracheostomy tube is below the larynx.
A 3-year-old female has been accidentally struck in the chest with a baseball bat during a domestic altercation. Assessment indicates redness to the right lateral chest with no deformity, crepitus, or broken skin. Vital signs are pulse 124, respirations 22, blood pressure 108/62, and SpO2 99% on room air. Given these assessment findings, you would:
treat the child for suspected internal chest injury.
The EMT is correctly assessing breath sounds on a 3-year-old male when he:
understands that sounds from the left lung can be heard on the right side of the chest.
On scene, a 6-year-old male who is short of breath will not allow EMRs to place a nonrebreather face mask on his face. Assessment indicates moderate respiratory distress with the following vital signs: pulse 124, respirations 24, blood pressure 98/56, and SpO2 93%. At this time, you:
use a nasal cannula with 2 liters oxygen.
