NREMT

Which of the following medical conditions is most likely to cause enlarged airspace beyond the terminal bronchioles with collapse and destruction of the alveoli?

Emphysema

Which one of the following would be considered a weapon of mass destruction?

Sarin gas

An older women presents with severe weakness,hypotension, lower back pain and vomiting, Her husband tells you she has not taken her prednisone in several days because she has not been feeling well. Which of the following should you suspect

addisonian crisis

The paramedic realizes that if patients are diagnosed with ataxia, they are experiencing:

loss of coordination and balance.

A 26-year-old woman was bitten on the leg by a rattlesnake. She is conscious and alert, but is anxious. Her BP is 114/66 mm Hg, her heart rate is 112 beats/min, her respirations are 20 breaths/min, and her oxygen saturation is 97%. The paramedic should:

splint the affected extremity and establish an IV line with normal saline.

You are dispatched to a ranch where a tractor has overturned and pinned the operator. Upon arrival at the scene, you should:

visually assess the stability of the overturned tractor.

You are assessing a man with a acute chest pain. As you are inquiring about the quality of his pain, he clenches his fist. This is called __________ sign and nonverbally conveys a feeling of:

Levine's, pressure.

You are going to administer 0.01 mg/kg of epinephrine to a pediatric arrest patient. You are using 1:10,000 epinephrine (1 mg/10 mL). The patient weighs 18 kg. How much epinephrine should you administer?

1.80 ml

A patient who is in cardiac arrest and intubated, should receive how many ventilations per minute during resuscitation?

10

Your adult status asthmaticus patient requires rapid sequence intubation due to rapidly increasing airway constriction. Which of the following would be mostappropriate following tube placement confirmation?

2.5 mg of albuterol in 3-mL solution, nebulized and delivered with ventilation

How does nitroglycerin relieve ischemic cardiac chest pain?

By reducing cardiac preload

Stage one of labor begins with the onset of labor and ends with?

Complete dilation of the cervix

If a paramedic commits a scope of practice violation, which of the following may result?

Criminal charges

You are treating a 32-year-old patient that presents with chest pain, altered mental status, and hypotension. The cardiac monitor reveals a polymorphic wide complex tachycardia. Which of the following would be the mostappropriate initial treatment?

Defibrillation at 360 joules (monophasic) or 120 joules (biphasic)

The administration of D50W is contraindicated in which one of the following patients?

Diabetic ketoacidosis

You respond to a 19-year-old female with difficulty breathing. The patient is very anxious and only responds with a "yes" when asked if she is choking. She is coughing forcefully, but with no relief. How should you proceed?

Do nothing, encourage her to cough

In regards to fetal circulation, in which fetal blood vessel is the oxygen content highest?

Ductus venosis

When serum glucose levels are low, what does the nervous system release to promote liver glycogenolysis

Epinephrine and norepinephrine

Which one of the following fractures is most likely to cause compartment syndrome?

Femur

Which one of the following questions would help the paramedic determine if a patient has a substance abuse issue?

Have you ever felt guilty about your drinking?"

Which of the following is MOST indicative of hyperglycemic ketoacidosis?

Hyperpnea

Which one of the following medication routes would be considered parenteral?

Intranasal

Narcan (naloxone) will reverse which one of the following drugs?

Lomotil

who has the ultimate medical authority at the scene of a mass casualty incident

Medical director

Which of the following ECG abnormalities is associated with hypothermia

Osborn wave

Which of the following 12 lead ECG findings signifies a left bundle branch block?

ORS duration of 124ms, terminal S wave in lead V1

While conducting a secondary assessment on a trauma patient, you see your partner percuss both sides of the thorax. He is trying to distinguish between which two types of injury?

Pneumothorax versus hemothorax

Which of the following techniques or devices will provide the highest tidal volume to a patient?

Pocket face mask with oxygen attached

Which of the following medications would mosteffectively block sympathetic nervous system stimulation of the beta cells in the heart, thereby reducing the heart rate and force of contraction?

Propranolol

The human body attempts to prevent substantial blood loss from an injury by initiating the formation of a blood clot at the injury site. Which of the following is a blood protein that is responsible for initiating the formation of thread-like fibers to form the clot?

Prothrombin

During which wave, complex, interval, or segment of an electrocardiogram tracing does the absolute refractory period take place in a normally functioning heart?

Q-T interval

A Tp wave is usually not seen due to it being covered up by which EKG feature?

QRS complex

You are percussing the hemithorax of a patient with a stab wound to the right anterior chest at the 4th ICS midclavicular line. You note a dull percussion tone when assessing at the 5th ICS at the midaxillary line. What does this finding suggest?

Right hemothorax

Your adult patient presents with an altered level of consciousness. Due to the patient's surroundings and bystanders' statements, it is apparent he suffers from alcohol intoxication. His vitals are within normal limits, but his blood glucose level is low at 52 mg/dL. After ensuring adequate airway control and oxygen therapy, which of the following would be mostappropriate?

Thiamine and Dextrose 50

A patient in the denial stage of death and dying would most likely say which one of the following sentences?

This is not fair, I've never smoked and I've always eaten right and been healthy.

Paramedics are called to care for a patient who has taken too many antacids for his severe acid indigestion. Which one of the following will likely be observed?

Tingling, dizziness, tremors, and seizures caused by metabolic alkalosis

What is the primary responsibility of the alpha cells located in the pancreas?

To produce and secrete glucagon

You are preparing to perform transcutaneous pacing to your symptomatic bradycardia patient after atropine fails to improve his condition and vital signs. What energy setting should be used initially in an attempt to gain electrical capture in a conscious patient?

To the minimum setting

Who is responsible for sorting patients based on severity of injury in an MCI?

Triage Officer

Which radio frequency used by EMS has the greatest range but follows the curvature of the earth, making it subject to noise or physical interference?

Very High Frequency (VHF) low band signals

side effects of atropine sulfate may include

acute urinary retention

You are transporting a mother and her newborn baby to the hospital. As you are calling your radio report to the hospital, the mother suddenly becomes dyspneic and complains of a sharp pain to the right side of her chest. She is tachycardic, has a blood pressure of 90/68 and is developing cyanosis. She is MOST likely experiencing

an acute puomonary embolism

To complete the Cincinnati Prehospital Stroke Checklist, you should assess speech, facial symmetry, and:

arm drift.

EMS systems do not rely solely on mobile phone technology for distance communication because it:

can be overwhelmed during multiple-casualty incidents.

The main purpose of listening to heart sounds is to:

determine if the cardiac valves are functioning properly.

The paramedic is preparing to start an IV line on a 39 yo patient who is HIV positive and complains of abdominal pain. What personal protective equipment is recommended

gloves and protective eyewear

When assessing lead II in a patient with a heart rate of 70 beats/min, the Q-T interval is considered prolonged if it is:

greater than one half of the R-R interval.

a hypoxemic patient

has a decreased oxygen level in the arterial blood

You would MOST likely encounter bradypnea in a patient who

has metabolic alkloisis

In caring for a patient with acute renal failure caused by ibuprofen overdose, the paramedic should be most alert to/for:

hypovolemia.

You are dispatched for a motor-vehicle crash involving a single vehicle. When you arrive at the scene and exit the ambulance, a police officer tells you that there were two occupants in the car, one of whom was ejected. You should:

immediately request another ambulance and then begin triaging the patients.

Following a motorcycle accident, a woman presents with deformity to the fifth and sixth thoracic vertebrae, a blood pressure of 74/52 mm Hg, and a pulse rate of 74 beats/min. Her skin is pink, warm, and dry. Her clinical presentation is MOST likely the result of:

impairment of the sympathetic nervous system.

When obtaining a 12-lead ECG, lead V1 should be placed:

in the fourth intercostal space just to the right of the sternum.

DNA is stored within the _____ of every cell in the body.

nucleus

While performing a 12-lead EKG, you note the QRS complexes are negative in leads I, II, III and positive in lead V1. What does this finding usually indicate?

Ventricular tachycardia (VT)

Which of the following airway devices are indicated for patients who depend on hypoxic drive to breathe?

Venturi mask

Which of the following may be effective in decreasing atrial automaticity, reducing AV conduction velocity, and prolonging the AV node's refractory period when adenosine fails to terminate supraventricular tachycardia (PSVT) with narrow QRS complexes and adequate blood pressure?

Verapamil

Paramedics called to the scene of a home where a new teenage mother is highly anxious about a white mucus covering her infant's tongue. Paramedics recognize this is a common childhood infection called:

candidiasis.

An important aspect in the management of a patient with extensive full-thickness burns includes:

continuous assessment of the airway.

General treatment for a patient with full-thickness burns includes:

covering the burns with a dry, sterile dressing and keeping the patient warm.

The Apgar scoring system is used to:

evaluate the adequacy of a newborn's vital functions following birth.

Which of the following medical conditions is caused by the atrophy or destruction of both adrenal glands?

Addison's disease

Which of the following conditions is most likely to be associated with a right axis deviation on the twelve-lead electrocardiogram?

Chronic obstructive pulmonary disease

You are treating a 32-year-old patient that presents with chest pain, altered mental status, and hypotension. The cardiac monitor reveals a polymorphic wide complex tachycardia. Which of the following would be the most appropriate initial treatment?

Defibrillation at 360 joules (monophasic) or 120 joules (biphasic)

Your patient has a suspected blunt force closed head injury affecting the medulla oblongata. What body functions may be affected by the injury?

Heart rate regulation, blood vessel diameter, breathing, swallowing, and vomiting

The human body regulates homeostasis by communicating at the cellular level through the nervous and endocrine systems. Which of the following is responsible for serving as the command and control center for linking the systems together?

Hypothalamus

What life-threatening condition should be treated for in all trauma patients?

Hypothermia

Which of the following conditions would produce the MOST rapid loss of consciousness?

Insulin shock

You are transporting a patient with respiratory distress and pneumonia to the hospital. The patient confides she is HIV positive, and has been undergoing treatment for the last seven years. Given the pathological basis of HIV, what will be this patient's most likely cause of death?

Infections

Nitroglycerin should be withheld entirely or given with extreme caution in which of the following locations of an evolving myocardial infarction?

Inferior

While performing a 12-lead ECG on your patient you see ST elevation in leads II, III, and aVF. You expect the patient may be experiencing a (n) _________________ infarction.

Inferior

Upon returning to quarters after working a major car accident involving an entire family, a member of the press calls and requests information regarding the call. Which of the following would be the paramedic's MOST appropriate action?

Inform him that the patients were transported to the hospital, but that you cannot disclose the extent of their injuries.

You are assessing a 20 yom who was the unrestrained driver of a small car that struck a bridge pillar while traveling at a high rate of speed. His skin is cool and clammy, he has unlabored tachypnea, and his pulse is rapid and thready. Auscultation of his breath sounds reveals that they are clear and equal bilaterally. You do not see any visible trauma to the patient's head or face. Which of the following is MOST likely responsible for his signs and symptoms?

Intraabdominal hemorrhage

You are called to assist LE with an adult mental health patient who has minor abrasions after a scuffle with law enforcement officers. On the scene, the patient refuses EMS care for his injuries. Officers on the scene give you permission to treat the patient. Which of the following forms of consent would allow the paramedic to treat the patient without fear of violating his right to refuse care?

Involuntary consent

The paramedic finds the patient with an altered mental status, a heart rate of 128, a blood pressure of 68 mm/Hg systolic, delayed refill, and tachypnea at 26/minute following significant trauma and a severe external hemorrhage. With those findings, the paramedic knows the patient is in what cellular stage of shock?

Irreversible

Which of the following is responsible for the production and release of albumin, fibrinogen, globulins, and clotting factor?

Liver

For which one of the following patients is external pacing definitely indicated?

Mobitz Type II block associated with weakness

If a trauma patient presents with an epidural hematoma, which cerebral artery is most likelylacerated or injured causing the hemorrhage? A.

Meningeal artery

You are performing a physical assessment on a child with fever, general malaise, and a headache when he complains of a stiff neck. When you flex his neck forward, he moves his hips. What is your most likely field impression?

Meningitis

During a routine intubation of an arrested patient, which body substance isolation (BSI) precaution is not warranted by the paramedic?

Moisture-resistant gown

What is the antidote for a Tylenol overdose?

Mucomyst

Radio systems utilizing radio signals to carry multiple streams of audio and/or data at the same time are referred to as:

Multiplex

What type of communication system operational mode is required for an EMS agency to be able to communicate simultaneously in both directions while also performing telemetry transmission?

Multiplex mode

Which of the following operational modes used in EMS communication can transmit voice as well as telemetry simultaneously?

Multiplex mode

Which of the following pieces of personal protective equipment will afford you the BEST protection against exposure to tuberculosis?

N-95 respirator

You are managing an adult patient who has an isolated lower extremity fracture and is experiencing intense pain. You elect to administer fentanyl. Upon arrival at the hospital, you inform the ED staff that you administered a narcotic. Under what kind of medical directives are you operating?

Off-line

Of the following patient assessment devices, which one would be most useful in helping medical professionals diagnose child abuse from shaken baby syndrome?

Opthalmoscope

In the ACLS algorithm for ROSC (return of spontaneous circulation), what is the first step?

Optimize ventilation and oxygenation

The responsibility of completing continuing education hours and maintaining paramedic certification and licensure rests on the:

Paramedic.

Which of the following would be considered a major burn?

Partial-thickness burn that involves the full circumference of an appendage or body part

You have arrived at a small local airfield because a two-seater aircraft crashed during take off. As you approach the scene, what should be your first priority?

Personal safety

Classification of seizures can be divided into two groups: generalized and partial. Each of these two groups has sub-categories. Which of the following is not a sub-category of generalized or partial?

Petit-mal

Long-term use of which of the following medications is most likely to cause an elderly type II diabetic patient to develop the signs and symptoms of hyperosmolar hyperglycemic nonketotic syndrome?

Phenytoin

Damage to what neurological structure will result in failure of the diaphragm in a patient with a high cervical-spine injury?

Phrenic nerve

If a patient has stopped breathing due to a spinal cord injury, which of the following nerves is likely involved in the injury?

Phrenic nerve

Which of the following provides the primary innervation for the diaphragm as well as the associated components of the mediastinum and pleura?

Phrenic nerve

Your adult trauma patient suddenly becomes apneic during extrication from his extremely damaged vehicle in which he was the restrained driver. There are no obvious signs of chest trauma or crepitus noted. However, he is suspected of suffering a brain and/or spinal cord injury. If so, which of the following is most likely responsible for causing the patient to suffer respiratory arrest?

Phrenic nerve injury/compression

Which of the following clinical signs is MOST indicative of adequate breathing?

Pink oral mucous membranes

Common signs and symptoms of endometritis include all of the following, except?

Pinpoint tenderness in the umbilicus

You suspect your 66-year-old patient may be experiencing an ischemic stroke due to his signs, symptoms, and especially his past medical history. Which of the following hematological disorders wouldmost likely cause or worsen a stroke caused by a blood clot?

Polycythemia

You respond to a woman who is 37-weeks pregnant. Her blood pressure is 168/96 and you notice her hands and feet are swollen. She states she has a terrible headache and blurry vision. What is this patient's condition called?

Preeclampsia

At the end of ventricular relaxation, the left ventricle contains 110 mL of blood. This is referred to as the:

Preload

You and your partner have been dispatched for a code 3 pregnancy problem at a private residence in a small, rural community. The local volunteer fire station is unable to provide staffing for the call so there are no additional resources available. Your patient is 23-year-old female in active labor. She and the baby have been receiving the appropriate care during her pregnancy, both are healthy, and the due date is today. She says she feels the need to push - you visually inspect the perineum and notice there is bulging present. The community hospital is 40 minutes away. What should you do?

Prepare for imminent delivery in the patient's home

Your patient has a history of renal failure secondary to renal artery stenosis. What type of renal failure would this be?

Prerenal

Following prolonged dehydration, a 67-year-old man presents with hypotension, tachycardia, and oliguria. He has no past medical history. Which of the following is the MOST likely cause of his condition?

Prerenal acute renal failure

Where is the correct Lead II positive lead placement when acquiring a 12-lead tracing on a patient with chest pain and respiratory distress?

Proximal to left medial malleoli

You are with a geriatric patient for the first time. She is conscious and speaking. How should you address her?

Refer to her as "Miss," "Mrs.," or "Ma'am."

A patient experiencing a right ventricular infarction would be expected to present with:

ST elevation in leads II, III, and aVF.

Why is fibrinolytic therapy screening in the pre-hospital environment primarily conducted on ST elevation chest pain patients?

ST elevation is most likely present before permanent cardiac tissue damage has occurred

Which complex, interval, or segment of an electrocardiogram tracing represents the early part of ventricular repolarization?

ST segment

If a patient was experiencing acute injury involving the interventricular septum and anterior wall of the left ventricle, you would expect the 12 lead ECG to reveal:

ST segment elevation in leads V1 through V4

You are treating a 50-year-old male with a cardiac history currently complaining of chest pain. He is breathing at 20 times a minute, has an irregular heart rate of 136 beats per minute, and a blood pressure of 120/60. His twelve-lead-tracing indicates the presence of an ST-elevation myocardial infarction (STEMI). What makes the ST-elevation infarction treatment different from a non-STEMI patient's treatment?

ST-elevation infarctions may respond to fibrinolytics, so time and destination are critical for this patient

A patient displaying rapid and deep breathing may be suffering from what type of a disturbance?

Sepsis

When assessing infants, apnea lasting longer than twenty seconds is classified as?

Serious apnea

Paramedics suspect that a patient with Wolff-Parkinson-White (WPW) syndrome is in SVT. What EKG change would the paramedic expect to see on the monitor?

Slurring of the QRS complex known as a delta wave

A paramedic is preparing to apply a transdermal nitroglycerin patch on a patient. Which one of the following actions performed by the paramedic is NOT correct?

She applies and rubs the patch firmly against the patient's shaved chest.

You are treating a 55-year-old cancer patient who tells you her physician has had to increase her dose of morphine four times in the last year. Which one of the following statements would best explain why this increase might be necessary?

She has developed a tolerance to morphine.

You are on-scene with a patient who was struck by a car on her bicycle. She is conscious and alert but has a possible closed right mid-shaft femur fracture. The patient advises you that she is sixteen but does not need parental consent to be treated. Which of the following situations would make this statement true?

She is an emancipated minor granted by the court

Which of the following interventions is considered a class III intervention for the treatment of regular wide complex tachycardias with rates over 150/minute?

Sotalol at 100 mg slow IV over five hours

Your patient is in hypertensive crisis. After assessing her breathing status, you find she is tachypneic and only speaks in two- or three-word sentences. Her skin color is ashen, with cyanosis to the fingertips. She also has a low pulse oximeter reading. Bystanders state the patient experienced a brief seizure prior to EMS arrival. Given this presentation, which one of the following is most indicative of inadequate breathing

Speech pattern

During a mass-casualty incident, personnel gather at a central point and are sent by the incident commander to various areas of the scene. This central point is referred to as the:

Staging area

You arrive on scene of a 48-year-old male in cardiac arrest. After 35 minutes of ALS resuscitation efforts, the patient remains in asystole. There is no indication that further efforts will be successful. At least ten family members are gathered in an adjacent room and are very emotional. How should you proceed?

Stop resuscitation and inform the family that the patient has died

Which one of the following abnormal respiratory assessments indicates an abnormality in the subglottic portion of the upper airway?

Stridor

a 62 yom complains of chest pain, nausea, and weakness. His Bp is 118/68 mm Hg, his pulse is 60 beats/min and his respirations are 18 breath/min. His medical history includes diabetes, anxiety, and hypertension. He currently takes insulin, tadalafil, lisinopril and alprazolam. Which of the patients medications would MOST likely alter the paramedics normal treatment plan?

Tadalafil

The ambulance begins to hydroplane while transporting a patient on a wet roadway. The vehicle operator should:

Take his/her foot of the gas and gradually slow down

After intubating an apneic adult patient, you quickly auscultate decreased breath sounds on the left side. Which of the following is most likely to cause this abnormal finding?

The ET tube has entered the right mainstem bronchus

What occurs at the beginning of ventricular contraction?

The atrioventricular valves close and the semilunar valves are forced open.

Which of the following MOST accurately describes the process of gas exchange in the lungs?

The gases exchanged in the lungs move from an area of greater concentration to an area of lesser concentration.

Which of the following is the most likely cause of a sudden loss of a capnography waveform on the monitor of an adult cardiac arrest patient who is intubated and is receiving chest compressions?

The patient's ET tube is dislodged, disconnected, and/or kinked

Your adult asthma patient is experiencing a severe asthma attack that is not improving after oxygen and maximal bronchodilator therapy. In which of the following situations should you consider intubating a conscious asthma patient?

The patient's PCO2 is increasing after maximum therapy

Your full-term pregnant patient is in active labor with contractions lasting one minute and coming every three minutes. Deciding that birth is likely imminent before you can safely reach the hospital, you prepare to help deliver the patient's neonate. The patient's vital signs are BP 128/72, HR 118, R 20, SpO2 95%. How much oxygen therapy should the patient receive, if any?

The patient's SpO2 is 95%, so oxygen therapy is not indicated

What can a paramedic expect to occur in a closed-head injury patient when the intracranial pressure increases and the mean arterial pressure decreases?

The patient's cerebral blood flow decreases

When responding to a patient with bipolar disorder, you might expect to find which of the following?

Wide mood swings

When giving a report over the radio to the hospital while en route, which of the following should not be given as it would constitute a violation of your patient's Protected Health Information (PHI)?

The patient's name

The clinical presentation of thyroid storm MOST closely resembles that of:

amphetamine use.

While backing up an ambulance, the spotter should be located at?

The rear of the ambulance on the driver's side

You are managing a patient with a penetration injury to the inner left thigh that is bleeding profusely. You have already attempted direct pressure, elevation, and cold compress application, but the bleeding has not yet slowed. What would be the next logical step in the progressive management of this external bleed?

Tourniquet application

During a mass-casualty incident, what officer is responsible for communicating with hospitals to ascertain their capabilities?

Transport

PVC's that appear in every third beat are referred to as?

Trigeminy

Sodium is the most common cation and is regulated primarily by the rennin-angiotensin-aldosterone system (RAAS). In the RAAS system, what does Angiotensin II cause?

Vasoconstriction and Aldosterone secretion

Which of the following can produce a sudden but temporary loss of consciousness most often associated with one or two minutes of nausea and vomiting prior to the loss of consciousness?

Vasovagal syncope

You are concerned that your adult MVA patient may have trouble protecting his own airway due to a suspected closed head injury and an obvious decreased level of consciousness. You and your partner have elected to perform rapid sequence intubation. Your partner administers succinylcholine and you are able to intubate your patient successfully. You are aware that you have a long transport time to the hospital, so you choose to administer a long-acting paralytic. Of the following, which medication and dosage is the best choice for this patient?

Vecuronium 0.1-0.2 mg/kg via IV push

You are responding to a possible assault call. You choose to park down the block from the house, as police have not yet made the scene safe. However, you see what looks to be a patient in distress in the upper story window. What would be the safest approach in this situation?

Wait for responding police to control the situation and say that it is safe for EMS

When brain-injured patients are said to have cognitive deficits, that means:

a deficit of language and communication, memory, and perceptual skills.

Post-cardiac arrest care for a child may include

a dopamine infusion for fluid refractory hypotension

Common clinical signs of respiratory distress include all of the following, EXCEPT:

a flushed appearance.

When using a laryngeal mask airway (LMA), how does the paramedic know when the device is successfully inserted?

When the cuff is inflated, the LMA will move slightly upward approximately 0.5-0.75 inch

While assisting a full-term pregnant female in delivering her newborn, at what point should the paramedic consider suctioning the infant's nose and mouth?

When the newborn's head is delivered

For breathing to occur intrathoracic pressure:

decreases and then increases.

You and your team are performing CPR on an 8 yof who is in cardiac arrest. You have reason to believe that the child ingested her mother's amitriptyline. Reassessment after 2 min of CPR reveals that the child is in ventricular fibrillation, you should

defibrillate and immediately resume CPR

While assisting in the delivery of a baby, you note that a loop of the umbilical cord is protruding from the vagina, just ahead of the presenting part of the fetus. As your partner applies oxygen tothe mother, your should

elevate her hips, instruct her to pant with each contraction, and gently push the baby back up into the vagina

You are transporting an intubated 7 yo who experienced a traumatic brain injury. Full spinal precaustions have been applied, you are ventilating the child at a rate of 20 breaths/min, and intraosseous catheter has been placed in the child's distal femur. Reassessment of the child's blood pressure reveals a reading of 70/40. You should

give a 20mL/kg crystalloid bolus and reassess blood pressure

The ratio of red blood cells to plasma is called

hematocrit

You should be MOST suspicious that your patient has experienced a cardiac tamponade if he or she presents with:

hypotension, jugular venous distention, and normal lung sounds.

Polycythemia is a condition that results in:

increased oxygen-carrying capacity of the blood.

A person's level of consciousness is regulated by the:

reticular activating system.

A cardiac patient with chronic pain tells the paramedic that he has had severe ringing in his ears for two days. He is frustrated and agitated by the constant noise. The following medications are part of the patient's medication list. Which one of his medications at toxic levels might be responsible for the patient's tinnitus?

Baby aspirin

You are ventilating a severely dehydrated apneic 70 yom with a history of end-stage emphysema. in order to minimize the risk of lowering his cardiac output and blood pressure, you should

adjust the ventilation rate to allow complete exhalation

You are called to an assisted living facility for a sick resident. The patient, a 70-year-old woman, reports tinnitus and difficulty concentrating. The patient's neighbor, who is present at the scene, tells you that the patient has consumed five or six cups of ice over the past hour. You should suspect:

chronic anemia.

While assessing a woman in labor, the paramedic notices that a loop of the umbilical cord is protruding from her vagina. The paramedic should:

ensure that the umbilical cord continues to pulsate.

Assessment of a patient with blunt chest trauma reveals labored breathing, tachycardia, pallor, diaphoresis, collapsed jugular veins, and absent breath sounds over the right hemithorax. you should

support ventilation, treat for shock, and prepare for transport

A 3-year-old child with a high fever experienced a seizure that lasted approximately 5 minutes. Treatment should include:

supportive care and transport.

What is the correct dose of atropine for a pediatric patient with symptomatic bradycardia?

0.02 mg/kg

Which one of the following is an acceptable dose for the drug diltiazem?

0.25 mg/kg

Which of the following represents the appropriate initial drug and dose that is given to all adult patients in cardiac arrest?

10 mL of epinephrine 1:10,000 every 3 to 5 minutes

Which one of the doses listed below could be an appropriate dose of dopamine for a patient in refractory symptomatic bradycardia?

10 mcg/kg/minute

As a general rule, what is the maximum amount of traction you should apply to a traction splint?

15 lbs

For a patient in V-Fib, what is the second dose of Amiodarone that should be administered?

150 mg

The appropriate second dose and method of administration of amiodarone for a patient with refractory ventricular fibrillation is:

150 mg via rapid IV/IO push.

You are working an adult cardiac arrest patient who is not responding to electrical therapy. According to ACLS guidelines, what is the appropriate concentration and dosage of epinephrine in a cardiac arrest patient?

1mg IV/IO every 3-5 minutes with a concentration of 1:10,000

The appropriate dose and route for magnesium sulfate in the setting of status asthmaticus is:

2 grams IVP over 30 minutes

Your trauma patient is bleeding profusely and showing the signs and symptoms of decompensated shock. MCP recommends you administer 2 liters of lactated Ringer's solution via rapid IV bolus. Which of the following set-ups is most likely to deliver the ordered fluids quickest and safest?

2 large bore short IV catheters, 1-16g in the right AC and 1-16g in the left AC, both with 10 gtts/min infusion sets under a pressurized system

Intelligence quotient scores of less than _____ are indicative of profound retardation.

20

Assessment of a 20 month old child reveals lethargy, poor skin turgor, dry mucous membranes, delayed capillary refill and a heart of 190 beats. Which of the following is the MOST appropriate rate for fluid rehydration?

20 mL/kg

A 4-year-old child remains in supraventricular tachycardia following an initial dose of adenosine. The appropriate second dose of adenosine for this child is:

3.2 mg

Following the resolution of PVCs from a loading dose of lidocaine at 1 mg/kg, you are going to initiate a lidocaine infusion at 2 mg/minute. If you mix 2 grams of lidocaine into a 500 mL bag of D5W, what would be your drip rate, using a microdrip administration set?

30 gtts/minute

A 145-pound man requires a dopamine infusion at 15 µg/kg/min for severe hypotension. You have a premixed bag containing 800 mg of dopamine in 500 mL of normal saline. If you are using a microdrip administration set (60 gtts/mL), how many drops per minute should you deliver to achieve the required dose?

36

You are treating a male patient with burns to his entire left arm, anterior abdomen and chest, and anterior left leg. What percentage of body surface area has been involved?

36%

Difficult deliveries will most likely take place in which trimester

3rd trimester

During your assessment, you find that your pulse oximeter reads 100% when your patient is on 4 liters per minute oxygen via nasal cannula. You suspect your patient's hemoglobin is fully saturated. How many oxygen molecules can one hemoglobin hold when it is considered fully saturated?

4

Which ribs are the most commonly fractured?

4-8

What is the approximate minute alveolar volume of a patient who breathes in 550 mL of air at a rate of 14 times per minute

5.4 L

Calculate the APGAR score for the following newborn: - Appearance: acrocyanosis - Pulse: 140 - Grimace: crying - Activity: active - Respiratory: vigorous cry

8

Evaluation of a newborn reveals that it has a pink body, but blue hands and feet; a strong cry; a pulse rate of 110 beats/min; and some spontaneous flexion of the extremities. It pulls its leg away when stimulated. You should assign an APGAR score of:

8

a 7 year old, 45 pound child is in cardiac arrest. The ECG shows ventricular fibrillation. if the first defibrillation is unsuccessful, you should defibrillate with

80 joules

You are assessing a 7-year-old boy who has signs of shock. A low normal systolic blood pressure for a child of this age is:

80 to 85 mm Hg

When using the SOAP format to organize the written patient care report, which section would contain the paramedic's general impression of the patient based on findings?

A - Assessment data

Which of the following signs would indicate a severe pericardial tamponade?

A drop in the blood pressure of greater than 10 mm Hg during inhalation

Which of the following corresponds with phase 3 (C-D) on a normal capnographic waveform?

Alveolar gas is passing by the CO2 sensor.

a 27 yof overdosed on an unknown type of drug. Her skin is hot and flushed and her breathing is rapid and deep. Her bp is 98/64 and her heart rates is 120. Which of the following drugs would MOST likely explain her clinical presentation?

Aspirin

Paramedics are caring for a patient experiencing chest pain. All of the following medications must be administered to this patient according to standard protocol. Which one should be given first?

Aspirin, 325 mg PO

At the scene of a violent crime, a man has been decapitated with an axe. Which of the following is the MOST appropriate way for you to manage this situation?

Avoid touching the body if at all possible.

A mechanical-piston device and load-distributing band in EMS is used to describe the category of machine which does which of the following actions?

Chest compressions

A 45-year-old man sustained an isolated stab wound to the upper left thigh during a bar fight. As you approach him, he is conscious and screaming in pain. You can see bright red blood spurting from the wound. You should:

Control the bleeding immediately.

Which of the following is the MOST effective way to reduce the mortality and morbidity resulting from trauma?

Coordinate and conduct injury prevention programs.

Which one of the following will have the greatest effect on cardiac output in a 65-year-old patient who has a baseline stroke volume (SV) of 70 mL and heart rate is 70 beats per minute?

Decrease in heart rate of 20, and decrease in stroke volume of 10

Which of the following conditions is characterized by extreme polyuria and polydipsia caused by a deficient production or secretion of the antidiuretic hormone or the inability of the kidney tubules to respond to the hormone?

Diabetes insipidus (DI)

You are caring for a morbidly obese, bariatric patient. While taking the history, which one of the medical conditions listed below are you least likely to encounter?

Diabetes mellitus Type I

When considering all the necessary links in the "chain of survival" as it pertains to the continuum of medical care and services, what component would have the greatest impact on the overall functioning and utilization of the medical system?

Dispatch

Which of the following statements regarding to the proper disposal or handling of sharps is correct?

Dispose of the needle in an appropriate container immediately after use.

Which of the following interventions has the greatest impact on patient survival from sudden cardiac arrest?

Early CPR and defibrillation

A 17-year-old patient with a history of asthma is suffering a severe attack. She is extremely dyspneic, has minimal air exchange with inspiratory and expiratory wheezing, and a pulse oximeter reading that is dropping rapidly. Following oxygen therapy and intravenous access, what drug/dose/route combination is most appropriate?

Epinephrine, 0.3 mg, IVP

Which type of trauma is associated with the highest morbidity and mortality rate in infants and children?

Head

The National Model EMS Clinical Guidelines indicate all the following considerations regarding head injuries except:

Hyperventilation with a bag valve mask in order to raise the PaO2

Which of the following is appropriate for the initial intervention of stable paroxysmal supraventricular tachycardia in a child that is not caused by heart disease or congenital defect/disease?

Ice pack maneuver

Which of the following occurs when a patient is hypoventilating?

Increased PaCO2, decreased PaO2, decreased pH

During compensated shock, what helps the body maintain cardiac output as well as normal systolic blood pressure?

Increased catecholamine production

Your patient is unresponsive and vomiting. Due to an intact gag reflex you are unable to intubate him to protect the airway. As such, during transport to the hospital, what is the best position in which to place him on the cot?

Lateral recumbent

Pregnant women with hyperemesis gravidarum are at greatest risk for:

Mallory-Weiss syndrome.

Which of the following situations would MOST likely require involvement of a technical rescue team

Man who fell from atop a mountain and landed on a ledge

The pre-hospital administration of medications to reduce intracranial pressure is controversial. However, medications that may be ordered by MCP to reduce cerebral edema and/or circulating blood volume includes which of the following?

Mannitol

Your adult patient was awakened with severe difficulty breathing and chest pain. During your assessment, you note rales and rhonchi in all lung fields and pitting edema peripherally. His heart rate and blood pressure are elevated, and he has a productive cough with pink, frothy sputum present. What medication may be effective in reducing the dyspnea after nitroglycerin administration if the symptoms continue and his blood pressure remains within normal limits?

Morphine

When interpreting an ECG on a 12-lead machine, you are unable to assess for which one of the following findings?

Myocardial contraction

Which of the following conditions would likely require a higher than normal loading dose of a medication to be administered in order to reach a therapeutic level?

Obesity

You are on scene with a forty-year-old female with a positive Murphy's sign during your examination. What symptom would the patient exhibit during your examination to result in the patient having a positive Murphy's sign?

Pain upon inspiration during palpation of the border of the liver directly below the rib cage

You are sitting in the front passenger seat of a small car assessing the driver after he struck a tree head-on. Your partner is maintaining manual stabilization of the patient's head from the back seat. The driver's side airbag deployed, but the passenger's side airbag did not. The patient's legs are pinned by the dashboard, and rescue personnel are preparing to disentangle him. What should be your MOST immediate priority?

Remaining at least 20 inches from the passenger's side dashboard if possible

Your adult respiratory insufficiency patient's respirations are shallow and irregular at six times per minute. His SpO2 is 76 mm Hg, and you suspect carbon dioxide retention due to the decreased respiratory effort. Which of the following should you suspect?

Respiratory acidosis

You are en route to the hospital with a patient in respiratory extremis. You have administered a sedative and a paralytic drug to the patient, but have been unable to successfully intubate him after two attempts. Your EMT partner tells you that the patient's oxygen saturation is 98% and that his heart rate is 80 beats/min. Your estimated time of arrival at the hospital is 7 minutes. Which of the following would be the MOST appropriate action?

Resume bag-mask ventilations at 12 breaths/min and insert a multilumen or a supraglottic airway device

After an acute inferior myocardial infarction (AMI), the paramedic notices the patient has developed ascites and bilateral jugular vein distention. Which condition should be suspected?

Right-sided heart failure

If fentanyl is administered too rapidly IV push, it can cause which one of the following adverse side effects?

Rigid chest-wall syndrome

You are caring for a neonate born five weeks prematurely to a mother who has had no prenatal care. Immediately after birth, he was gasping to breathe. But despite oxygen and stimulation, he has become apneic. What is this condition called?

Secondary apnea

During which phase of patient assessment would an unstable, multi-system trauma patient have her fractured tibia/fibula splinted?

Secondary assessment

Of the following actions associated with adult endotracheal intubation, which one is NOT correct?

Secure the tube at a depth of 26 cm at the lips.

Which of the following patients is the BEST candidate for nasotracheal intubation?

Semiconscious, pulmonary edema, tachypnea

You are assessing a patient with a neurological disease that affects the afferent tracts of her spinal cord. You would expect the patient to have trouble with?

Sensory input

What tissue is most often harvested for transplantation?

Skin

Your adult trauma patient sustained blunt force abdominal trauma from an industrial accident. He is conscious and alert with equal breath sounds and a pulse of 110/minute. His abdomen is tender on palpation with guarding and rigidity, especially in the upper quadrants. The patient reports severe left shoulder pain but denies injury to the area. Inspection reveals no obvious injury to the left shoulder region, and the patient denies any change in pain during palpation. Which of the following injuries is most likely to cause the patient finding?

Splenic rupture

During a detailed physical exam of your dyspneic 73-year-old female patient, you palpate small pockets of air in the subcutaneous tissue of the skin in the upper right region of her chest, just below her clavicle. Which of the following medical conditions is most likely to cause this abnormal finding?

Spontaneous pneumothorax

You respond to the home of a 17-year-old female who is having a seizure. Her mother explains that her daughter has a history of seizures. She tells you that her daughter usually has a seizure and then recovers quickly, however, today, her daughter had a seizure and before recovering began another seizure. She is experiencing:

Status epilepticus

What does it mean to say that two drugs have a synergistic effect?

The combined medications have a more profound effect than if each is given alone.

You are on-scene with a patient who accidentally lacerated the lateral aspect of his right upper thigh with a chainsaw. You are able to quickly control the hemorrhage with a pressure dressing and direct pressure, however, the loss of blood was obviously significant prior to your arrival. The patient is conscious but confused with cool, pale, diaphoretic skin. His heart and respiratory rates are elevated. The patient's only complaint is being cold and increasing shortness of breath. Why is your patient most likely becoming increasingly dyspneic?

The direct loss of erythrocytes decreases the amount of oxygen the available blood can carry to the tissues of the body

You are on-scene with a 59-year-old patient who complains of generalized weakness. On arrival, she is found to be lethargic, hypotensive, and experiencing unexplainable bradycardia at 42 beats per minute. Her breath sounds are clear and equal, and respirations are adequate. Which of the following could be the possible cause of your findings?

The ingestion of a medication with negative inotropic properties

When administering an intramuscular injection to an adult, which of the following is most appropriate?

The injection should be delivered at a 90-degree angle to the skin, and the volume to be injected should not exceed 5 mL in a large muscle mass

Your adult patient is in cardiac arrest. Although intubation, positive pressure ventilations, defibrillation attempts, and adequate CPR are being delivered effectively, intravenous access has proven impossible to this point. This prompts you to begin looking for a good intraosseous site. Which of the following potential IO sites would be most appropriate for an adult in cardiac arrest in need of infusion and cardiac medication administration?

The proximal tibia, at the tibial tuberosity insert just 2 cm medially from that site

In which of the following situations is transcutaneous cardiac pacing (TCP) clearly indicated?

Third-degree AV block in a patient with pulmonary edema.

A patient's medication regimen includes fluoxetine, Toprol, Proscar, lansoprazole, and Klonopin. Which of these medications is used to treat cardiovascular disorders?

Toprol

While working a cardiac arrest patient, you quickly note the presence of a cardiac rhythm that appears to be a polymorphic ventricular tachycardia. It is characterized by short periods of alternating amplitudes of the chaotic waveforms. What is the cardiac arrhythmia on the monitor?

Torsades de pointes

You suspect your adult trauma patient has a potential complete spinal cord transection. If so, which of the following would you expect to find?

Total absence of pain, sensation, and movement (paralysis) below the point of the transection (injury)

You are called for an unresponsive male at home. You find him in bed in the back of the house. You have to use the front door for extrication, and the patient is unstable. What type of moving technique would you use?

Urgent move

After assisting a pregnant patient to deliver her full-term newborn at home, you quickly dry the infant and open his airway to help begin spontaneous respiration. However, after a few seconds, you realize the newborn has copious secretions in his airway preventing effective spontaneous respiration. Which of the following should you do to safely and effectively clear the infant's airway?

Use a bulb syringe to suction his mouth first and then his nose second

If your adult patient is suffering an anterior wall left ventricular myocardial infarction, which leads of a 12-lead EKG are most likely to show evidence of the infarction?

V3 and V4

Which of the following arrhythmias is most likely to cause hypotension, decreased cardiac output, and decreased brain perfusion?

Ventricular escape rhythm

You and your crew have decided to fly an 18-year-old female patient by helicopter to a regional trauma center. As the lead responder, you know that you never want to approach the helicopter until?

You receive the okay from the crew members of the helicopter

Paramedics are assessing a woman who struck a utility pole with her car. She wsa not restrained and is still in the vehicle. Her loc is decreased, her skin is pale and diaphoretic, and her pulse is rapid and weak. Which of the following extrication techniques would be the MOST approopriate to use for this patient

apply a cervical collar, slide a long spine board underneath her, and remove her from the vehicle

After inserting an advanced airway device in an adult patient who is in cardiac arrest, you should:

deliver each breath over a period of 1 second at a rate of 10 breaths/min.

In preparing a patient for rapid sequence intubation (RSI), the paramedic assesses and documents a Mallampati score of "Class III." Based on this information, the paramedic should next:

discontinue the RSI process and seek alternative airway management options.

Shortly after his dialysis treatment, a 66-year-old man presents with confusion, a headache, and nausea. You should suspect:

disequilibrium syndrome.

Following delivery of a baby who was born at 38 weeks, you note the presence of thick particulate meconium in the amniotic fluid. The newborn has a strong cry, a heart rate of 120 beats/min, good muscle tone, and central cyanosis. You should:

ensure the newborn is warm and dry, suction its mouth and nose, and administer blow-by oxygen.

Prehospital treatment for a patient with a blood glucose reading of 400 mg/dL and polyuria includes

fluid rehydration with an isotonic crystalloid

You are administering midazolam to a seven-year-old male to stop a seizure. The most likely side effect of this medication would be:

respiratory depression.

When securing a patient with a suspected spinal injury to a long backboard, it is important to:

secure the torso as your partner maintains manual stabilization of the head.

Tidal volume is defined as the:

volume of air moved in and out of the lungs per breath.

A 9-year-old child has generalized weakness; blood in the stool; and bruising, even from minor trauma. These findings are MOST consistent with:

leukemia

Easy bruising, lymph node enlargement, and splenomegaly are clinical manifestations of:

leukemia.

If a patient complained of orthopneic dyspnea, he would mean that he has difficulty breathing when he:

lies flat.

All of the following are techniques that can be used in vehicle stabilization, except:

lifting the vehicle six to eight inches off the ground with air bags.

In order to reduce your risk of personal injury while lifting and moving a patient, you should:

minimize the number of body lifts you have to perform

While treating a patient with severe pain, the paramedic accidentally gives the patient 10 mg of morphine when he meant to give 5 mg. As a result, the patient becomes bradycardic and hypotensive. The paramedic's action constitutes:

misfeasance.

When performing tracheobronchial suctioning on an adult, it is important to:

monitor the patient's oxygen saturation and cardiac rhythm.

following a research program in which you studied men between the ages of 40-50 who have angina, you analyze your data and achieve quantifiable statistics by adding the variables of mean, median, and mode, the mode is the

most frequent age of the participants

Immediate care for a severely burned patient includes:

moving the patient to safety.

Treatment for a patient who has a pulse and a documented core body temperature of 92.8° F includes:

passive and active external rewarming.

Which of the following is of LEAST pertinence when assessing the mechanism of injury of a patient who was involved in a mvc

patient weight

Addressing a patient with an expression such as "Hello, my name is Eryk and I'm a paramedic. What's your name?" allows you to:

perform a cursory mental status assessment.

When lifting a patient who is on an ambulance stretcher, you should:

position your palms up whenever possible.

After delivering a baby, you clear the airway and take measures to prevent hypothermia. As you assess the newborn, you note the presence of central cyanosis and a pulse rate of 90 beats/min. Treatment should include:

positive pressure ventilation.

Which of the following is an abnormal physiologic process that occurs at the capillary level during shock

precapillary sphincter relaxation in response to lactic acid buildup

You are ordered to administer morphine sulfate to an eight-year-old child with an open tib/fib fracture. Which of the following dosage ranges and routes would be most appropriate?

0.1 - 0.2 mg/kg IV

For a patient in cardiac arrest, how many joules should you deliver with a biphasic monitor?

120-200J

What is the target heart rate for a 30 yom who had a resting heart rate of 70 beats/min

153 beats/min

Your adult trauma patient is found to be hypotensive from an apparent lower extremity hemorrhage that is now controlled with a pressure bandage. Which of the following IV catheters would you choose for this patient?

16-gauge IV catheter

Your 23-year-old diabetic patient was found unresponsive with increased respirations, hypotension, and bradycardia. Family members state he recently had a tooth pulled and was prescribed Vicodin. Which of the following is most likely to cause the patient's presentation?

Ketoacidosis

A 70-year-old man complains of dyspnea that began 2 days ago. He cannot speak more than three words at a time without stopping to catch his breath. Which of the following assessments would give the paramedic the MOST information regarding the possible cause of his dyspnea?

Lung sounds

If the medical command physician orders you to deliver a 200-mL normal saline bolus to a patient showing the signs and symptoms of cardiogenic shock with profound hypotension, out of the following, which must be monitored closely due to this intervention?

Lungs sounds for increased congestion/rales

While assessing a middle-aged man who complains of nausea and weakness, he suddenly becomes unresponsive. The cardiac monitor shows that he is in ventricular fibrillation. After determining that he is apneic and pulseless, you should:

start CPR and prepare to defibrillate

Which of the following situations BEST describes a mass-casualty incident

when there are two critical patients and one ambulace

You are assessing an adult patient with a head injury. He opens his eyes only when you speak to him, and when you ask him his name, he replies slowly by saying "No thank you." When you apply a painful stimulus by pinching his arm, he pulls his arm away from you. What is this patient's Glasgow Coma scale score?

10

Which of the followng patients would benefit the Most from continuous positive airway pressure (CPAP).

61 year old make with severe respiratory distress and diffuse crackles

Based on the normal discharge rate of the sinus node, how many total P waves would the paramedic expect to see on an ECG strip?

65

Which one of the patients described below is the best candidate for elective nasotracheal intubation?

67-year-old male patient with exacerbated COPD and breathing inadequacy

The normal partial pressure of oxygen in arterial blood is:

80-100 mm Hg

What would be the expected normal PaO2 for a healthy adult who is breathing normally?

80-100 torr

You are transporting a critical trauma patient 15 miles to the nearest trauma center. What temperature should you keep the ambulance at?

85 degrees Fahrenheit

a 170 pound male experienced partial and full thickness burns to 45% of his body surface area. transport to the closest appropriate facility will take longer than an hour, so medical control has ordered you to begin IV fluid therapy based on the Parkland formula. according to this formula how much IV fluid should the patient receive per hour

870 mL

What is an acceptable SpO2 range when providing supplemental oxygen to a pediatric patient?

94%-99%

Your adult patient was involved in a structure fire and received possible airway burns. The patient complains of shortness of breath, but there are no obvious burns noted in his oropharynx. However, his dyspnea fails to improve after several minutes of high-flow oxygen therapy, and his lung sounds reveal a grating sound during equal inspiration/exhalation. Which of the following should you suspect?

A loss of pulmonary surfactant

You are assisting the ventilations of an adult with a bag-valve-mask device. The patient is responsive to pain only and has a heart rate of 140 beats/min. Which of the following signs would indicate that your assisted ventilations are inadequate?

A marked increase in heart rate

You are having a difficult time ventilating an intubated patient due to suspected copious secretions in the patient's lungs. However, proper suctioning technique fails to remove the secretions. What should you do at this point to ensure effective ventilation?

Administer 3 to 5 mL of sterile saline directly down the ET tube to loosen thick secretions

Your patient is having an acute anaphylactic reaction. The failure of which body system would most likely cause death first?

Airway due to glottic edema

You are selecting a landing zone for a helicopter. Which one of the following should NOT be among your primary considerations?

An updated patient report

In the absence of spontaneous breathing and circulation, which one of the processes below will contribute the most to cellular and tissue death?

Anaerobic metabolism

You are called to a 54-year-old male patient complaining of cardiac-type chest pain. When looking at his 12-lead, which finding is not suggestive of ischemia?

Asymmetric T wave

Regarding normal ventilation of the lungs, what gas law best describes the bellows action of the chest?

Boyle's

Which of the following cardiac rhythms would you MOST likely encounter in a 6-month-old infant with lethargy, profound respiratory distress, and an oxygen saturation of 79%?

Bradycardia with or without AV block

If considering the administration of magnesium sulfate to a pregnant patient for preeclampsia, what other medication should the paramedic have close at hand during the intervention?

Calcium gluconate

Which one of the following clinical findings would NOT be indicative of a high priority, or unstable, patient?

Chronic change in mental status

You are transporting a patient three days post-traumatic event, from a small hospital to a larger teaching hospital. The patient, it is explained to you, has acute renal failure (ARF) and acute respiratory distress syndrome (ARDS), necessitating transport. With this history, what piece of equipment or medication will the paramedic likely use?

Continuous positive airway pressure (CPAP)

you are using 12 lead ECG obtained in the field to review with your colleagues. Which of the following information would be the MOST important to remove from each ECG

ECG identification number

Your adult trauma patient remains entrapped and may be experiencing the signs and symptoms of crush syndrome after having his right leg buried in dirt at a commercial construction site for an extended period. If so, which of the following interventions would be most appropriate before the compressive forces are released?

Ensure the patient is receiving high flow oxygen

Which of the following effectively measures the amount of carbon dioxide in a patient's exhaled air?

EtCO2

Some patients with pulmonary edema also suffer from fluid overload. In these patients, a medication that reduces venous return, reduces intravascular volume, and improves overall respiratory effort is needed. What emergency pharmacological agent is indicated for this purpose?

Furosemide

Which one of the following disorders is most likely to present with melena?

Gastritis with peptic ulcer disease

Which one of the following drug names is most widely known and used by health-care providers?

Generic

When evaluating a patient with acute abdominal pain, what is the presence of severe referred pain that radiates to the left shoulder called?

Kehr's sign

A patient with chest pain and ST segment elevations in Leads AVL, V5, and V6 is most likely experiencing a myocardial infarction (MI) to which wall of the heart?

Lateral wall, left ventricle

Where is the point of maximal impulse (PMI) located in most people?

Left anterior chest, in the midclavicular line, at the fifth intercostal space

Which of the following is considered a single ectopic impulse that forms in the lower portion of the heart and occurs earlier than the next expected beat?

Premature ventricular contraction (PVC)

Which of the following complications would MOST likely occur if a patient with renal failure missed his or her dialysis treatment?

Pulmonary edema

When considering the administration of cardiac medication to a severely hypothermic patient in cardiac arrest, which of the following is true?

The patient will most likely not respond to cardiac medication and allow toxic accumulation of the medications

Why are posterior wall infarctions of the left ventricle atypical in the prehospital environment?

The posterior wall is perfused by both the right and left coronary arteries.

Ensured that team member responsibilities were defined and understood. Computed, recorded, and proofread data, records and reports. Described merchandise and explain the operation of merchandise to customers. Computed sales prices, total purchases and processed payments.

To prevent atelectasis from occurring at the end of exhalation

Sudden cardiac arrest in the adult population is MOST often secondary to:

a cardiac dysrhythmia.

When administering oxygen via nasal cannula during a long-range transport, you should:

attach an oxygen humidifier.

a patient with a reactive lover airway disease would be expected to present with

expiratory wheezing

Death in sickle cell anemia is often caused by:

pneumonia.

A four-year-old child has had two tonic-clonic seizures in a row without regaining consciousness. This condition is called:

status epilepticus.

What is the MOST appropriate dose and rouste of diphenhydramine for a patient who is experiencing a severe allergic reaction

25-50 mg IV

Which of the following patients is MOST in need of rapid extrication following a motor vehicle crash

28 year old man with a unilateral femur fracture and confusion

According to the AHA, what is the proper dosage of amiodarone for a patient in cardiac arrest (V-Tach or V-Fib)?

300mg IV/IO, repeat with 150mg IV/IO after 3-5 minutes

You are called to the residence of a 26-month-old female where the patient's mother is concerned that she is acting inappropriately. You place the patient on the cardiac monitor and see SVT at 230 bpm, with a SpO2 of 91% and an RR of 26. You determine the patient to be unstable and prepare for cardioversion. You shock the patient once with no change. What is your subsequent biphasic dose for this 16 kg patient?

32 J

You are on-scene with an apneic adult who collapsed one to two minutes prior to your arrival, according to bystanders. Which of the following endotracheal tube size ranges would be most appropriate for an average adult respiratory arrest patient who shows no signs of airway trauma or obstruction?

7.5-8.5 ET tube

You are evaluating an adult patient who called for help after experiencing a severe headache with confusion, nausea, and vomiting. He is now unconscious and experiencing hypertension associated with diminished respiratory effort and bradycardia. Which of the following is most likely to cause these findings?

A severe increase in intracranial pressure

Croup, bronchiolitis, epiglottitis, and asthma are all examples of pediatric respiratory problems that may require EMS intervention. Which of the following bestdescribes or defines bronchiolitis?

A viral infection caused by RSV that affects children between six and 18 months old

Which of the following can MOST easily be assessed without talking to a patient who is experiencing a behavioral crisis?

Affect

A pregnant patient is being transferred to a tertiary-care facility. A nurse is accompanying the patient, who is receiving magnesium sulfate for preterm labor. Paramedics should have the following on hand to treat magnesium toxicity.

Calcium gluconate

You and a partner are dispatched on a non-emergent fall patient. However, on arrival, you surprisingly find an unconscious 52-year-old male that fell from a second-story window. How should you first proceed?

Call for additional ALS units

You arrive at the city park for a child who was climbing a tall tree and fell. When you arrive, the patient appears to be unresponsive, and is entangled in branches, about 15 feet off the ground. What should you do next?

Call the fire department for assistance (if they are not yet responding).

Following an apparent terrorist attack, numerous patients present with shortness of breath and persistent coughing. A green haze is noted in the area in which the patients are located. Which of the following agents should you suspect they were exposed to?

Chlorine (CL)

You are called to the scene of a cardiac arrest. On arrival, you find a 55-year-old male with a history of hypertension, COPD, and congestive heart failure, pulseless and apneic. His wife tells you that he collapsed about three minutes before your arrival. Your partner begins one-rescuer CPR, and another paramedic on-scene controls the airway. As you are applying your ECG leads, the patient's wife tells you that she wants you to let him die in peace. Which of the following would be most appropriate in this case?

Continue performing resuscitation efforts, and ask if the patient has a living will or DNR

While treating an elderly woman who is in cardiac arrest, a man approaches you and states that the patient is his mother and that she did not want to be resuscitated. What is the MOST appropriate course of action?

Continue resuscitation and ask for a valid living will.

A 2-year-old child was playing with his toy cars outside when his mother noticed the child becoming cyanotic. You and your partner arrive on scene to find that one of the wheels from the truck has become lodged in the child's throat. Where is the wheel most likely lodged?

Cricoid cartilage

You are called to the home of a 2-year-old male. His mother states that he's had between a 100 and 101 degree fever the last few days, and woke with a 'bark-like' cough. On arrival, you find the boy sitting upright with inspiratory stridor. His condition is most likely caused by?

Croup

When a pregnant female is in active labor, what key finding indicates the beginning of the second stage of labor to the paramedic?

Crowning

Which of the following findings would a paramedic expect to see in a patient with a chronic adrenal dysfunction such as Addison's disease?

Darkened skin, anorexia, hypoglycemia, nausea and vomiting

What respiratory changes would you expect to see in a patient with alkalosis?

Hypoventilation

Which of the following causes of pulseless electrical activity (PEA) would be the MOST likely to respond to immediate treatment in the prehospital setting?

Hypovolemia

Which etiology of shock would be most responsive to fluid preloading by the paramedic?

Hypovolemic

In the 12 lead ECG the high lateral wall of the left ventricle is viewed by leads?

I and aVL

What are the therapeutic effects of morphine sulfate when administered to a patient with cardiogenic pulmonary edema?

Increased venous capacitance and decreased preload

Shortly after the uneventful delivery of a healthy neonate, paramedics assess the fundus to be at four fingerbreadths above the umbilicus and firm. Placental delivery was also uneventful. Vaginal bleeding has been minimal, and she complains of abdominal pain of 5/10. Vital signs are Bp 88/47, R 22, P 104, O2 saturation of 96% on 100% nonrebreather. Paramedics are still 25 minutes from the hospital. Which one of the following actions is indicated next?

Initiate a second IV and keep the patient warm.

In times of stress or exertion, a person's heart rate increases to meet the metabolic needs of the body. How does the parasympathetic nervous system act to slow the heart rate back down to normal after the "stress" has passed?

It sends acetylcholine to the SA node, making it more permeable to potassium, and stimulates the cardiac branch of the vagus nerve

The expectation of EMS personnel to treat all patients equally with respect and to not show any bias or judgment is called?

Justice

You arrive to a car into a pole. You notice wires down on the ground and on top of the patient's car. You see one patient who appears unconscious in the vehicle. Bystanders have begun to gather around the scene wondering what is going on. What is your top priority?

Keep the bystanders back and secure the scene

While on-scene of a two-car MVA, you and your partner are responsible for proper extrication and treatment of a conscious adult driver of a vehicle with major front-end damage. The driver-side airbag did not deploy during the accident and remains intact. Fire rescue has safely detached the battery cables from the vehicle. Which of the following would be the safest way to extricate your patient in this situation?

Maintain a safe distance from the undeployed airbag

For EMS professionals to determine death in the pre-hospital environment, which of the following criteria must be met by the paramedic?

No electrical activity in the heart as confirmed by an EKG tracing indicating asystole

Policies for determining death in the field should be established by medical direction in accordance with state and local protocols. Determination of death is usually confirmed by which of the following signs?

No spontaneous electrical activity in the heart, confirmed by asystole in several leads

Your patient's significant soft-tissue injury to the leg has been bleeding profusely. After controlling it, you find a pulse oximeter reading of 92%, heart rate 112, respiration 24, and a systolic blood pressure of 89 mmHg despite oxygen and fluid administration. Your paramedic partner asks you about starting a dopamine drip to raise the blood pressure. Which one of the following statements is your best response?

No, the use of dopamine is not warranted, because the patient is probably maximally vasoconstricted now.

An overturned tanker has a solid green placard on its side and rear. What type of hazard does this indicate?

Non-flammable gas

Which of the following medications is classified as a tricyclic antidepressant?

Nortriptyline hydrochloride

In a patient suffering from COPD, their respiratory drive is dependent on?

Oxygen

Your patient presents with ischemic changes on a 12-lead, chest pain, nausea, and respiratory distress. Of the following medications, which one should be administered first?

Oxygen via nonrebreather

Which of the following ECG findings indicates a pathologic delay at the AV node

P-R interval of 0/28 seconds

You have four patients who need transport to the hospital, and only one ambulance available. Patient A is combative, unable to maintain an airway, and suffering from facial trauma. Patient B has an open fracture of the left femur, and is writhing in pain. Patient C is not breathing or responding, and has an agonal heart rate and exposed brain matter. Patient D is a child with a fractured humerus and an amputated index finger on the left hand. Who would you transport first?

Patient A

Your adult trauma patient is experiencing severe pain from a femur fracture. He is conscious, alert and oriented, with a heart rate of 120 per minute; his respirations are 28 per minute, and his blood pressure is 78/30. He is begging you to administer something for pain. He states he is allergic to Vicodin and aspirin. Why would medical command most likely decline the request for morphine sulfate in this case?

Patient is hypotensive

An adult male sustained blunt chest/abdominal trauma when thrown off a motorcycle. In your assessment, you find the patient to have jugular venous distension (JVD). Breath sounds are clear. The systolic blood pressure is 92 mmHg with a narrowed pulse pressure. Heart rate is fast, and the pulse oximeter reading is 94% on room air. Respirations are 18 per minute. You note pulsus alternans on the monitor. What is your field impression?

Pericardial tamponade

Pericardial tamponade and hemorrhagic shock present very similarly in the pre-hospital environment. What is the best way, of those listed, to distinguish between the two diagnoses?

Pericardial tamponade presents with jugular vein distension, and hemorrhagic shock normally does not cause jugular vein distension

Which of the following signs is unique to a severe foreign body upper airway obstruction?

Perioral cyanosis

Which of the following endocrine glands, located posterior to the sinus cavity, is responsible for the production of the antidiuretic hormone as well as the production of oxytocin?

Pituitary gland

You are treating an adult closed-head injury patient whose respirations are irregular, shallow, and very fast at 40 times per minute. What does this usually indicate in a patient with a closed-head injury?

Respiratory alkalosis and an increase in intracranial pressure

Which of the following vitals is NOT a useful indicator of shock?

Respiratory effort

While transporting the fifth adult patient this week from a local hospital to a major cardiac facility in a nearby town, you notice that all the patients have a subclavian central line placed on their right side. What is the reasoning for the right side placement?

To avoid puncturing the thoracic duct

Which one of the following is the primary goal in the management of a patient with increased intracranial pressure?

To maintain oxygenation and ventilation

Which of the following is an acceptable initial intervention to treat stable paroxysmal tachycardias in an attempt to slow the heart rate and decrease the force of atrial contraction in the pre-hospital setting?

Vagal maneuvers

On an EKG strip, what does the QRS complex represent and what is its normal duration?

Ventricular depolarization; less than 0.12 sec

When conducting a 12-lead electrocardiogram on a patient, which lead is located on the right side of the body and does not view a specific area of the heart?

aVR

You and your team are attempting to resuscitate a 66-year-old man in cardiac arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient has been successfully intubated and an IV line has been established. As CPR is ongoing, you should:

administer 10 mL of epinephrine 1:10,000 IV.

During your assessment of a patient with labored breathing, you note asymmetric chest wall movement. This indicates that:

airflow into one lung is reduced.

Homeless patients are at an increased risk for complications of chronic health problems. The paramedic understands the increased risk is related to all of the following variables except:

ambivalence in the homeless about their own mortality.

You and your partner arrive at he scene of a mva, quickly size up the scene, and note that there are two patients , both of which are critically injured, You should

call for a second ambulance to respind to the scene

a 39 yom is unrespinsive, pulseless and apneic after being lost in the woods during the middle of winter. He has a core body temp of 85. When treating this patient, you should avoid

cardiac medications

The most common cause of cerebral palsy is:

cerebral dysgenesis.

A pediatric patient is on beclomethasone for his asthma. Paramedics reviewing the medication list understand that this medication is used in asthma patients to:

decrease inflammatory cell response.

You and your team are performing CPR on a middle-aged male who presented with asystole. After 2 minutes of CPR, you reassess him and note that his cardiac rhythm has changed to ventricular fibrillation. You should:

defibrillate and then resume CPR.

A 59-year-old female complains of a headache. She is conscious and alert, has a patent airway, and is breathing adequately. You should:

determine when her headache began.

A patient who is in her third trimester of pregnancy has vaginal bleeding. She is conscious and alert. Her BP is 108/68 mm Hg, her pulse is 80 beats/min and strong, and her respirations are 20 breaths/min and unlabored. You should:

establish an IV with normal saline.

A 19-year-old woman, who is 28 weeks pregnant with her first baby, presents with a headache, edema to her ankles and hands, and a blood pressure of 144/88 mm Hg. She is conscious and alert. You should:

establish vascular access, transport her, and monitor her for seizure activity.

A 47-year-old male took two of his prescribed nitroglycerin tablets prior to calling EMS. When you arrive at the scene, the patient tells you that he has a throbbing headache and is still experiencing chest pain. Your MOST immediate suspicion should be that:

he is experiencing continued myocardial ischemia.

a 30 yom has a closed head injury and is unresponsive. His left pupil is dilated and he has extensor posturing. His BP is 180/100, his pulse is 50 beats and his respirations are 8 breaths and irregular. Treatment for him shoud include

intubation with ventilations aimed at maintaining an ETCO2 of 30 to 35

In a trauma situation, it is acceptable to administer either normal saline or lactated Ringer's to your patient for volume replacement. What is the primary benefit of choosing lactated Ringer's?

it helps decrease acidosis in a hypovolemic patient

A hiker fell approximately 25 feet and is semiconscious. There is obvious deformity to his thoracic spine and he has a large laceration

loss of nervous system control over the systemic vasculature

A 19-year-old patient has a traumatic brain injury and is unconscious. When supine, the patient stops breathing. This apnea is most likely caused by:

poor airway muscle control.

A 4-year-old child has labored breathing. During your assessment, you note that his pulse rate is 70 beats/min. This pulse rate is:

significant as it indicates hypoxia

In older adults, an S3 heart sound:

signifies moderate heart failure.

Which of the following patients is more likely to experience dyspnea, syncope, and/or confusion rather than chest pain during an acute myocardial infarction?

A 60-year-old female who has diabetes

Which of the following patients best fits the criteria for a critical burn?

A 60-year-old patient with partial-thickness burns across 25% of the body, not involving the hands, feet, face, or genitals

You arrive on the scene of a MCI and you are delegated the job of triage officer. Four patients are brought to your attention. Which of the following patients is your top priority?

A 62-year-old male, difficulty breathing

Which of the following assessment findings helps distinguish envenomation due to a black widow spider bite from an acute abdominal condition?

Abdominal rigidity without palpable tenderness

Your 78-year-old male patient is showing a second-degree, type I heart block. The patient is bradycardic and hypotensive. What chemical mediator is most likely responsible for this disturbance?

Acetylcholine

You are dispatched to a residence for a 50-year-old male complaining of weakness. The patient denies chest pain or shortness of breath with clear breath sounds auscultated at 14 breaths a minute. His heart rate is 134 beats a minute, and his blood pressure is 80 palpated. Which of the following interventions would be appropriate?

Administer a 250-500 mL normal saline fluid bolus to ensure adequate ventricular filling before vasopressor administration

Paramedics are preparing to administer a routine medication to a patient who is pregnant at 17 weeks gestation. The drug book identifies the medication as "Class B Pregnancy." The paramedic should:

Administer the medication because the risk for fetal injury is remote.

You are administering epinephrine to your non-trauma patient in asystole. Following the administration of the medication through a patent peripheral IV line, what should you do to help ensure a fast, safe delivery of the medication into the central circulation?

Administer the medication via IV push, followed by 20 mL fluid bolus

Which of the following prefixes would a paramedic use when describing any condition within a patient's musculoskeletal joints?

Arthro

a 29 yom ingested a bottle of extra strength acetaminophen. He presents with malaise and palpable tenderness to the right upper quadrant of his abdomen. He is conscious and alert, his BP is 136/66, his pulse is 100 beats and regular, his respirations are 16 breaths and unlabored and his oxygen saturation is 98%. Treatment for this patient should include

An IV of normal saline set to keep the vein open, cardiac monitoring and transport

During an intubation attempt, you are having difficulty viewing the patient's vocal cords. Which of the following actions would MOST likely help?

Ask your partner to manipulate the external larynx.

While treating a cardiac syndrome with related chest pain, which of the following protocol interventions is administered to begin the degradation of the thrombus?

Aspirin

While evaluating the 12-lead electrocardiogram of your adult patient, where would you expect to see the axis in a normally conducting myocardium?

Between negative thirty (-30) and positive ninety degrees (+90)

A patient is presenting with dyspnea, inspiratory rales, jugular venous distention (JVD), and a dropping pulse oximeter reading. He says his doctor told him he needs a "new heart valve." What cardiac valve is most likely failing, causing this presentation?

Bicuspid

Paramedics respond to a chemical plant and can see a hazardous material placard from a distance. Which diamond area would identify the health hazards of the chemical?

Blue

The START system uses color to represent triage categories. Which one of the following colors is NOT used?

Blue

The cardiovascular system is divided into three categories, which are sometimes referred to as the "Perfusion Triangle." Which of the following is not a component of the "Perfusion Triangle?"

Brain

Your adult patient called for help after developing a blistering lesion on his left thigh a few days after returning home from vacation. The blistered area is encircled by a red ring that gives it the appearance of a "bull's eye." Which of the following should you suspect?

Brown recluse spider bite

Which of the following spinal cord injuries classically presents with weakness of the upper and lower extremities on the ipsilateral side and loss of pain and temperature sensation on the contralateral side

Brown-sequard syndrome

Paramedics document that a patient with a history of alcoholism has a positive Grey Turner's sign. What did the paramedic assessed for and what did it indicate?

Bruising over the flanks; hemorrhagic pancreatitis

You are caring for a male patient with blunt chest trauma, mild dyspnea, and no external hemorrhage. The abdomen is soft, lungs are clear bilaterally, and pulse, motor function, and sensation are intact. The only clinical finding of concern is hypotension and tachycardia. What is your most likely field impression?

Cardiac contusion

When providing positive-pressure ventilation(PPV) to a patient, the paramedic should recall that

PPV can impair venous return and cause hypotension

If a drug had an effect on the adrenergic activity of the body, which one of the body systems listed below would it influence?

Central nervous system

You suspect your adult chest pain patient may be experiencing the onset of a myocardial infarction. Which of the following medical conditions may mask the severity of the infarction by suppressing the normal ST elevation often seen in onset myocardial infarctions?

Diabetes

Your 23-year-old asthma patient is experiencing a severe asthma attack. He is alert and oriented but struggling to breathe with inspiratory wheezing noted. His respirations are 30 per minute with a SpO2 of 88. Which of the following may prove beneficial in managing the bronchospasm after nebulized albuterol and oxygen therapy fails to improve his condition?

Continuous positive airway pressure (CPAP)

You are called to assist a worker at a local fertilizer plant after he began experiencing rapid-onset agitation, anxiety, confusion, and dyspnea. During your assessment, his dyspnea increases with wheezing while his pulse rate decreases. Yet, he is found to be hypertensive without any history of high blood pressure. Which of the following would you suspect in this case?

Cyanide exposure

Which of the following clinical presentations is MOST indicative of a patent airway?

Diaphoresis; tachycardia; gagging

All of the following happens during inhalation, except?

Diaphragm moves upward

Which of the following conditions is characterized by the local or diffuse changes in muscle tone that cause painful muscle spasms, unusual movement patterns, and fixed postures?

Dystonia

Which of the following findings is MOST suggestive of right-sided heart failure?

Engorged jugular veins

What is the ultimate goal of any quality assurance program?

Ensure that high-quality care is consistently delivered.

There are many types of blood cells in the body, each with various responsibilities. Which one of the following cells is NOT responsible or capable of phagocytosis?

Eosinophils

After being struck in the head with a baseball bat, a 9 yom immediately loses consciousness. On your arrival, he is conscious but confused. Shortly into your assessment, he becomes unresponsive. Which of the following injuries has this child MOST likely sustained?

Epidural hemorrhage

The leaf-shaped structure that is designed to prevent food and liquids from entering the trachea during swallowing is called?

Epiglottis

What is the drug of choice for an adult asthma patient who cannot tolerate nebulized beta-agonist treatments and is experiencing severe dyspnea with wheezing from bronchoconstriction?

Epinephrine

You are attempting to revive an adult patient who is showing asystole on the monitor. Which of the following medications is appropriate in the pre-hospital setting?

Epinephrine

Which of the following clinical presentations is MOST consistent with exposure to a chemical nerve agent?

Excessive tearing, hypersalivation, bradycardia, and miosis

Which of the following signs is MOST indicative of inadequate breathing in an infant?

Expiratory grunting

If a patient has severe bronchoconstriction secondary to an asthma attack, what phase of ventilation would become initially deranged?

Expiratory phase

Which of the following would MOST likely cause laryngeal spasm?

Extubation of a semiconscious patient

Which of the following creates a secure loop at the working end of a rope, which can be used to attach the end of the rope to a fixed object or a piece of equipment?

Figure eight on a bite

Medications administered by way of intravenous push are typically less subject to which one of the pharmacokinetic principles listed below?

First-pass metabolism

According to current Guidelines for Field Triage of Injured Patients, which of the following patients should be transported to a trauma center that provides the highest level of care within the defined trauma system?

Fractured humerus and femur; systolic BP of 110 mm Hg; heart rate of 120 beats/min

Your medical command physician has ordered you to place a nasogastric tube (NG) in the stomach of your 60-year-old patient with abdominal pain. It is suspected he is bleeding from peptic ulcers due to his past medical history and a large amount of blood in his emesis. What would be the most appropriate way to measure the proper length of the NG tube?

From the patient's nose to his ear to his xiphoid process

You are inserting a nasopharyngeal airway in your altered level of consciousness patient when he begins to gag. Which of the following may be helpful in this case?

Gently pull the nasal airway back 0.5 to 1 cm and slowly re-insert the airway

You are inserting a nasopharyngeal airway in your altered level of consciousness patient when he begins to gag. Which of the following may be helpful in this case?You are inserting a nasopharyngeal airway in your altered level of consciousness patient when he begins to gag. Which of the following may be helpful in this case?

Gently pull the nasal airway back 0.5 to 1 cm and slowly re-insert the airway

Your apneic adult patient is intubated and in need of airway suctioning. Which of the following would be mostappropriate while performing this procedure?

Gently rotate the suction catheter between your fingers while withdrawing the catheter with 80 to 120 mmHg suction applied for no more than 15 seconds at a time

A patient who complains of abdominal pain informs you that she is HIV-positive. Which of the following is appropriate personal protective equipment?

Gloves and safety glasses

Venous blood samples are often obtained in the pre-hospital setting for various tests to be performed at the hospital. What color tube stopper would a paramedic want to use if law enforcement at an accident requests the patients involved have their blood drawn at the scene to be tested for the possibility of alcohol intoxication at the hospital?

Gray

As you are performing triage in a multiple casualty incident, a patient gets up, and limps towards you screaming in pain from the burns on his arms. His arm is also broken and deformed. You tag him?

Green

Your patient is a 2-year-old female who was chasing the family dog outside when she ran into the play structure. She struck her anterior body on a pole of the play structure and is complaining of severe abdominal pain. Which of the following is the correct order in which to perform your physical assessment of the patient?

Head, neck, chest, back, extremities, abdomen

While assessing a patient with abdominal pain, you note a distended and tender upper right quadrant and icterus to the sclera. The patient's skin is jaundiced. Which one of the diagnoses below could be the cause of those findings?

Hepatitis

When involved in transporting a patient from the hospital (regardless of the destination), which of the following disease processes, along with HIV/AIDS, must be reported to the transporting crew members to prevent the accidental transmission of the disease?

Hepatitis and tuberculosis

Of the following toxins and antidotes, which one is NOT correctly matched?

Heroin: Romazicon (flumazenil)

You are called to assist a 55-year-old male who complained of sudden onset chest pain, dyspnea, and palpitations. On arrival, he is found unconscious with a pulse rate too fast to palpate and a blood pressure of 75/43. Once on the monitor, you immediately recognize torsades de pointes at approximately 200 beats per minute. Which of the following would be the most appropriate intervention for this patient?

High-energy unsynchronized shock

Your adult patient has a history of sickle cell anemia and called for assistance today with a complaint of severe all-over body pain and shortness of breath. He reports the episode began three days ago but today, worsened to the point he could not handle it any longer without help. He is breathing at 26 times per minute with an oxygen saturation of 88 percent on room air. His heart rate is 128 beats per minute, and his blood pressure is 90 systolic. Which of the following interventions would be mostappropriate after initiating high-flow oxygen therapy?

IV fluid replacement with normal saline at 30 milliliters per kilogram of body weight

The alpha, beta-1, and beta-2 receptors are important in the maintenance of heart rate and respiratory function. What can we expect to occur if a patient's beta-1 receptors are stimulated?

Increased heart rate and strength of contraction

You administer a medication by injecting a needle at a 90-degree angle into the deltoid tissue of the upper arm. Which one of the following medication routes did you use?

Intramuscular

You are ordered to administer 0.3 mL of epinephrine for a moderate allergic reaction. What is the preferred initial route of administration of epinephrine for an allergic reaction?

Intramuscular

You are called by the police for a patient who is attempting suicide at home. Upon your arrival, the patient's mental status regarding events and surroundings is appropriate, but he keeps saying, "I'm gonna hurt me, or I'm gonna hurt you ... which is it gonna be?" The police then move in, to arrest and secure the patient. Under which type of consent are you now able to provide care?

Involuntary

An unresponsive adult trauma patient exhibits pale, cold, and clammy skin that appears ashen/cyanotic. He is breathing less than eight times a minute, has a heart rate of 32 beats a minute, and shows an irregular bradyarrhythmia on the monitor in lead II. He is experiencing frank hypotension that is barely palpable. Which of the following stages of shock is most likelycausing his presentation?

Irreversible shock

You are working a 55-year-old patient in cardiac arrest. When it comes time to push amiodarone for ventricular fibrillation, you note that your stock of the preferred medication has been depleted on a previous call. What medication can be safely used in place of amiodarone in this situation?

Lidocaine

Which of the following statements regarding lightning injuries is correct?

Lightning injuries tend to resemble blast injuries more than they do high-voltage injuries.

Which of the following factors or conditions would MOST likely impair hemostasis and increase the risk of complications from blunt trauma?

Liver disease

You are on-scene with a 60-year-old COPD patient complaining of shortness of breath. During your exam, you note the presence of clubbed fingertips. Which of the following is most likely to cause this finding?

Long-term hypoxemia

You are on-scene with a patient suspected of taking a large amount of meperidine hydrochloride. Which of the following interventions may be effective in reversing the adverse effects of the ingested medication?

Naloxone

You have applied the leads and acquired a 12-lead ECG. Upon first glance at the printed rhythm, you note that the AVR lead has a positively deflected P wave and QRS. What does this most likely suggest?

One of the leads is likely not placed correctly.

You are assessing a patient that you suspect is experiencing the adverse effects of a closed-head injury. If so, which of the following will most likely be present?

Pupillary changes and hypertension

A patient tells you his headache started very suddenly three hours ago while he was working outside. He describes it as a sharp pain, very intense in nature, which will not resolve with aspirin. From this brief description, what is still missing from your OPQRST history?

Radiation

You are called to the scene of a single car MVA with one unconscious 32-year-old male patient. He has been placed on a backboard, but has profuse bleeding inside his mouth. What would be the best way to help this patient?

Roll him on his side while backboarded and suction his airway

What are the physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain, pressure, or discomfort?

Smooth muscle relaxation and decreased preload

What type of ion rapidly crosses into the interior of a cardiac cell during phase "0" of the action potential cycle?

Sodium

You are on scene with a cardiac disease patient showing atrial fibrillation with a rapid ventricular response on the twelve-lead electrocardiogram. He is hypotensive with serious signs and symptoms of hypoperfusion. Which of the following interventions would be most effective in correcting the dysrhythmia?

Synchronized electrical cardioversion beginning at 120-200 joules (biphasic defibrillator) or 200 joules (monophasic defibrillator)

In general, paramedics should avoid accessing central lines or central venous catheters in the prehospital setting because:

The risk for infection when accessing a central line is high.

Which of the following interventions may be effective in eliminating stable Torsades de pointes when the normal means of rate control have failed?

Unsynchronized shocks

You are assessing a conscious patient with a medical emergency. The most valuable information regarding your differential diagnosis will most likely come from which part of your assessment?

Verbal history

Thiamine is the generic drug name for what medication?

Vitamin B1

It is early in the morning, and you and your partner are returning to base from a long transport to a neighboring state. Your partner, who is driving, is starting to nod off at the wheel. You should:

get your partner's attention and offer to drive the rest of the way back.

For occasional or intermittent symptoms of asthma, the drugs of choice are :

beta 2 agonists because they have rapid onset and short duration.

Wernicke's encephalopathy is most commonly caused by:

chronic vitamin deficiency.

An 8-year-old child remains in ventricular fibrillation despite two shocks and high-quality CPR. Vascular access has been obtained, one dose of epinephrine has been given, and an advanced airway device has been placed. If the child remains in ventricular fibrillation following the third shock, you should continue CPR and then:

give 120 mg of amiodarone.

A 36-year-old male been shot in the right chest. He presents with shortness of breath, chest pain, and decreased lung sounds on the right side. His vitals are: pulse 104, respirations 34, and blood pressure 100/80. The most appropriate immediate treatment for this patient would be to:

initiate rapid transport and monitor vital signs.

Emergency care for a child with suspected anemia should include:

supplemental oxygen and transport.

Which one of the following statements is most accurate regarding coronary artery perfusion and heart rate?

Shorter diastole leads to decreased coronary perfusion.

A hypotensive patient with fluid-refractory septic shock requires a norepinephrine infusion at 5 mcg/min. You add 8 mg of norepinephrine to 500 mL of normal saline and will run the infusion through a pump. How many milliliters per hour should the patient receive?

19

You are performing orotracheal intubation on an average-sized, apneic adult. At what depth marking should the airway be properly positioned 2 to 3 cm above the carina?

19 to 23 centimeters

What is the medication type of choice for relieving bronchospasm associated with COPD in the pre-hospital setting?

Beta-agonists

While assessing the respiratory effort of a non-intubated adult COPD patient using capnography, you note the presence of a shark fin waveform on the monitor. Which of the following is most likely the cause of this finding?

Bronchospasm

You and your partner are triaging four patients at the scene of a motor-vehicle crash while awaiting the arrival of additional ambulances. Which of the following patients would be triaged as delayed?

Bilaterally deformed femurs; severe neck pain; conscious and alert

What form of noninvasive pressure support ventilation allows the spontaneously breathing patient to exhale against a lower pressure than she is being aided with upon inspiration?

Bilevel positive airway pressure (BiPAP)

A 29-year-old female complains of bilateral lower abdominal quadrant pain. Which of the following additional findings should make you the MOST suspicious for an ectopic pregnancy?

Intrauterine device use

Which of the following medication types are used to decrease the workload of the heart by blocking sympathetic stimulation of receptors that work on the SA node and myocardial cells, thus decreasing the force of myocardial contraction and directly reducing a patient's heart rate?

Beta-blockers

What condition is most likely to cause an adult female patient to present with non-traumatic lower abdominal quadrant pain reported as severe, agonizing, and often radiates to the patient's shoulders?

Ectopic pregnancy rupture

If a patient is showing an inferior wall infarction of the left ventricle, how will this change the paramedic's treatment of the myocardial infarction (MI)?

The patient needs V4R determined before treatment.

You are working a respiratory arrest patient and have just successfully placed a combi-tube in your apneic patient. What should you do if the chest fails to rise appropriately and gastric sounds are present?

Remove the BVM from tube #1 and ventilate through tube #2

You are intubating a 26-year-old who is apneic. Once the endotracheal tube passes through the vocal cords, how much farther should the endotracheal tube be advanced before inflating the cuff and confirming proper placement?

0.5 to 1 inch

You are called to assist a mother who found her two-year-old playing with insecticide that contains organophosphates. The child is showing signs and symptoms of poisoning with excessive salivation and diaphoresis apparent. Medical command recommends the administration of atropine to help dry the secretions and increase the child's cardiac output. Which of the following dosages of atropine would be considered appropriate for this patient?

0.05 mg/kg IV (max of 3 mg)

A 40 year old construction worker fell approximately 10 feet and sustained an open fracture of the left femur. Further examination reveals that he distal femur is protruding through the skin. What is the MOST appropriate care for this injury?

Cover the wound with a sterile dressing and immobilize the leg

When performing endotracheal intubation on an adult patient who is apneic, which of the following is the next step taken by the paramedic after inflating the cuff of the ET tube?

Attach the bag-valve mask with an EtCO2 detector and begin ventilations

Your adult patient has suffered a prolonged cardiac arrest interval and is receiving advanced cardiac life-support interventions. When administering medications intravenously, why should calcium chloride and sodium bicarbonate not be administered through the same IV line?

Calcium chloride will precipitate/crystallize when mixed with sodium bicarbonate

During a triage operation, you encounter a 5 ear old boy who has been injured. He is conscious, cannot walk and has a respiratory rate of 50 breath. you should

assign him an immediate triage category and move to the next patient

A patient has been shot with a low-caliber weapon in the first segment of the large intestine. This part of the intestine is known as the:

cecum.

The baroreceptors in the aortic arch and carotid sinuses are extremely sensitive to:

changes in arterial perfusion pressure.

Which of the following represents the correct adult dosing regimen for adenosine?

6 mg, followed by 12 mg in 2 minutes if needed

Which of the following frequency bands used by EMS for radio communication, uses a repeater system and is best suited for urban areas?

800 MHz

You are treating a 48-year-old patient who presented with symptomatic narrow-complex supra-ventricular tachycardia that has not responded to vagal maneuvers and adenosine. The patient remains hemodynamically stable and shows no signs of congestive heart failure. He is conscious and denies any other past medical history. The patient refuses to allow electrical cardioversion to convert the rhythm. What secondary pharmacological agent may be effective in converting the rhythm in this situation?

A beta-blocker or calcium channel blocker

You and your partner are standing by at a community softball tournament when you witness the collapse of a 39 yom immediately after he was struck in the chest by a softball. You quickly assess him and determine that he is apneic and pulseless. The patient's cardiac arrest was MOST likely caused by:

A cardiac dysrhythmia

An ambulance responding with lights and siren to a medical emergency comes upon a stopped school bus in the same travel lane, displaying its flashing lights. Which one of the following actions is most appropriate?

Come to a complete stop, leave the lights on, and turn off the siren. Proceed only when directed by the bus driver.

Your patient was involved in a farming accident that led to the partial amputation of his left hand. You have a tourniquet in place, and the bleeding has stopped at this moment. As you prepare your IV supplies, you ask the patient about his history. He advises he has a history of HTN, liver problems, and diabetes. His vital signs are BP 80/58, HR 122, R 18, SpO2 94%. What treatment would you not give to this patient?

A fluid bolus of Lactated Ringers

You are orally intubating a patient experiencing spasmodic closure of the vocal cords from laryngeal spasm. What is the best way to get the cords to allow the passage of the ET tube in this situation?

A forceful upward pull of the jaw to reposition the airway

A patient awaiting a heart transplant has an implanted left ventricular assist device (LVAD). He goes into cardiac arrest. Which one of the following is generally considered to be true regarding this patient?

A manual foot or hand pump may be used to support circulation.

You are preparing to intubate an unresponsive 9-kg infant. Which laryngoscope blade would be mostappropriate in this case?

A number 1 Miller

Which of the following patients would be most likely to receive a traction splint?

A patient with a closed femur fracture with no other noticeable leg injuries

A 59-year-old male with a history of hypertension and diabetes presents with dark, tarry stools. He is confused, has a blood pressure of 84/62 mm Hg, and a pulse rate of 74 beats/min and weak. Which of the following would MOST likely explain his heart rate?

A prescribed adrenergic blocking agent to treat his hypertension

You are evaluating a cardiac patient for possible compromise when you note the presence of a second R wave that is taller than the first R wave and part of each QRS complex. With this finding, which of the following cardiac arrhythmias should you suspect?

A right bundle branch block

Your 80-year-old female patient suddenly became apneic during a pre-hospital medical exam. After intubating the patient, you quickly auscultate decreased breath sounds on the left side of the patient's chest, although breath sounds on the right are clear. Which of the following is most likely to cause this to occu

A right mainstem intubation

Your 80-year-old female patient suddenly became apneic during a pre-hospital medical exam. After intubating the patient, you quickly auscultate decreased breath sounds on the left side of the patient's chest, although breath sounds on the right are clear. Which of the following is most likely to cause this to occur?

A right mainstem intubation

Which of the following injury mechanisms involves axial loading?

A rollover motor-vehicle crash in which the unrestrained occupant strikes his head on the interior of the roof

A patient has overdosed on a narcotic prescribed to her for back pain. Upon your arrival, she is breathing shallowly at six times per minute. What cellular effect will this have on the patient?

A shift to anaerobic metabolism will occur.

In contrast to unstable angina, stable angina occurs when a patient

experiences chest discomfort after a certain, predictable amount of exertion

a 16 yob has severe headache and vomiting that has progressively worsened over the past 36 hours. Which of the following questions would be MOST important to ask him

have you experienced a recent head injury

What can the paramedic expect to find when evaluating the pupillary response of a patient suspected of suffering from herniation?

A unilaterally, unequal and non-reactive pupil

You are on-scene with a cardiac patient who recently had a pacemaker implanted in his chest. It is intended to help produce a myocardial contraction when his heart rate falls below a preset rate. Once on the electrocardiogram, you note the presence of a pacer spike that precedes each QRS complex. What type of pacemaker do you believe is being utilized in this case?

A ventricular demand pacemaker

Your patient is suffering cardiac arrest with adequate CPR and ACLS interventions initiated including intubation by your crew. Once capnography is introduced to monitor the effectiveness of the resuscitation effort, what can the paramedic expect to see on the monitor if the patient has a return of spontaneous circulation (ROSC)?

A waveform that suddenly rises from around 10-20 mmHg with high-quality CPR to above 40 mmHg

You are treating a 38-year-old male patient with a cardiac history for generalized weakness. He is conscious and alert with warm, dry, skin and pink, moist mucosa. His heart rate is 46 beats per minute, and his blood pressure is 100/40. This prompts you to get a twelve-lead EKG tracing, as soon as possible. The tracing shows a second degree, type II AV block. This causes you to reconsider administering atropine to the patient; why?

AHA guidelines state to not rely on atropine in Second Degree Type II AV Block or Third Degree AV Block

You and your partner are on-scene with a patient who needs to be transported to the hospital for chest pain. You have established an IV, placed the patient on the monitor, administered oxygen, one dose of nitroglycerin, and aspirin. His vitals are stable, and he reports pain relief. However, he wishes to be transported for evaluation. Your partner checks his watch and notes that his shift is over. You remove the monitor and politely tell the patient the oncoming crew will come and transport him to the hospital. His daughter is on the scene and is a trained first responder. She tells you she will stay until another crew arrives to transport the patient. Leaving the patient in the care of his daughter, in this case, is an example of which of the following?

Abandonment

You are dispatched to a 20-year-old male complaining of acute, "unbearable, knife-like pain" in his abdomen that radiates to his back. He is very anxious and tells you he feels like he's going to die. He also tells you he is having pain in his lower extremities and they are starting to tingle. Vitals: skin is pale and diaphoretic, BP 90/50, HR 110, RR 30. As you expose his abdomen, you do not see any pulsating masses or distention, but it's tender to palpation. Your patient's medical history includes asthma and Marfan syndrome. Which is most likely the cause of his pain?

Abdominal aortic aneurysm

Which of the following would a paramedic expect to see when evaluating an elderly dyspnea patient with a history of right ventricular dysfunction?

Abdominal ascites

Your closed head injury patient is suspected of suffering brainstem herniation. If so, which of the following indicators will most likely present?

Abnormal extension with decerebrate posturing or no motor response to painful stimuli

You are on-scene with a 44-year-old female asthma patient struggling to breathe. She reports that she takes a corticosteroid as well as a beta-adrenergic agent to help control her asthma. The patient's respiratory status continues to deteriorate despite you administering an almost continuous nebulized albuterol treatment. What medication would be your next best choice?

Epinephrine

You have responded to a motor vehicle crash and arrive to find one car head-on into a tree. Your female patient is complaining of severe abdominal pain. She is 34 weeks pregnant. Her abdomen is firm and tender and she is otherwise atraumatic. What is your primary differential diagnosis?

Abruptio placentae

Which of the following assessment findings would BEST indicate that a patient with blunt abdominal trauma is in decompensated shock?

Absent radial pulses

After assisting a pregnant female with the delivery of her full-term infant, you note the presence of meconium around his mouth and nose prompting you to suction the newborn's mouth and nose before the meconium can be aspirated into the lungs. During the suctioning procedure, the newborn's heart rate falls drastically. What has likely caused this to occur?

Accidental vagus nerve stimulation from the suctioning of the hypopharynx

You arrive on scene for a 24-year-old male patient in respiratory distress. The patient has inspiratory and expiratory wheezes, body-wide hives, intercostal retractions, and deteriorating vitals. For this patient, what medication would be warranted first?

Epinephrine

Your adult patient has a history of atherosclerosis. He called for assistance after developing sudden-onset pain in the right calf region. On arrival, the patient is conscious and alert with a blood pressure of 160/100, a heart rate of 100, and respirations of 16. He has a pulse, motor, and sensation in all extremities except the right leg, which is pulseless and cool to the touch. Which of the following should be suspected until proven otherwise?

Acute arterial occlusion in the femoral artery

Which of the following is MOST consistent with a foreign body upper airway obstruction in a child?

Acute dyspnea without a fever

You are called to assist a 50-year-old patient with rapid-onset pain in his right lower calf. The patient denies trauma but has a past medical history of hypertension and heart disease. The right lower leg is cool and pale, and the patient reports cramp-like pain in the area that began while he was sitting. His left leg remains asymptomatic. Which of the following conditions should be suspected until proven otherwise?

Acute femoral artery occlusion

Your patient reports the abrupt onset of difficulty breathing and chest discomfort. During your examination, she is found to have acute pulmonary edema, tachycardia, and cool, diaphoretic skin. Which of the following should be suspected until proven otherwise?

Acute myocardial infarction

When serum glucose levels are low, what does the nervous system release to promote liver glycogenolysis?

Epinephrine and norepinephrine

Your adult female postpartum patient delivered her newborn with the assistance of her husband five minutes prior to your arrival on the scene. The infant's Apgar score is 10, and the baby seems to be fine. However, the mother continues to bleed heavily after an adequate fundal massage and encouraging the infant to breastfeed. Her current heart rate is 125 bpm; her blood pressure is 108/60, and she is breathing 22 times a minute with an SpO2 of 97. After ensuring a second infant is not present, which of the following interventions would medical command most likely recommend?

Administer oxytocin infusion (1 unit per 100 mL of lactated Ringer's solution) at 20 to 30 gtts/min (micro-drip tubing) depending on bleeding severity

The following medication is an anti-arrhythmic known as the "Chemical Cardioverter" that slows conduction through the AV node and is useful in patients with supraventricular tachycardia.

Adenosine

You are on-scene with a 60-year-old cardiac patient with a normal blood pressure and no complaint of chest pain. The patient does complain of mild shortness of breath and palpitations. The patient is showing monomorphic ventricular tachycardia on the monitor with unknown origin. What is the first-line medication for this condition in the pre-hospital setting?

Adenosine

A 30-kg child presents with a regular, monomorphic, wide-complex tachycardia at 190 beats/min. He tells you that his chest feels funny, but otherwise has no other symptoms. He is conscious and alert and his vital signs are stable. Which of the following interventions is indicated?

Adenosine, 3 mg

a 42 yom presents with difficulty breathing, diffuse wheezing, urticaria, and a blood pressure of 74/44. His skin is cool and clammy. The paramedic should

Administer 0.3 mg epinephrine 1:1,000 SC

Your adult patient is unresponsive after a probable narcotic overdose. He has shallow respirations and is diaphoretic. What is your initial treatment?

Administer Narcan 2 mg IN

You are working in an EMS system on an ALS ambulance. You are the lead medic, and you have arrived at the emergency room with your patient. Upon your arrival, dispatch radios you stating that they have calls pending, and asks for you to hand-off the patient and respond to a call as soon as possible. After moving your patient to their ER bed and your partner has left with the gurney to clean the ambulance, when is the most appropriate time to return to your ambulance and go back into service once your unit is ready?

After a verbal hand-off has been performed to an RN or higher level of care in the ER, and they have accepted the transfer of care

Which of the following ways would be most likely for hepatitis C to be transferred to a paramedic from a Hep-C positive patient?

After administering an IM medication to the patient, the paramedic accidentally sticks the needle into her hand while trying to re-cap it

Your adult patient is experiencing laryngeal spasm, making it impossible to effectively establish an open airway. What is the best way to initially manage the airway of a patient suffering laryngeal spasm?

Aggressive ventilation and a forceful upward pull on the lower jaw

A paramedic experiences an increase in heart rate, blood pressure, and respirations as he responds with lights and siren to the scene of an emergency. His increased alertness is a result of sympathetic nervous system stimulation. Which phase of the general adaptation syndrome (GAS) is he in?

Alarm

Your patient is having an asthma attack. When listening to lung sounds, you hear wheezing in all fields. You decide to use a beta-2 sympathomimetic to reverse bronchospasms. Which of the following are beta-2 sympathomimetics?

Albuterol and Terbutaline

You are called to assist a 23-year-old suffering a severe asthma attack. On arrival, the patient is extremely dyspneic with audible inspiratory and expiratory wheezing. His wife informs you that he has an extensive asthma history and takes Proventil via a metered dose inhaler. She states the medication failed to prevent the escalation of today's asthma attack, so she called for help. His respirations are currently 33 per minute; his heart rate is 130 and regular, and his blood pressure is 128 systolic. He is somewhat cyanotic around his nail beds and diaphoretic. Which of the following medications, routes of administration, and dosage range would be mostappropriate after epinephrine fails to relieve the severe bronchospasm?

Albuterol via oxygen powered nebulizer at 6 liters per minute with 5 mg of medication mixed in 6 mL of normal saline (5 mg/6 mL)

An elderly patient presents with acute, reversible confusion also known as delirium. Which one of the following is NOT a likely cause?

Alzheimer's disease

Which of the following would be indicated in refractory ventricular fibrillation when repeated shocks and epinephrine fail to convert the lethal rhythm?

Amiodarone

Your adult cardiac arrest patient is in refractory ventricular fibrillation. He has failed to respond to three defibrillation attempts and a single dose of epinephrine. Therefore, you decide to administer the next medication in the sequence, amiodarone. What would be the proper first and second dose of the medication?

Amiodarone 300 mg via IV bolus first dose and 150 mg the second IV dose

Your patient is in active labor. Which one of the following factors suggests her newborn will need extensive resuscitation?

Amniotic fluid stained with meconium

An EMS crew is called to a home for pediatric dyspnea. While managing this pediatric asthma attack, a paramedic administers an incorrect dose of albuterol to the patient. Although there is no harm at all to the child, the parents elect to sue the paramedic and the EMS service after learning of the accidental drug miscalculation. What element required to show negligence is still missing from this set of facts?

Damages to plaintiff

You are evaluating a 58-year-old who presented with sudden onset chest pain that radiates downward to his lumbar spine region. His peripheral pulses are present but unequal with a significant difference in blood pressure between his left and right arms. Which of the following conditions is most likely to cause the patient's presentation?

An aortic aneurysm dissection

You have just inserted a nasogastric (NG) tube in your intubated patient to relieve gastric distension. Which of the following confirmation means is mostappropriate for determining the placement of an NG tube?

Auscultate the epigastric region while injecting 20 to 30 mL of air into the NG tube

You are on-scene with an adult patient who was found with an extremely altered level of consciousness, and a small amount of blood noted on his lips. There are no other obvious signs of trauma during the primary assessment other than a small tongue laceration. After ensuring an adequate airway, you discover the patient's small tongue laceration appears consistent with biting his tongue. He also has obviously swollen gums that do not appear to be caused by trauma. His vital signs are found to be within normal limits, and his pupils react to light, but his level of consciousness continues to be decreased to painful stimuli only. With the limited findings, which of the following conditions is most likely to cause the patient presentation?

An epileptic seizure is likely responsible for causing the patient's condition

Your 50-year-old patient is apneic on your arrival. You intubate the patient and visualize the tube passing through the cords. What is your next step in tube placement confirmation?

Auscultating over the epigastric region

Your patient has an open neck wound after being stabbed during a robbery. To reduce the potential for an air embolism, what should you include in your treatment plan?

An occlusive dressing and placement of the patient in the Trendelenburg position

You are called to the scene of an assault at a party. Your patient is a 58-year-old male who has been stabbed in the chest. As you approach, you notice his breathing is labored and you hear sucking sounds coming from his chest. Your care of this patient will most likely include?

An occlusive dressing over his chest wound

Which of the following findings is the MOST clinically significant when assessing a patient with a severe headache?

An unsteady gait

Simply put, shock is a state of hypoperfusion due to several different causes. Which one of the following types of shock would be considered distributive shock?

Anaphylactic shock

You arrive on scene for a patient in acute respiratory distress. According to family members, after starting a new medication, the patient complained of itching and a skin rash, and then started to "swell up." Your assessment reveals a lethargic patient with swollen eyes and lips and hives covering her body. Her breathing is labored and tachypenic, and you hear inspiratory stridor. This is most likely what type of emergency?

Anaphylactoid reaction

EMS personnel are required by law to report certain medical cases to the proper authority in the region. Which of the following would fall under the mandatory reporting rules?

Animal bites

A patient has wrecked his all-terrain vehicle on a remote trail. By the time you arrive by his side, he is conscious, but still amnestic to the events leading up to this point. If there is no other life threat to the airway, breathing, or circulation, what general impression would have of this patient?

Appears stable, but is potentially unstable

You are called to assist a twenty-three-year-old patient complaining of nausea and vomiting. On arrival, the patient reports that he became nauseated then began vomiting after the sudden onset of lower abdominal pain earlier in the day. He states the pain is now in the lower right abdominal quadrant and worsening. He rates the pain at ten on the pain scale. His skin is somewhat hot and dry but pale. Which of the following abdominal conditions is most likely to cause his signs and symptoms?

Appendicitis

Your 25-year-old female patient is experiencing sharp abdominal pain in the RLQ of her abdomen, accompanied by nausea, fever, and a decrease in appetite. Which of the following would most likely be causing her symptoms?

Appendicitis

A man has a large laceration to his inner thigh and is bleeding heavily. You apply direct pressure, which controls the bleeding. The patient is conscious, but restless and is diaphoretic. Your next action should be to:

Apply a pressure bandage

Your adult trauma patient sustained a large deep laceration to his right thigh, which is spurting bright red blood. He is conscious and alert but beginning to show the signs of hypovolemia. Which of the following would be the most appropriate initial intervention?

Apply direct pressure to the wound

Paramedics are called to the scene where a man has cut himself with a chain saw. He is found supine, with blood spurting from a gaping laceration to the upper thigh. The initial general impression reveals a pale and pasty-looking patient. After donning personal protective equipment and ensuring scene safety, which action should the paramedic take next?

Apply direct pressure to the wound and continue your initial assessment.

You are the paramedic on an ambulance, and you are first in on an MVA on a busy highway. Where is the bestposition to park your unit?

Approximately 100 feet past the scene on the same side of the road, with emergency lights turned on

Which of the following is a potentially life-threatening emergency that most often occurs with injuries above T4 to T6 and results from the loss of parasympathetic stimulation?

Autonomic dysreflexia

Which of the following injury types is most likely to occur if your adult patient strikes his head on the bottom of a shallow pool while attempting to dive?

Axial loading

Your fifty-year-old COPD patient presents with a productive cough, pleuritic chest pain, and a fever with chills. Which of the following should you suspect due to his signs, symptoms, and history?

Bacterial pneumonia

A paramedic is attempting to extricate and transport a patient with extreme morbid obesity (500 or more pounds). His chief complaint is significant infections to the skin overlying sutures from gastric bypass surgery. What type of stretcher should be used for this patient?

Bariatric

Classic symptoms of cardiac tamponade include jugular vein distension (JVD) , hypotension, and muffled heart sounds. Together, these three findings are known as:

Beck's triad.

At the scene of a motor vehicle accident, you note that the driver, a young woman is lying next to her car and has agonal gasps and no palpable pulse. Other than a closed tibial fracture, she has no other obvious trauma. She is wearing a bracelet that identifies her as an organ donor. How should you manage this situation?

Begin aggressive treatment and transport immediately

A 71-year-old male presents with chest pain and shortness of breath. He is conscious, but confused, and is profusely diaphoretic. He has weakly palpable radial pulses, a BP of 70/40 mm Hg, and diffuse crackles in all lung fields. You administer high-flow oxygen and apply the cardiac monitor, which reveals sinus tachycardia. The closest appropriate hospital is 40 miles away. Which of the following is the MOST appropriate next action?

Begin an infusion of dopamine.

You quickly control the airway of an unconscious patient using a combi-tube. During transport to the hospital, the patient regains consciousness and begins to resist the tube. What should you do at this point?

Begin rapid sequence induction in order to sedate the patient and control the gag reflex

Other than a stroke, what is a common cause of one-sided facial droop and paralysis in an adult patient who exhibits no other neurological findings?

Bell's palsy

Which one of the following drug classes would be most appropriate for a patient experiencing status epilepticus?

Benzodiazepines

You are assessing an unresponsive man's respirations and note that he is taking irregular breaths that vary in volume and rate with periods of apnea. This breathing pattern is MOST consistent with:

Biot's respirations.

When monitoring the electrical activity of a patient's heart, which standard limb lead records the difference in electrical potential between the left leg and the right arm when the left leg is positive and the right arm is negative?

Bipolar limb lead II (LII)

A semiconscious young female has just been extricated from her wrecked vehicle. Her airway is patent, her respirations are rapid and shallow, and her pulse is rapid and weak. She has bilaterally closed femur fractures; an open humerus fracture with active bleeding; a rigid, distended abdomen; and a large hematoma to her forehead. The closest trauma center is 25 miles away. What interventions should you perform at the scene?

Bleeding control, ventilatory assistance with a bag-valve-mask and 100% oxygen, and full spinal precautions

Which of the following victim or bystander reactions would MOST likely escalate the stress associated with a mass-casualty incident?

Blind panic

Other than establishing and maintaining an open airway and supporting ventilatory function, what should be the paramedic's priority when treating patients who have possibly been exposed to an agent such as sarin?

Blocking the effects of acetylcholine on the nervous system

A 60-year-old male presents with an acute onset of confusion and slurred speech. His family states that the episode began while he was watching TV, and that he was normal all morning. Which of the following assessments would be the MOST likely to reveal a possible cause of his altered mental status?

Blood glucose level

Which of the following would be an early sign of a possible aortic dissection?

Blood pressure difference of 20 mmHg or more in the upper extremities

A patient has sustained a spinal-cord injury at the level of C-6. The patient is at risk for developing the complication of autonomic dysreflexia. Which one of the following symptoms would alert the paramedic to the presence of this high-risk complication?

Blurred vision

You are evaluating a trauma patient who may have sustained a spinal cord injury. Which of the following would you expect to see in a trauma patient with a spinal cord injury with autonomic nervous system involvement?

Bradycardia, hypotension, and a loss of sweating or shivering ability

Of the following clinical findings, which one is least likely to be seen in a patient experiencing a thyroid storm?

Bradypnea

Which of the following is associated with insufficient carbon dioxide elimination?

Bradypnea and hypopnea

Which of the following requires immediate removal of an ambulance from service?

Brake fade

Your adult trauma patient may be experiencing the adverse effects of a crush injury that triggered the sudden release of high levels of histamine. What would this usually cause?

Bronchoconstriction and vasodilation

Your adult respiratory distress patient is struggling to breathe on your arrival. The overweight patient reports a productive cough and appears slightly cyanotic around his lips and nail beds. During auscultation of his lung fields, you note the presence of coarse rhonchi making it apparent the patient is experiencing resistance during inspiration and expiration. Which of the following medical conditions do you suspect is causing his presentation?

Bronchitis

You arrive on scene of a 24-year-old female who was involved in a head-on motor vehicle collision. While assessing your patient, you find contusions to the head, neck, and chest. You hear snoring respirations and palpate a weak and thready radial pulse. Your first course of action would be?

C-spine immobilization and opening the airway with a modified jaw-thrust maneuver

During an adult cardiac arrest, what would a PETCO2 of less than 10 mmHg indicate?

CPR compressions and ventilations need improvement

What is the pathophysiologic difference between cyanide and carbon monoxide?

Carbon monoxide binds to the hemoglobin molecule.

Which of these factors do not affect stroke volume?

Cardiac elasticity

While evaluating the electrocardiogram tracing of a 60-year-old patient, you note the presence of deep, symmetrically inverted T waves. The tracing also reveals normal QRS complex and P-R interval durations. The patient states he has a history of hypertension, heart disease, and high cholesterol but denies a past heart attack or stroke. What is the most likely cause of the electrocardiogram findings?

Cardiac ischemia

A patient is complaining of respiratory distress, but has clear breath sounds and no objective signs of dyspnea. A 12-lead electrocardiogram (ECG) shows ST elevation in Lead II, AVF, and V4R. The patient also suffered an old spinal-cord injury that left him paralyzed from the chest down. Given those findings, what body system is most likely the cause of the dyspnea?

Cardiovascular

When a patient has decreased blood flow and hypoperfusion at the tissue level, a shock state exists. When the body can overcome the decrease in available fluid, the shock is compensated. How is the body able to respond to the "low fluid" and maintain cardiac output and perfusion in this stage of shock?

Increases catecholamine production in an attempt to maintain cardiac output and blood pressure

What is the most significant reason a high-velocity bullet causes more damage than a medium-velocity bullet?

Cavitation occurs with higher velocity penetrations.

Your conscious, alert, and oriented adult patient was involved in a motor vehicle accident involving major rear-end impact. He was the restrained driver and is now complaining of the inability to move either of his arms. There are no obvious injuries noted. The patient is able to move both lower extremities but reports weakness and decreased sensation to the interior aspects of both thighs. The patient has diminished but present distal pulses. He only has some touch sensation, and no grips or hand/arm movement, leading you to determine upper extremity paralysis exists. Which of the spinal injury syndromes is most likely to cause the signs and symptoms described above?

Central cord syndrome

Which of the following incomplete spinal cord syndromes commonly occurs with hyperextension and/or flexion cervical spine injuries and presents with a greater loss of function in the upper extremities than in the lower extremities?

Central spinal cord syndrome

You are called to an unknown medical call. On arrival, a bystander points out your patient who is about twenty yards away. He is sitting upright and leaning forward with his hands on his knees and only able to speak in short sentences. At first glance, which of the following medical conditions would you suspect?

Chronic obstructive pulmonary disease exacerbation

When assessing a patient with a closed head injury, you note the presence of trismus. This is defined as:

Clenching of the teeth

An adult patient who experiences the loss of his/her gag reflex following a closed-head and suspected spinal injury may have suffered an injury to which of the following cranial nerves?

Cranial nerve X (vagus)

An adult trauma patient suffered a fall from greater than 15 feet. When predicting the injuries associated with this type injury, the paramedic should evaluate the distance fallen, the position of the body on impact, and which of the following?

The type of landing surface involved

A patient is experiencing a possible neurological emergency from a blunt force closed head injury. He is found to have abnormal pupillary reactions to light and has lost the ability to move his eyes from side to side to follow your finger movements. He is also unable to identify the number of fingers you are holding up. He reports he is able to see the fingers but is not able to focus enough to identify how many fingers are present. Which of the following cranial nerves should you suspect may be involved in his injury?

Cranial nerves II, III, and IV

You are the incident commander at a mass casualty incident. Two passenger trains have collided inside a tunnel that is one mile in length. Initial casualty reports are in the hundreds. What type of incident is this?

Closed

A responsive 20 yom with a suspected foreign body airway obstruction is anxious, coughing forcefully, and is able to speak with difficulty. You should:

Closely monitor the patient's condition and encourage him to keep coughing

When auscultating a patient's heart sounds, what does the first sound of the cardiac cycle indicate?

Closure of the atrioventricular valves during ventricular systole

Paramedics are assessing a man who reportedly overdosed. The patient is agitated, his BP is 180/100 mm Hg, his pulse rate is 150 beats/min, and his skin is hot to the touch. Which of the following drugs would MOST likely cause these signs and symptoms?

Cocaine

Your adult trauma patient is showing the signs and symptoms of compensated shock including blood shunting and tissue hypoxia at the cellular level. Which of the common shock findings would lead you to suspect blood shunting and cellular hypoxia is occurring?

Cold extremities and the presence of cyanosis

Which of the following is considered a solution that contains molecules, such as proteins, that are too large to pass through the capillary membrane?

Colloid solution

You are attempting to perform a needle cricothyrotomy on a patient with complete airway occlusion from severe facial trauma. You will palpate the larynx for what landmark structure to puncture?

Cricothyroid ligament

if a paramedic commits a scope of practice violation, which of the following may result?

Criminal charges

While treating a patient with a closed-head injury and a major bleeding wound to his inner thigh, you suspect the presence of hypovolemia due to his blood pressure of 66 systolic and a heart rate of 120. However, your evaluation also reveals signs and symptoms of increased intracranial pressure. Which of the following would medical command most likely recommend in this case?

Crystalloid fluid boluses in an attempt to maintain the blood pressure at 90 systolic

An adult asthma patient is experiencing laryngospasm and ineffective respirations, making orotracheal intubation impossible. You quickly decide to employ nasotracheal intubation. Which of the following tubes would be most appropriate for the procedure for an average height and weight adult?

Cuffed 6.0-6.5 mm endotracheal tube

Your adult patient is showing signs and symptoms of heat stroke after working in extreme heat all day. During treatment and evaluation, your patient begins to seize. Which of the following is recommended to treat the patient's seizure?

Diazepam

A 33-year-old female presents with a headache, extreme weakness, chills, and a high fever for the past 10 days. She denies vaginal discharge, urinary difficulty, or painful intercourse. Assessment of her abdomen reveals palpable tenderness to the left upper quadrant. Which of the following is the MOST likely cause of her symptoms?

Cytomegalovirus

Why is the administration of 50% dextrose contraindicated in infant patients?

D50W can be extremely detrimental to the infant's blood vessels.

Triage this patient: A 63-year-old female with severe hip pain after a bus crash. She has obvious bilateral femur fractures. Her respiratory rate is 26 breaths per minute and she has a rapid radial pulse. She follows your commands but is unable to move her legs. The passenger next to her is dead.

DELAYED (yellow)

You have arrived on scene of a female that has fallen off her roof. The roof looks to be about 20 feet high and your patient has a GCS score of 7. You begin to intubate with assistance from your partner. After you have successfully inserted the ET tube and inflated the cuff, your partner auscultates as you begin to attach the ETCO2. Your partner finds breath sounds in only the right lung. Next you should?

Deflate the cuff and retract the tube a half inch

You are on scene with a patient in respiratory arrest. After intubating the patient using the endotracheal route, you note the presence of adequate breath sounds on the right side, but you auscultate decreased breath sounds on the left side of the patient's chest. What should you do at this point in the intervention?

Deflate the cuff, pull the ET tube back 2-3 cm, re-inflate the cuff, and reassess breath sounds for presence and quality

A 49-year-old man with type I diabetes has not taken his insulin in the past 2 days. Which of the following signs and symptoms would the paramedic MOST likely encounter?

Dehydration; deep, rapid breathing; warm, dry skin

When the paramedic responds to a crime scene, which one of the following is NOT an appropriate action?

Delay resuscitation in the interest of preserving the crime scene.

Which of the following is the earliest sign of shock in an 18-month-old child?

Delayed capillary refill

Your 30-year-old patient presents with severe anxiety, agitation, and hyperactivity. His heart rate is 138 beats per minute and irregular. He is hypertensive and quickly admits to cocaine ingestion in the past few hours. He is very agitated and fears he will die. Which of the following would be most effective in managing this patient?

Diazepam

You have a 70-year-old female patient in cardiac arrest. Your partner begins compressions, and another paramedic on-scene begins ventilating with an OPA and BVM. You look over to the fridge and find the patient's DNR orders that state the patient does not want any life-saving procedures and looks to be signed and valid. However, the patient has many pictures of her family on the fridge, and pictures drawn for her by her grandchildren. There is no family on-scene. What are the next steps that you should take?

Discontinue all resuscitation measures, and take the next steps of notifying your dispatch and/or local medical coroner, as laid out by protocol

Anaphylaxis would most commonly be an example of what kind of shock?

Distributive

You are on-scene with an adult patient who is hypotensive, has pulmonary edema, and profound hypotension at 48 systolic from an apparent third-degree AV block. The patient's blood pressure fails to respond to adequate transcutaneous pacing at 70 beats per minute with electrical and mechanical capture obtained. Which of the following would be most appropriate in an attempt to increase the patient's blood pressure?

Dopamine infusion

Your adult patient is exhibiting the signs and symptoms of shock a week after experiencing a small myocardial infarction that kept him in the hospital for two days. He reports the doctor told him there was no permanent damage to his heart, but he has not returned to full activity yet. His heart rate is 110 with a blood pressure of 68 systolic. His skin is cool, clammy, and diaphoretic with rales auscultated throughout his lungs. Which of the following would be most appropriate?

Dopamine infusion at 2-20 mcg/kg/minute titrated to a systolic BP of 90 mmHg

A patient has suffered an anoxic brain injury following prolonged seizing activity. During the postictal phase, the patient is demonstrating agonal breathing. What neurologic region of the brainstem is responsible for this abnormal breathing pattern?

Dorsal respiratory group

You are assessing a patient with an altered mental status and has a diabetic history. Which of the following would most likely indicate the patient is suffering from diabetic ketoacidosis?

Dry skin, dry mucous membranes, hypotension, shallow rapid respirations, and family members report that the patient spoke of increased thirst and frequent urination for several days before calling 9-1-1

Which of the following organs is not an intraperitoneal organ?

Duodenum

Fractures and dislocations are normally splinted in the position found. However, if circulation is impaired distally, if allowed by medical control, an attempt may be made to realign the fracture/dislocation in hopes of regaining circulation. What is the one exception to this rule indicating re-alignment should never be attempted in the pre-hospital setting?

Elbow fractures/dislocations

You are teaching a continuing education class for your EMS agency. One night you ask participants to identify categories of weapons of mass destruction. Which one of the following would NOT be correct?

Electrical

The QRS complex on an ECG represents:

Electrical depolarization of the ventricles.

A patient has been injured when his mid-size tractor rolled over him. Paramedics on scene suspect crush syndrome. In addition to standard trauma care, which one of the following diagnostic instruments can help verify the diagnosis?

Electrocardiogram

What type of stroke shares the same basic pathophysiological process as a myocardial infarction?

Embolic

You find a patient unresponsive in a home full of smoke from a stove fire. Although there is no risk of open flame or explosion, the smoke is heavy. If you are to remove the patient from the residence, what type of moving technique should you use?

Emergency move

Which of the following statements regarding the incident command system is correct?

Emergency response agencies are required to use the incident command system, regardless of the type, size, or complexity of the incident.

You are interviewing a patient with terminal bone cancer. She is in extreme pain. You say, "I am sure your pain must be intense. I can only imagine." In doing so, you are employing what type of interviewer response technique?

Empathy

Which of the following medical conditions is most likelyto cause enlarged airspace beyond the terminal bronchioles with collapse and destruction of the alveoli?

Emphysema

Which of the following medical conditions or injuries is most likely to cause problems with both the internal and external processes of normal respiration?

Emphysema

Which of the following respiratory diseases is associated with decreased alveolar elasticity, air trapping in the lungs, and an increase in residual lung volume?

Emphysema

A patient was bitten by fire ants and is unresponsive. He has severe edema to the face and neck and generalized urticaria. Breath sounds are difficult to hear, and loud inspiratory stridor is noted. Which of the following interventions has the highest priority?

Endotracheal intubation

Of the following routes for emergency administration of Narcan (naloxone) during an asystolic cardiac arrest, which one would be the LEAST desirable route to use?

Endotracheal tube

Which of the following airway devices is MOST appropriate to use in a deeply unresponsive intoxicarted patient?

Endotracheal tube

Your trauma patient sustained a large laceration to her left thigh that was bleeding profusely on your arrival, but now the bleeding is controlled with a bulky pressure dressing. The patient is confused, pale, and found to have a blood pressure of 90 systolic just after the injury was treated. After medical intervention and treatment for shock, the patient's blood pressure continues to fall. Which of the following most likely caused this to occur?

Increasing hypoxemia and lactic acidosis

A pediatric patient is complaining of respiratory distress. She is sitting upright and has slight inspiratory stridor with drooling. The pulse oximeter reading is 94% on room air. What is your field impression?

Epiglottitis

You are dispatched for an 8-year-old male patient with difficulty breathing. Your initial impression when you walk into the bedroom reveals a child in respiratory distress in the sniffing position with oral secretions and audible stridor. Upon assessment, the patient complains of a sore throat and difficulty swallowing. You notice the patient has a muffled voice. The mother on scene states the patient has has cold-like symptoms for the last two days and most recently had a 102.7 degree fever, taken 20 min prior to arrival of EMS. The mother states the patient has not had a cough and denies any vomiting or diarrhea. Your differential diagnosis is?

Epiglottitis

With regard to endotracheal intubation, which of the following is the MOST harmful to your patient if unrecognized?

Esophageal intubation

You are called to assist a 50-year-old female patient with a history of hypertension and liver cirrhosis. Her chief complaint today includes abdominal pain with nausea and vomiting of bright red blood. With her history and current findings, which of the following should you suspect?

Esophageal varices

You are working in a pre-hospital setting and are called for a 40-year-old male who was the victim of a stabbing. The patient has a blood pressure of 87/50 and a heart rate of 130. There is a large amount of blood on the scene. After applying direct pressure to the wound on the patient's arm and stopping the bleeding, of the following what would be the bestintervention to mitigate the patient's blood pressure?

Establish an IV, and administer fluid to keep the patient's BP at or near 90 systolic

a 170lb adult lost a large amount of blood from an external wound. He is conscious and alert, but restless and has cool, clammy skin. His blood pressure is 112/70 and his pulse is 110 beats and strong. Which of the following statements regarding IV therapy in this patient is MOST correct?

Establish at least one large-bore IV and give enough crystalloid solution to maintain perfusion

The CHARTE method and SOAP method are two methods utilized by paramedics to complete the narrative portion of the patient care report. Which of the following is not a component of the CHARTE method?

Etcetera (etc.)

You are called to transport a 14-year-old boy with an unknown problem. Upon arrival, you find the patient to be in some distress with a very stiff neck (torticollis). He displays difficulty swallowing and unusual tongue movements. His friend admits that they took a couple of his grandmother's pills the night before to see what would happen. He thinks the name of the medication is haloperidol. What is the most likely explanation for the patient's symptoms?

Extrapyramidal syndrome

A patient is found unresponsive in his small bathroom. He is not breathing and is sitting in the corner. Two paramedics are able to reach him, but they are unable to stand side by side. He appears to weigh about 150 pounds and there is no evidence that he has been injured. Which of the following would be the quickest and MOST efficient way of moving him out of the bathroom?

Extremity lift

The following statements address the role of EMS personnel in an auto extrication. Which one is most correct?

Extrication can be as simple as opening an unaffected door on the vehicle.

All emergency vehicle operators may be held liable for traffic incidents that involve excessive speed, improper use of emergency warning equipment, and which of the following?

Failure to consider road and weather conditions in the area

You have arrived to a skier vs. skier accident to find an unconscious 16-year-old male patient lying prone. The patient is sluggish, bradycardic, and has non reactive pupils. You begin to ventilate the patient at 20 breaths/min because you suspect?

Increasing intracranial pressure

Paramedics are caring for a 15-year-old female involved in a sporting accident. She is anxious and apprehensive during the exam. Which one of the following is NOT a common fear typically seen in this age group

Fear of contracting a serious disease

You are caring for a neonatal patient with seizures. Which one of the following types of seizure would most likely require non-pharmacologic treatment?

Febrile seizure

Which one of the following ALS medications may have an initial dose of 1 mcg/kg?

Fentanyl

You are caring for a 19-year-old male who wrecked his motorcycle and sustained an open fracture of the tibia/fibula, resulting in extreme pain. There are no other distracting injuries or clinical indications of deterioration. What could be an appropriate initial medication and dose to administer?

Fentanyl, 100 mcg

You are assessing a 32-year-old female who complains of chills, muscle aches, and a headache. She tells you that she began feeling bad a few days ago, and has been taking ibuprofen for her headache. Her blood pressure is 130/72 mm Hg, pulse is 118 beats/min and strong, and respirations are 16 breaths/min and unlabored. The patient denies any significant medical problems and is conscious and alert. Further assessment of this patient will MOST likely reveal:

Fever

You are evaluating a burn injury that appears pearly white, charred, and leathery. The patient states it hurt very bad initially but is relatively pain-free now. Which of the following burn depths is most likely to cause the presentation?

Full-thickness burn

The AHA utilizes a system to describe the relative importance of certain medications or interventions. The medications and interventions listed within the AHA guidelines have varying degrees of support through reliable scientific evidence. What does Class IIa indicate?

Indicated moderate evidence

What is the large opening in the base of the skull where the spinal cord enters?

Foramen Magnum

What is the abnormal OB/GYN condition that occurs during active childbirth, when the buttocks of the infant are visible at the opening of the birth canal with flexed hips and legs extended in front of them?

Frank breech

You are caring for and transporting a female patient in active labor. Only the infant's buttocks are presenting. How would you describe the infant's position to the receiving facility staff?

Frank breech

Which of the following is the MOST effective method for preventing the spread of disease?

Frequent hand-washing, especially in between patients.

A 75-year-old female is complaining of acute abdominal pain and calls EMS. When you arrive, you find her in bed, conscious, and looking very distressed. She has a tender abdomen, and says the pain started shortly after eating dinner at a fast food restaurant with her grandchildren. She denies any recent change to bowel or bladder habits, and has had no abdominal surgery. She has a history of diabetes and an ulcer "years ago." Of the following potential diagnoses, which one is most likely at this point?

Gastritis

On your day off, you are driving home from the grocery store and you see a three-car crash occur in front of you. You safely park your car and offer assistance until EMS arrives. Unfortunately, someone at the crash site dies, and you are subsequently sued by the grieving family for contributing to the death. Which item in the list below would be your best defense in a court of law?

Good Samaritan

You are called to the scene of a lethargic elderly patient. Upon arrival, you find the patient in bed, responsive only to deep painful stimuli. She is tachypenic, tachycardic, and has a low blood pressure with a wide pulse pressure. She is a known diabetic, and you see a large ulceration on her leg that looks infected. She has slight inspiratory rales and jugular venous distention (JVD). Given this presentation, which one of the following differential field impressions is most likely NOT present?

Gastrointestinal bleeding

You are dispatched to a 67-year-old female who overdosed on a beta blocker. Which medication has positive inotropic and chronotropic effects on the heart that are independent of beta-adrenergic receptors that will benefit in this overdose?

Glucagon

You have been called to a local movie theater for an adult male who is unresponsive in the men's room. During your assessment and management of the patient, which one of the following medical monitoring devices would be most helpful during your differential diagnosis?

Glucometer

Which of the following conditions is considered an autoimmune disorder that can cause respiratory muscle paralysis as the disease progresses?

Guillain-Barre syndrome

You are called to assist a 66-year-old who has been experiencing increasing leg weakness with tingling for over a week, according to his family. It has now progressed to the point he cannot ambulate and states his arms are now feeling the same. He also complains of waking up this morning with mild shortness of breath. The patient states he has no significant past medical history although he recently experienced viral pneumonia but recovered well. He has no known allergies and takes no daily medications. Which of the following medical conditions is most likely to cause this presentation?

Guillain-Barre syndrome

Your patient is experiencing an allergic reaction to a bee sting, causing a natural release of histamine and other mediators by the body. What will the release of histamine and the mediators do for the patient?

Hypotension and bronchospasm

You are ordered to administer 3 mg of morphine to a chest pain patient. In which of the following situations should morphine be administered with extreme caution?

Inferior wall myocardial infarction

A 23-year-old woman who is 35 weeks pregnant complains of right upper quadrant abdominal pain, bruising to her arms, a severe headache, and pain to her right shoulder. Her BP is 180/94 mm Hg, her pulse rate is 110 beats/min, and her oxygen saturation is 95%. The paramedic should suspect:

HELLP syndrome

You are called to the scene of an automobile accident to find a local politician in the passenger seat of one of the vehicles with a known male prostitute in the driver's seat. Both occupants deny injury and sign refusal of care forms on-scene. The male politician is married and has children, so he begs you not to tell anyone of his indiscretion. However, when a local reporter asks you about the incident, you quickly tell him exactly what occurred, including the name of the politician's companion. In doing so, which of the following may have occurred?

HIPAA violation

Paramedics are called to transport a patient from a hospice house to the hospital emergency department. The patient is on reverse isolation because he is immuno-compromised. Paramedics learn he has Kaposi sarcoma. This patient's primary diagnosis is:

HIV

A 56-year-old man complains of chest pain that began while he was lying in bed reading a book. He appears anxious and frightened. His skin is pink, warm, and moist; his pulse is 74 beats/min and strong; and his respirations are 18 breaths/min and unlabored. His medical history includes hypertension and angina. His medications include lisinopril and nitroglycerin, but he tells you that he ran out of his nitroglycerin tablets a week ago. Which of the following is the MOST clinically significant of these findings?

He was at rest when the chest pain began

A patient has suffered soft-tissue trauma from a motor-vehicle collision. Which one of the factors listed below would contribute the most to delayed healing of the tissues?

History of diabetes

You are on-scene with a 30-year-old patient with dyspnea, fever, and pleural friction rub. You suspect he may be experiencing a pulmonary embolus. However, you are unable to establish the possibility of an embolus from other conditions with similar signs and symptoms. Which of the following contributing factors may lead you to confirm a pulmonary embolus in this case?

History of recent pelvic or lower extremity fracture

The ideal location for a glucose stick on a newborn would be?

Heel

Common signs of a layngeal fracture include all of the following, EXCEPT:

Hematemesis

Chronic hypertension is the most common cause of what kind of stroke?

Hemorrhagic

Your adult chronic hypertension patient calls for help after developing a sudden-onset headache that he describes as "the worst headache he has ever experienced." You note nausea, vomiting, and a steady decrease in mental status when he begins to experience a tonic-clonic seizure. Which of the following should you suspect until proven otherwise?

Hemorrhagic stroke

When a tension pneumothorax patient requires pre-hospital intervention to maintain an adequate cardiac output, which of the following signs and symptoms would indicate the patient may be in need of pre-hospital needle decompression?

Tachycardia, hypotension, jugular vein distension, and subcutaneous emphysema

You are assessing a young female and are trying to determine if she experienced a seizure or a syncopal episode. Which of the following findings is MOST consistent with a seizure?

Her heart rate is 120 beats/min.

You are called to assist an adult female at a local restaurant who was found in the bathroom, unable to speak and is barely conscious. Her husband states she was eating dinner when she simply got up from her chair and went to the bathroom. He is upset and bewildered at how she was found. As soon as you see your patient, you quickly suspect a foreign body airway obstruction. Which of the following signs would lead you to believe a foreign-body airway obstruction is present?

Her skin is cyanotic, and she has stridor respirations on inhalation

You have been dispatched for "chest pain" at a local bowling alley. Your patient is an 82-year-old male who was participating in his bowling league when he experienced severe, sudden-onset chest pain. Your patient sat down after becoming dizzy and diaphoretic. His 12-lead is attached. Vitals: P 64, BP 108/60, SpO2 99%, RR 14. The patient denies all other complaints other than chest pain. Which of the following treatments is not indicated for this patient?

High-flow oxygen

A 30-year-old man has an obvious head injury. You are unable to locate any other injuries during your rapid assessment. He has a blood pressure of 84/62 mm Hg, a weak pulse rate of 124 beats/min, and respirations of 28 breaths/min. Which of the following represents the MOST appropriate treatment for this patient?

High-flow oxygen and a 10 to 20 mL/kg bolus of normal saline

Your unconscious cardiac history patient is showing signs and symptoms of cardiogenic shock including difficulty breathing. Which of the following interventions would be contraindicated?

High-flow oxygen therapy with continuous positive airway pressure

A man is threatening to kill himself. You see no visible weapons on his person. What should be your initial concern?

His ability to injure you or your partner

You suspect that your trauma patient may be experiencing the adverse effects of a crush injury after being entrapped under a fallen building for several hours before rescue. He is found to be wheezing with shortness of breath and hypotension with no obvious sign of chest wall/lung injury or blood loss. What is the most likely cause of these findings in a crush injury patient?

Histamine release

Which of the following conditions is most likely to prevent the sinoatrial node from initiating an electrical impulse needed to begin myocardial depolarization?

Hypoxia

You are assessing a critical patient and considering the possibility of a reversible cause of his symptomatic slow heart rate. Which of the possibilities is most likelyto cause a patient to present with a slow heart rate and associated signs/symptoms of bradycardia?

Hypoxia

You are called to the scene of an attempted suicide by local law enforcement. It is determined the juvenile was attempting to commit suicide in his car by mixing several household cleaners. Once on the scene, there is a strong odor of rotten eggs and a barely breathing teenager. Which of the following agents is most likely to cause the findings in this case?

Hydrogen sulfide

A patient with diabetic ketoacidosis would typically present with which of the following signs and/or symptoms?

Hyperglycemia and dehydration

You suspect that your 23-year-old trauma patient may be experiencing increased intracranial pressure from a closed head injury. The patient initially complains of a severe headache, nausea, and vomiting. If the pressure within the patient's cranium continues to rise, which of the following signs and symptoms can you expect to develop?

Hypertension associated with bradycardia and a decreased respiratory effort

Which of the following factors would reduce the blood's natural ability to clot, thus worsening internal or external bleeding?

Hypothermia

Which of the following findings is MOST suggestive of myxedema?

Hypothermia

A patient with a severe form of hypothyroidism known as myxedema may exhibit which of the following signs and symptoms?

Hypothermia, hypoglycemia, hypotension, respiratory depression, and coma

Which of the following disorders can mimic depression?

Hypothyroidism

An End-Tidal CO2 reading of 50mmHg signifies which of the following conditions?

Hypoventilatio

A 40-year-old female presents with diffuse abdominal cramping, nausea, vomiting, and diarrhea. She tells you that this began the day before, and is worse today. She is conscious and alert, lightheaded, and has a resting heart rate of 120 beats/min. Her temperature is 97.7° F orally, blood pressure is 110/70 mm Hg, and oxygen saturation is 99% on room air. She denies any past medical history, but states that she has been taking ibuprofen for a headache. Which of the following would represent the MOST appropriate treatment approach?

IV of normal saline; 500 mL fluid bolus; 4 mg ondansetron IV

Which of the following best describes why hypertensive crises are seldom treated with pharmacological agents in the pre-hospital setting?

If the blood pressure of a hypertensive patient is lowered too quickly, it can cause myocardial infarction, acute renal failure, and/or stroke

Your adult diabetic patient has a low blood glucose level and is unconscious. When would it be appropriate to administer glucagon to the patient in an attempt to correct the low blood glucose level?

If the patient has an altered level of consciousness and you are unable to obtain a patent IV line

You arrive on the scene of a "man down" call to find an 80-year-old male patient pulseless and apneic. The family states he stopped breathing just prior to your arrival. The patient has an active do not resuscitate order on site. However, the patient's wife is distraught and begs you to override the order and do everything possible to help him. Which of the following actions would be mostappropriate in this situation?

Ignore the order, and initiate full resuscitative efforts while contacting medical command

Several minutes after sealing your adult trauma patient's sucking chest wound with an occlusive dressing secured on three sides, he begins to experience increasing shortness of breath, jugular vein distension, decreasing unilateral breath sounds on the affected side, and his blood pressure is less than 90 systolic and falling. Repeated attempts to relieve the pressure at the occlusive dressing have proven ineffective. At this point, which of the following should be initiated

Immediate needle decompression using a 10- or 14-gauge catheter that is at least 2 or 2.5 inches long

Which of the following is designed to limit the amount of air that enters the chest during the upstroke phase of chest compressions, thereby enhancing negative pressure inside the chest during cardiopulmonary resuscitation efforts?

Impedance threshold device (ITD)

What is the MOST important concept to explain to a group of non-BLS trained citizens when discussing the importance of rapid EMS notification for a patient in cardiac arrest?

Importance of early CPR and defibrillation

While assessing the respiratory function of an ill five-year-old child, you note the presence of inspiratory stridor, even though the patient appears to have adequate oxygenation. Since the stridulous respirations are inspiratory only, what area of the child's respiratory system do you suspect the adventitious breath sounds are originating?

In the upper airway immediately above the glottic opening

The 1965 publication "Accidental Death and Disability: The Neglected Disease of Modern Society" revealed multiple deficiencies. Which one of those listed below was NOT one of them?

Inability of EMS systems to get community support

What does hyperventilating a patient with a closed head injury and increased intracranial pressure accomplish?

Increased cerebral vasoconstriction

Following blunt force trauma to the anterior chest, a man presents with difficulty breathing, engorged jugular veins, absent breath sounds over the left side of the chest, and hypotension. Which of the following BEST describes the pathophysiology of this patient's injury?

Increased pressure in the pleural space is compressing the great vessels

Which of the following is considered an early sign of shock?

Increased rate of respirations

Which of the following is not a cause of shock?

Increased systemic vascular resistance

All traditional means of clearing an obstructed airway have been exhausted, and your adult patient is quickly approaching cardiopulmonary arrest. As a last-resort effort to save your patient's life, you decide to attempt ventilation through a needle cricothyrotomy. Where do you want to insert the catheter in order to ventilate the patient?

Into the midline of the cricothyroid membrane at a 45-degree angle toward the feet

In supine hypotensive syndrome, the uterus becomes large enough that, when laying supine, it compresses which blood vessel?

Inferior vena cava

Your suspected myocardial infarction patient has exhibited ST elevation in Leads II, III, aVF on the electrocardiogram. What area of the heart do you suspect is being damaged?

Inferior wall

Which of the following is not one of three general approaches used in patient assessment

Informational

You arrive at a manufacturing facility for a "man down." You are escorted into the building and led to a painting booth, where you can see three workers lying on the floor, unresponsive. Given this limited information, what is one likely scene hazard?

Inhalation exposure

You are on-scene with an adult male who appears to have a partially obstructed airway. Bystanders state he is choking on pizza. He is slightly cyanotic around his mouth and nose as well as his nail beds. He is obviously struggling to breathe with diminished inspiratory/expiratory wheezing in all lobes and an ineffective cough. What would be the most appropriate intervention at this point?

Initiate a rapid, safe transport and encourage him to cough in an attempt to expel the foreign body

After being unable to clear a foreign body obstruction from the airway of your now unconscious adult patient using the Heimlich maneuver, which of the following interventions would be the most appropriate?

Initiate chest compressions

You are on-scene with a 55-year-old cardiac history patient who suddenly collapsed during dinner with his family. He is found to be pulseless and apneic with his family performing adequate CPR on arrival. His wife is distraught and hands you a legal DNR order signed by his physician. She states that he does not have a terminal illness and begs you to ignore the legal order and "do everything in your capabilities to save him!" Which of the following would be most appropriate in this situation?

Initiate full resuscitation efforts including advanced life support, and contact medical control

Your patient is a 68-year-old male complaining of weakness, dizziness, and shortness of breath. He is pale and diaphoretic. Vital signs are BP 88/64, R 18, P 32, SpO2 96%. ECG reveals second degree Type II AV block. After gaining IV access, what is your next step?

Initiate transcutaneous pacing

While evaluating the twelve-lead electrocardiogram tracing of your 66-year-old cardiac history patient for the possibility of an acute myocardial infarction, you note the presence of deep symmetrically inverted T waves. Which of the following is most likely the cause of this abnormal finding?

Ischemia

If a paramedic gives a medication to a patient to counteract or interfere with the effects of another drug or medication, what can be said about the medication he/she is giving the patient?

It is considered an antagonist medication

Your 20-year-old patient has reportedly been ill for three days with a high fever, chills, nausea, and vomiting. Her skin is cool and pale and has a delayed skin turgor response. Her heart rate is accelerated while her respirations are shallow and fast. Her blood pressure is borderline hypotensive, and she has a decreased level of consciousness. Suspecting dehydration, which of the following IV fluid would be most appropriate to administer to this patient?

Isotonic solution

What happens to most of the oxygen that enters the bloodstream?

It binds with hemoglobin on red blood cells

You are on-scene with a patient who you suspect may be experiencing a myocardial infarction. He is conscious and alert, anxious, and has dilated pupils. He complains of substernal chest pain and admits to recent cocaine use. How does the use of cocaine increase the risk of experiencing an acute myocardial infarction?

It causes coronary artery constriction and increases the chance of dislodging a thrombus or plaque

Some medical command physicians will order procainamide to be administered to patients who failed to convert from supraventricular tachycardia after vagal maneuvers and adenosine. Why may procainamide be successful in converting the rhythm when adenosine failed?

It prolongs the Q-T interval

What is the benefit of inducing mild hypothermia to a post-arrest patient who has a return of spontaneous circulation?

It reduces intracranial pressure, the cerebral metabolic rate, and the brain's demand for oxygen

Epinephrine is effective in helping reverse the adverse effects of anaphylaxis. It is the drug of choice because it causes bronchodilation and vasoconstriction to improve respiratory effort and improve blood pressure. What other effect does epinephrine have on the patient's body during an anaphylactic reaction?

It reduces the release of chemical mediators from the mast cells

What is the drug of choice for providing sedation prior to performing rapid sequence intubation in patients with hypotension?

Ketamine

Your patient was involved in an auto accident and struck his face on the steering wheel. He has facial edema, epistaxis, numbness to the chin area, and obvious lengthening of the face. Later, at the hospital, it is determined he has a facial fracture that runs across his face just below the nose but above his teeth. What type of fracture is most likely present?

Le Fort I fracture

Which one of the following traumatic injuries poses the greatest threat to the patient's airway when the patient is immobilized to a backboard?

LeFort III fracture

During the treatment of ventricular fibrillation, which of the following can be substituted for amiodarone when it is unavailable?

Lidocaine

In the pre-hospital setting, which of the following medications may be indicated when attempting to intubate a closed-head injury patient who already has an increase in intracranial pressure?

Lidocaine

You are preparing to intubate an unconscious closed head injury patient with an increased intracranial pressure due to respiratory insufficiency and inability to control his airway. Concern at an additional increase in intracranial pressure prompts you to consider the intravenous administration of which of the following prior to an intubation attempt

Lidocaine

You are preparing to intubate an unconscious closed head injury patient with an increased intracranial pressure due to respiratory insufficiency and inability to control his airway. Concern at an additional increase in intracranial pressure prompts you to consider the intravenous administration of which of the following prior to an intubation attempt?

Lidocaine

The pre-hospital pharmacological treatment of head injury with increased intracranial pressure is controversial. However, some medical control physicians may recommend the administration of which of the following medications to decrease cerebral edema?

Mannitol

The family members of a 64-year-old smoker with a history of COPD called the ambulance because the patient has acute onset respiratory distress and chest pain. He has two-word dyspnea. Family members relate that the patient had an outpatient bronchoscopy earlier today to "check for lung cancer." Given this history, which one of the following should the paramedic do first?

Listen to lung sounds.

Which of the following medications may be effective in reducing cerebral edema and circulating blood volume after an injury?

Mannitol

You have used your medication-facilitated intubation protocol on a patient with a suspected brain injury who is unable to maintain an airway. Following intubation and confirmation of the ET tube placement, you set up the mechanical ventilator. Choose the correct set of ventilator values for this patient, assuming she weighs 140 pounds.

Mode=A/C, PEEP=4 cmH2O, FiO2=1.0, Rate=12/minute, Vt=540 mL

Which of the following organs would produce the MOST severe blood loss following trauma to the abdomen?

Liver

Which one of the following organs would most likely be associated with medication elimination?

Liver

You are on-scene with a 19-year-old who witnesses state began seizing about 15 minutes prior with only one break in the seizure, lasting about 30 seconds. The patient is currently seizing again, making intravenous access virtually impossible at present. However, MCP orders you to administer a benzodiazepine to help suppress the spread of the seizure's focus. Which of the following medications would be mostappropriate in this case?

Lorazepam

You arrive on-scene of a seizure call to find a 22-year-old patient actively seizing. Family on scene reports the patient has an epileptic seizure disorder that sometimes causes seizures that last a minute or two. Today, the seizure has lasted for longer than fifteen minutes prior to your arrival without a break in the tonic-clonic phase. Your attempts to gain IV access are restricted due to the ongoing seizure activity. Which of the following is the drug of choice for intramuscular injection to control the prolonged seizure in this situation?

Lorazepam

You are on-scene with a 28-year-old patient who called for help after sustaining a possible dislocated shoulder at a local ski resort. He is conscious and alert, denying any injury other than the right upper extremity injury. Upon examination, his right shoulder is obviously anteriorly dislocated. His right arm is cool and pale with no palpable distal pulses noted. Due to a long transport time and the absence of distal pulses, medical command gives you orders to attempt a reduction, one time, after giving the patient lorazepam intramuscularly. Why would the physician order a benzodiazepine to be administered prior to the reduction attempt instead of a narcotic in this situation?

Lorazepam would be more helpful in the reduction due to its muscle relaxing, anti-anxiety, and sedative-hypnotic effects that narcotics do not possess

You are caring for a female patient stabbed in the chest by her boyfriend. What would you consider the weapon's velocity to be?

Low

Your adult patient was located within the primary blast zone of a natural gas explosion at a local residence. If the patient was in close proximity to the source of the explosion, which of the following injuries would be referred to as primary blast injuries?

Lung injuries such as pneumothorax due to sudden pressure changes

Which of the following female hormones stimulates ovulation?

Luteninzing Hormone (LH)

You are assessing a patient who fell from a first-floor roof. The patient has blood and broken teeth in her oral cavity. Breathing is irregular and slow, and peripheral pulses are absent. There is instability noted to the cervical vertebrae. What portion of the primary assessment do you still have to perform?

Mental status

Your adult patient is found unconscious with decreased respirations. Which of the following medical conditions is most likely to cause a direct decrease in a patient's respiratory effort and/or breathing rate?

Metabolic alkalosis

Your adult trauma patient has a potential internal injury allowing bleeding into the thoracic cavity. As a general rule, where should the patient's mean arterial pressure (MAP) be maintained while treating and transporting the patient to the hospital?

MAP of 60 mmHg to 65 mmHg

You have at your disposal a medication that acts as a physiological calcium channel blocker. It is occasionally used to help inhibit the labor of childbirth. What drug does this describe?

Magnesium sulfate

which of the following would provide the paramedic with the BEST protection from legal liability

Maintain a consistently high standard of care when treating all patients

You are treating a burn patient who has partial-thickness burns over 25% of his total body surface area. According to the classification of burn severity, to what category of injury does this patient belong?

Major or critical burn requiring a level 1 burn center

Your unconscious closed head injury patient presents with a widened pulse pressure and bradycardia. Her pupils are sluggish to react, and she is exhibiting abnormal extension posturing. Her signs and symptoms lead you to believe she is experiencing increased intracranial pressure from the injury. What area of the brain is most likely impacted by the increase in pressure?

Midbrain

A 40 yom presents with acite respiratory distress while eating a meal. He is conscious and alert; is able to speak, but with difficulty; and has pink, moist skin. Which of the following statements BEST decribes this patient's condition?

Mild airway obstruction with adequate air exchange

Negligence is divided into three categories. Which of the following is not one of the categories?

Milfeasance

Of the factors listed below, which one had the greatest influence on shaping EMS in the United States?

Military wars

Which of the following should be your MOST immediate priority when caring for a patient with a closed femur fracture?

Manually stabilize the leg

Which of the following interventions is ONLY performed at the end of the third stage of labor?

Massaging the uterine fundus in a circular motion

You are called to the scene of a passenger car train derailment with possible injuries and/or fatalities. Once all services are on-scene, who has the ultimate authority for all issues regarding patient care at the scene of the potential mass-casualty incident?

Medical group officer

A 30-year-old man sustained multisystem trauma after being struck by a car that was traveling at a high rate of speed. Which of the following is the MOST critical to his survival?

Minimal on-scene time and rapid transport

A patient with a grossly deformed right humerus who is following your verbal commands should be triaged as?

Minor

Which of the following would MOST likely occur if an adult patient is breathing at a rate of 36 breaths/min and shallow?

Minute alveolar ventilation would decrease.

You are backing up another ALS unit for the management of a patient suffering a myocardial ischemic event as evidenced by ST elevation in V3, V4, V5, and V6. Thus far, they have administered 15 Lpm oxygen, 1.2 mg total nitroglycerin, 6 mg total morphine. What other drug might be considered, providing no contraindications exist?

Metaprolol

Which of the following beta blockers would be mostappropriate for the treatment of paroxysmal supraventricular tachycardia?

Metoprolol

The signs and symptoms of Wernicke's encephalopathy include ataxia, nystagmus, eye muscle weakness, and mental derangement. The pre-hospital treatment includes oxygen, IV access, and which of the following medications and dosages?

Thiamine 100 mg IM/IV and 25 g of dextrose 50 percent IV

To combat increasing ICP in a head injury, the body utilizes this principle:

Monro-Kellie Principle

You are treating an 80-year-old CHF patient. Of the following medications, which may be beneficial for this CHF patient because its mechanism of action causes venous pooling which will reduce preload and cardiac workload? You know that you must monitor the patient's respiratory effort because it is also a respiratory depressant.

Morphine

Which of the following interventions would be mosteffective in decreasing the venous return to the heart by dilation of the peripheral vessels in the venous beds?

Morphine sulfate

Which of the following statements regarding vehicle airbags is correct?

Most airbag-related deaths are the result of the occupant being too close to the airbag when it deploys.

You are assessing the cardiac rhythm of a woman with respiratory distress. The rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves vary in shape. Which of the following BEST fits this description?

Multifocal atrial tachycardia

Which of the following is responsible for the kidney failure associated with crush injury syndrome?

Myoglobin released from damaged muscles is filtered by the kidneys, causing renal failure

Some patients, such as combative or active seizure patients, may require medication administration during transport to the hospital when intravenous access is not possible. Some emergency medications can be safely and effectively administered via the nasal route using atomized forms of those medications. Which of the following are considered emergency medications that can be administered via the intranasal route?

Naloxone

When assessing an unresponsive patient, you note that he is not breathing. Which of the following airway devices or interventions is contraindicated?

Nasotracheal intubation

You are on-scene with an adult patient who has suffered a possible basilar skull fracture. During your assessment, he suddenly becomes apneic. Which of the following airway procedures are contraindicated for use when a patient who has a potential basilar skull fracture?

Nasotracheal intubation

The National Highway Transportation and Safety Act (NHTSA) created a document that provides guidelines as to what skills each level of EMS provider should be able to accomplish. What is the name of this document?

National EMS Scope of Practice Model

A 19-year-old male is suffering from fractured ribs sustained while playing football. He is complaining of difficulty breathing and intense chest wall pain on the right side. He denies back or neck pain and was ambulatory on-scene. Following proper oxygenation, he has progressive shortness of breath, absence of breath sounds on the affected side, cyanosis, JVD, subcutaneous emphysema, and hypotension. Which of the following interventions would be mostappropriate?

Needle decompression of the affected lung with a large bore IV catheter

What lead III ECG change would you expect to see in a pregnant patient in her third trimester?

Negative T-waves

Which of the following is correct regarding inspiration?

Negative pressure results from the contraction of the diaphragm, which causes the lungs to expand as they fill with air

If there is a civil claim against a paramedic, which of the following must be proven?

Negligence

The paramedic fails to administer oxygen to a severely hypoxic patient. As a result, the patient develops respiratory arrest. The patient is delivered to the emergency department; however, the paramedics leave without providing a verbal hand-off report. Which of the following does this scenario depict?

Negligence and abandonment

You are on-scene with a patient in cardiac arrest. You turn the monitor/defibrillator on and attach the pads to the patient. When it begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. You have no other batteries available, and an electrical plug is not available. The patient subsequently dies despite adequate CPR and advanced airway and ventilation during transport. Which of the following could result?

Negligence charges could be brought against the paramedic in charge of the unit

Which form of shock should you suspect if your fifty-five-year-old trauma patient presents with a suspected spinal cord injury and hypotension with no apparent internal or external blood loss?

Neurogenic shock

The pronator drift test is used under certain clinical situations to help derive what field impression?

Neurological deficit

Thyroid storm is caused by the acute hyperfunction of the thyroid gland and is a true medical emergency that requires emergent hospital intervention. Which of the following signs and symptoms would a paramedic expect a patient experiencing a thyroid storm to exhibit?

Tachycardia, tachypnea, hyperthermia, palpitations, and delirium

Your adult patient complains of dyspnea but denies chest pain or nausea and vomiting. Her heart rate is 100; her respirations are 26, and her blood pressure is 166/110. Her lung sounds reveal rales in all lobes indicating pulmonary edema. Which of the following medications would be indicated to reduce preload and afterload supporting cardiac output?

Nitroglycerin

You are called to assist a 50-year-old cardiac history patient complaining of chest pain. On arrival, the patient rates his pain at an eight on the pain scale. His skin is cool, clammy, and diaphoretic with a SpO2 of 88 percent on room air. His respirations are at 33 per minute and shallow but clear. His heart rate is 40 beats per minute with a blood pressure of 90 systolic. Which of the following interventions would be inappropriate at this point?

Nitroglycerin therapy

A diabetic patient presents with extreme fatigue, diaphoresis, dizziness when standing, jugular venous distention, pitting edema, inspiratory rales, and dyspnea of rather sudden onset. The patient has a heart rate of 110, blood pressure is 190/100, respiration is 26, and SpO2 is 96% on high-flow. The 12-lead is nonconclusive due to artifacts from the diaphoresis inhibiting the electrodes sticking to the skin. Given this presentation, what would be the next drug of choice following IV initiation?

Nitroglycerin, 0.4 mg, SL

Your 69-year-old patient awoke with severe dyspnea and is only able to talk in two- to three-word bursts. Her skin is cool, pale, and diaphoretic with labored respirations at 30 with an SPO2 at 80 on room air. She has audible wheezes and rales with pitting edema peripherally. She has an irregular heart rate of 100 to 110 bpm, and her ECG shows A-fib with no obvious pathological ST elevation or depression. Her blood pressure is 160/100 in an upright sitting position. She has a history of COPD, hypertension, and congestive heart failure. Which of the following would be a first-line medication for this patient?

Nitroglycerine

Which action by the paramedic is appropriate when she encounters a Native American Indian infant with large Mongolian spots over his back and buttocks?

No action is needed; these spots are normal.

A 3 year old child presents with a heart rate of 190 beats. Which of the following observations would MOST likely exclude a diagnosis of reentry supraventricular tachycardia

No fluctuation in rhythm regularity when the child moves

You are unable to control an upper arm hemorrhage from a laceration that is located just above the patient's antecubital fossa on the inner aspect of his upper arm. After all bleeding control measures fail, you decide to apply a tourniquet to control the hemorrhage. After the tourniquet is properly applied, the bleeding controlled, and the tourniquet secured, what should you do after reassessing the injury site?

Note the time the bleeding was controlled, and make sure the tourniquet can be seen by everyone treating the patient

You were called to assist a conscious, alert, and oriented adult male. The patient's friend called for help after the patient complained of chest pain, followed by what the friend described as a syncopal episode lasting less than a minute. He now denies chest pain and refuses treatment or transport. The patient is already loaded in the unit, so you tell him he cannot refuse transport. The patient then loses consciousness, and you decide to transport, despite the patient's initial refusal of treatment and transport. Later at the hospital, it is determined the patient was experiencing a large aortic dissection that required emergency surgery to save the patient's life. He is now stable and has a good prognosis. Which of the following may result from the paramedic's actions?

Nothing. It is considered implied consent.

You and your partner are the first to arrive at the scene of a mva crash involving two cars ans a truck. You see four patients, two who are ambulatory and two who are still in their vehicle. You should:

Notify dispatch to send additional ambulances and then begin triaging all patients.

Paramedics are caring for a child with croup. Which one of the following assessment findings would indicate a need for immediate interventions?

Tachypnea

When preparing to initiate a synchronized electrical cardioversion procedure on a patient with symptomatic paroxysmal supraventricular tachycardia, the ECG displays a "marker" denoting the location where the desired energy will be discharged. During what part of the cardiac cycle should the "marker" appear on the oscilloscope screen?

On the peak of each and every R-wave

You are caring for a pediatric patient suffering from epileptic seizures. You elect to administer a benzodiazepine, so you radio medical direction. After describing the patient's condition, you are given permission to administer the drug. What is this type of medical direction called?

On-line

Which of the following would be the best option for controlling nausea in a typical adult patient?

Ondansetron

During a multiple-casualty incident (MCI), the staging unit leader is heard saying over the radio, "Triage officer: this is the staging unit leader. Do you need another 1756 at your location, response 3?" What is wrong with this radio message?

Only plain English should be used, not codes or signals.

You arrive on scene to a 23-year-old male involved in a fight, where he was hit with a bat. He is complaining of left flank pain and is in respiratory distress. You suspect all of the following, except?

Open pneumothorax

Paramedics are called to assist in the resuscitation of an obese trauma victim with craniofacial trauma and a head injury. Despite multiple attempts to open the airway using the jaw-thrust maneuver, snoring respirations remain. The patient's oxygen saturations are 84%. Which one of the following actions is most appropriate?

Open the airway using the head-tilt/chin-lift maneuver.

You are dispatched to the scene of a one-vehicle motor collision. Upon your arrival at the scene, you note that the vehicle struck a tree on the driver side. The driver is the only patient, and she is still sitting in the driver seat of the vehicle. The vehicle is stable and has moderate damage noted to the driver side, which prevents the driver side door from opening. Which of the following would be the most appropriate way to extricate the patient from the vehicle?

Open the passenger side door and extricate through the passenger side

After being stung by a hornet, a 34-year-old man is unresponsive, has stridorous respirations, a generalized rash, and swelling to the face and neck. His BP is 70/44 mm Hg, his pulse is 140 beats/min and thready, and his respirations are 36 breaths/min and labored. Which of the following represents the MOST appropriate treatment for him?

Orotracheal intubation and 0.1 mg of epinephrine 1:10,000 IV or IO

If the paramedic wanted to assess a patient for possible hypovolemia, which one of the following clinical assessments/diagnostics would be most accurate?

Orthostatic vitals

You respond to the scene of a patient who was lost in the woods for several hours in freezing temperatures. This hypothermic patient's ECG might exhibit a slow, positive deflection at the end of the QRS complex called a:

Osborn wave

When using the START procedure for the initial triage of the patient involved in an accident, what can be said about a patient classified as a priority-2 patient?

They respond to simple commands but are not likely able to walk to the appropriate area under their own power

A 30-month-old child is having an acute asthma attack. He is short of breath, has a heart rate of 124, and a respiratory rate of 55. Which one of the following blood gas results would the paramedic expect to find in this pediatric patient?

PO2 82

You are transporting a patient complaining of chest pain. Your initial assessment of the patient on scene revealed a 42-year-old male sitting in his recliner and clutching his chest. He said he was having "10/10, crushing chest pain." After determining your patient had no allergies and starting an IV, you administered Aspirin and Nitro. He experienced no relief and his 12-lead showed ST-elevation in leads I, aVL, V5 and V6. After receiving subsequent Nitro doses en route to the hospital, your patient experienced major relief, but his 12-lead remained the same. During your secondary assessment, you have asked him about the onset of his chest pain. What should your next question be?

Palliation and/or provocatio

A penetration injury through the thoracic wall may disrupt what structural lining, likely causing the lung to collapse?

Parietal pleura

Which one of the following best describes how a flail chest disrupts the mechanism of breathing?

Paradoxical motion of the chest wall defeats the ability to change pressures in the chest cavity.

If a myocardial infarction patient presents with bradycardia and hypotension, which of the following is most likely the cause?

Parasympathetic nervous system response to an inferior wall MI

You are called to the scene where a 36-year-old male was shot in the back while running away from an assailant. While treating and attempting to stabilize the patient, what should be done with the clothing he was wearing?

Place them in a paper bag along with the disposable latex gloves you were wearing when you took or cut the clothing off; seal the bag listing the items it contains; document patient's name, time/date, and your name and title on the bag

a 35 yof experienced a syncopal episode shortly after complaining of palpitations. She was reportedly unconscious for less than 10 seconds. Upon your arrival, she is conscious and alert, denies any injuries, and states that she feels fine. she further denies any significant medical history. Her vital signs are stable and the cardiac monitor reveals a sinus rhythm with frequent prematre atrial complexes. On the basis of this information, which of the following would be the MOST likely cause of her syncopal episode

Paroxysmal supraventricular tachycardia

The paramedic is evaluating four different blood gases drawn on four separate patients. Which one of the following would be of greatest concern?

Patient on a ventilator with pneumonia; pH 7.33, PCO2 49, PO2 90, HCO3 25

Which of the following reason would indicate that a medical director's decision to remove a specific drug from the protocols was evidence -based

Patient outcome are worse the specific drug is administered

Four elderly patients, all 67 years old with preexisting diseases, are involved in identical traumatic accidents. Which one of the following patients is most likely to die from the traumatic event?

Patient with renal disease

You and your partner are triaging four patients at the scene of a motor-vehicle crash. Additional units are responding, and will arrive in approximately 8 minutes. Patient 1 is a 30-year-old male with a unilaterally deformed femur, restlessness, diaphoresis, and tachycardia. Patient 2 is a 49-year-old conscious and alert female with paralysis to her lower extremities and adequate breathing. Patient 3 is a young adult female who is unresponsive and apneic. Patient 4 is a 57-year-old male who is responsive to pain only and is coughing up blood. How should you triage these patients?

Patients 1 and 4, immediate; patient 2, delayed; patient 3, expectant

You are called to assist an adult at a local bar for an unknown reason. On arrival, you are met by a man who has his arms crossed, grasping at his throat with both hands, and he is unable to speak to you. What should you do at this point to assist your patient?

Perform abdominal thrusts while he remains conscious

A large-scale disaster is in process, and grief counselors from an outside mental health agency have been called in to assist the responders in dealing with the severity and enormity of the situation. In which one of the following sectors should the counselors be directed?

Place them in the rehabilitation area

You are on-scene with a 50-year-old patient complaining of substernal chest pain that radiates to her jaw and left shoulder. She rates the pain at ten on the pain scale. She is pale, cool, and diaphoretic with rapid, shallow respirations, but she denies shortness of breath or dyspnea. Her lung sounds are clear and equal bilaterally, and there is no evidence of pulmonary or pedal edema. Her pulse rate is 100 beats per minute; her respirations are 26 per minute, and blood pressure is 140 systolic. Which of the following would be the most reliable indicator that an acute myocardial infarction (AMI) is occurring?

Perform and evaluate the patient's twelve-lead EKG for the presence of ST-segment changes

You are treating a 65-year-old female patient complaining of chest pain and shortness of breath. Her pulse rate is 165 bpm, blood pressure is 85/50, and SpO2 is 90%. You attach a four lead to your patient, and the monitor shows rapid atrial fibrillation. From the information that you have, which of the following would be the best intervention for this patient?

Perform synchronized cardioversion at 120 to 200 joules biphasic or 200 joules monophasic

Which of the following injuries would MOST likely cause obstrucitve shock

Pericardial tamponade

Your 55-year-old patient is suspected of having a myocardial infarction. He is complaining of substernal chest pain that came on during rest. His heart rate is 88 beats per minute, and his respirations are 20. His skin is cool, pale, and diaphoretic with a blood pressure of 110 systolic. What does the presence of pale, diaphoretic skin typically indicate during a cardiac event?

Peripheral vasoconstriction and sympathetic nervous system stimulation

If a patient is suffering from pulmonary edema, which of the following will be helpful in increasing the patient's lung volume and vital capacity while reducing venous return to the heart and helping to diminish the overall work of breathing without affecting blood pressure?

Placing the patient in sitting position with his legs dependent

You are cleaning the back of the truck after transporting a trauma patient to the emergency department. Which of the following contaminated items should not be placed in a plastic biohazard bag?

Plastic IV catheter

Which one of the following medications would be appropriate to enhance uterine contractions and subsequently control excessive uterine bleeding?

Pitocin

Which of the following would be the most appropriate way to care for a deceased patient who is an organ donor?

Place lubrication or saline pads over the patient's closed eyes, and tape them shut

Paramedics are attempting to count respirations and are having difficulty because the patient's breathing is so shallow. Which one of the following actions is the preferred technique for counting respirations?

Place the back of the hand on the chest to see chest movement better.

Which of the following is not a correct action to take when assisting with a breech delivery in which the infant's head has not delivered yet?

Place the mother in left lateral recumbent position and initiate rapid transport

What is the best way to increase a conscious and alert, dyspneic patient's lung volume and improve her vital capacity while reducing the venous return to the heart and her overall work of breathing?

Place the patient in the sitting position with her legs dependent and apply oxygen

Your adult patient presents with shortness of breath and chest pain. She reports the pain began last night and has worsened. She is breathing 28 times per minute with a SpO2 of 96 percent on room air. She reports the pain worsens when asked to take a deep breath. Lung sounds are equal with a grating sound heard on inhalation. The patient's heart rate and blood pressure are normal. She is showing a sinus rhythm with a first-degree atrioventricular block present in lead II on the ECG. Which of the following is most likely the cause of her complaints?

Pleurisy

A patient presents with an acute onset of dyspnea. Which of the following conditions would be the LEAST likely underlaying cause

Pneumonia

Your adult respiratory distress patient presents with a productive cough, fever, and shaking chills. Which of the following conditions is most likely occurring?

Pneumonia

You suspect your 66-year-old patient may be experiencing an ischemic stroke due to his signs, symptoms, and especially his past medical history. Which of the following hematological disorders would most likely cause or worsen a stroke caused by a blood clot?

Polycythemia

Cardiovascular drugs are classified according to their action on the heart. Which of the following cardiovascular medication types are administered to increase the strength and/or force of the cardiac contraction?

Positive inotropic agents such as digoxin (Lanoxin)

What is the best position for a paramedic to assume when gathering a history from a stable patient?

Position yourself at the patient's eye level.

A patient's systolic blood pressure is low, secondary to a weakened left ventricle from chronic congestive heart failure (CHF). The emergency management of this patient may include administering a medication with what quality?

Positive inotropic

A 17-year-old female patient presents with repeated occurrences of abdominal pain associated with vaginal discharge. She states she has not had a period for several months, but adamantly denies she is pregnant. Upon assessment, you note enlarged vaginal tissues and a clear liquid discharge with a large mucous-and-blood clot. The patient says the abdominal cramping is getting worse. What should the paramedic do?

Prepare for delivery, because the patient is pregnant.

In which of the following do baroreceptors sense a change?

Pressure

When assessing the pupils of a patient with a severe closed head injury, you note that they are bilaterally dilated and nonreactive. What does this specifically indicate?

Pressure on the oculomotor nerve

What are the therapeutic effects of aspirin when given to patients experiencing an acute coronary syndrome?

Prevents platelet aggregation

What is the most significant finding in most patients with an abdominal aortic aneurysm that has not yet ruptured?

Pulsating abdominal mass

You are assessing a middle age female who complains of chest discomfort. She is conscious, alert, and oriented. Her skin is diaphoretic. Her blood pressure is 122/72, pulse rate is 120 and respirations are 20. On the basus of her chief complaint, which of your assessment findings is the MOST significant?

Pulse rate of 120

You are dispatched to a 22-year-old male involved in an industrial accident. The patient's right arm is entrapped in a machine. Why is it important to remove any jewelry or restrictive clothing from the patient's right arm before or immediately after the compression is released?

Protein that escapes the vascular bed through inflamed or damaged capillary walls will result in an increase in fluid oncotic pressure and subsequent edema for the entire extremity

A patient has attempted suicide with a shotgun blast to the face. Upon your arrival, half the jaw has been blown off as has the anterior tongue and upper lip. The patient is still conscious but disoriented and is bleeding heavily. Emergency Medical Responders on scene are providing blow-by oxygen to the patient. What should the paramedic's first action be to manage the airway?

Provide oral suctioning

A patient with a diagnosis of bipolar disorder, manic episode, is extremely active, talks constantly, and is having difficulty focusing on the assessment questions being asked. Which one of the following interventions by the paramedic is likely to be most effective?

Providing distraction

A patient receives a traumatic blunt injury to the chest wall when a piece of machinery falls on him. You find left thoracic tenderness, with diminished breath sounds and localized inspiratory rales. The patient is complaining of chest pain and significant respiratory distress. What injury is likely causing the distress?

Pulmonary contusion

Which one of the following pulmonary disorders could result in unilateral bronchoconstriction and wheezing?

Pulmonary embolism

You are on-scene with a bedridden stroke patient who developed sudden-onset pleuritic chest pain that worsens when he attempts to take a breath. His breath sounds are diminished in the lower lobes bilaterally, but he has equal expansion and a SpO2 of 84. Which of the following conditions is most likely causing his presentation?

Pulmonary embolism

When evaluating a patient's electrocardiogram tracing, the period from the beginning of ventricular depolarization to the end of ventricular repolarization is referred to as the:

QT interval

cardioversion involves delivering a shock that is synchronized to occur during the

R wave

After decompressing your 68-year-old septic female patient's chest, her BP rises, anxiety decreases, and her saturation levels improve. After 3 minutes, the patient becomes hypotensive again, with decreasing saturations and increased anxiety. You note that the decompression catheter appears to be clogged with mucus-like secretions. What should your next course of action be?

Re-decompress the patient's chest

Chronic alcoholics often present with serious neurological disease secondary to the body's inability to use certain vitamins and minerals usually found in an average diet. Which of the following is most likelyto cause the serious neurological deficits that accompany chronic alcoholism?

Thiamine

After intubating a cardiac arrest patient, you observe a capnography reading that is steadily decreasing. During each ventilation, you see obvious bilateral chest rise and ventilatory compliance is goo. You should:

Reevaluate the effectiveness of your CPR

You are assessing a 60-year-old male patient complaining of chest pain. He tells you that the pain is not only felt in his chest but also in his jaw and down his left arm. This is known as:

Referred pain

A 26-year-old full-term pregnant female appears to be in active labor. She reports that she is experiencing intermittent abdominal pain consistent with contractions. Which of the following signs should alert the paramedic to prepare for imminent childbirth on the scene?

Regular contractions that last 45 to 60 seconds each and occur at no more than 2-minute intervals

A construction worker fell approximately 30 feet and landed on a concrete surface. he is responsive to pain only, has rapid, shallow respiration's, and slow weak pulse.as your partner maintains manual stabilization of his head and assists his ventilation, you perform a rapid head to toe assessment. the patient has a closed deformity to his right femur, numerous abrasions, an open deformity to his right humerus and deformity in the area of the fifth thoracic verebra. His blood pressure is 74/50 mm. what is the MOST likely pathophysiology of this patient's clnical presentation

Relative hypovolemia due to impaired adrenergic function

You are managing an adult patient with significant leg trauma following a construction accident. You notify medical direction to get orders for additional doses of narcotics for pain management. While speaking to the physician on the radio, what communication technique should you employ?

Repeat the dose back to the physician.

You contact medical command requesting morphine sulfate orders from MCP for a 36-year-old cardiac history patient experiencing crushing chest pain, unrelieved by nitroglycerin. What should you do immediately after receiving the medication orders from MCP?

Repeat the order back to medical command to prevent a medication error

You are triaging a female patient who was near a building when it exploded. According to the Simple Triage and Rapid Treatment (START) system, what should you do if she is apneic?

Reposition her airway

You are attempting to ventilate a patient with a bag-valve-mask device and do not see the chest visibly rise. What should your initial course of action be?

Reposition the patient's head

You are the first ambulance to arrive on the scene of a single-car accident. As you approach the scene, you see four patients, two have been ejected from their vehicle, and two are still in the vehicle. What should be your next course of action?

Request additional resources, such as fire rescue, and additional ambulances to respond to the scene

A patient with a destructive pulmonary disease resulting in alveolar damage will likely have a detrimental change in which one of the lung volumes listed below?

Residual volume

What should be a paramedic's primary concern when administering Narcan to a patient?

Reversing critical symptoms to stabilize the patient

What are the "5 Rs" of administering medications?

Right patient, right drug, right dose, right route, right time

Your adult post-MI patient is complaining of abdominal pain and nausea. She presents with jugular vein distention, peripheral edema, and an engorged liver. She also reports fluid accumulation in her abdominal cavity that makes her feel bloated. She has a past medical history that includes hypertension, COPD, and the recent right ventricular myocardial infarction. Which of the following conditions is most likely causing her current signs and symptoms?

Right ventricular failure

During an assessment of a cardiac patient, you note she is displaying jugular venous distention (JVD) while sitting in a semi-Fowler's position. That finding is most consistent with what cardiovascular event?

Right ventricular infarction

A 32-year-old male experienced blunt abdominal trauma. When he is positioned supine, he experiences severe pain in his left shoulder. Which of the following should the paramedic suspect?

Ruptured spleen

a patients cardiac rhythm is irregular and the rate is 50 per minute. There are more P waves than QRS complexes and the PR intervals vary in duration. The paramedic should interpret the cardiac rhythm as

Second-degree AV block

Which of the following statements regarding right ventricular failure (RVF) is correct?

Sacral and pedal edema are common signs of RVF.

at 2:30 am, you respond to crowded homeless shelter for a 52 yom who is sick. The patient complains of intense itching to his hands and axillae. Assessment of these areas reveals the presence of a rash. The patient denies any medical problems, but states that he was stung by a hornet two days ago. Which of the following should you suspect?

Scabies

You are assessing a 29 yom with an apparent emotional crisis. He is agitated and refuses to give you any any information because his roommate told him not to trust anyone. His small apartment clearly indicates that he is the sole occupant. Your partner finds a prescription for Zyprexa, which is prescribed to the patient. The patient MOST likely has:

Schizophrenia

Which of the following personality disorders are characterized by an acute discomfort in close relationships?

Schizotypal

A 67-year-old woman who slipped and fell reports pain to her left hip area. Which of the following devices would be MOST effective in removing her from her house?

Scoop stretcher

You are evaluating the electrocardiogram tracing of your cardiac history patient who presented with general malaise. His vital signs are all within normal limits, but you note the presence of P-R intervals that progressively lengthen in duration until a P wave is so distant that it fails to elicit a ventricular response and a single QRS complex is dropped. What cardiac rhythm is most likely to cause this to occur in an otherwise healthy adult

Second-degree atrioventricular block, type I (Wenckebach)

During an explosion, your patient was struck with flying debris from a nearby wall and window. He has a fractured left humerus and lacerations all over his body. What type of blast injuries did this patient sustain?

Seconday

Your adult patient calls for assistance today after becoming weak, short of breath, and developing severe pain throughout his body especially his abdominal region. He reports having an inherited blood disorder that affects red blood cells. The disease produces abnormal hemoglobin that crystallizes when the victim's red blood cells are exposed to low-oxygen states. Today, he states the pain and shortness of breath are worse than previous episodes. Which of the following conditions is most likelycausing his complaints?

Sickle cell anemia

You are on-scene with an adult patient suspected of having either a myocardial infarction or an aortic dissection due to the patient's history and assessment. Which of the following findings would lead you to believe an aortic dissection is causing his signs and symptoms?

Significant blood pressure differences between the right and left arms

An aortic dissection and a myocardial infarction are difficult to differentiate in the pre-hospital setting. However, there are a few distinctive differences. Which of the following findings would lead a paramedic to suspect an aortic dissection may be occurring rather than a myocardial infarction?

Significant blood pressure differences in the left and right arms or between the arms and legs

Due to automaticity, a cardiac cell can initiate electrical impulses. The more superior its location, the more intrinsic beats it is able to produce per minute. Which of the following is known as the chief pacemaker of the heart?

Sinoatrial node

You are assessing an ECG strip with the following characteristics: sinus node discharge rate of 48, PRI 0.22, QRS width 0.11, T wave is positive. What is the name of the rhythm

Sinus bradycardia, with first-degree AV block

Which one of the following developmental milestones is consistent with the activities of a six-month-old?

Sits with support

Which of the following assessment findings would be the MOST clinically significant in a 60-year-old patient with a BP of 240/120 mm Hg?

Slurred speech

You are on-scene at a local residence with an adult cardiac arrest victim. The family initiated CPR prior to your arrival and states the patient was fine until her home dialysis treatment earlier in the day. Once on the cardiac monitor, the patient is exhibiting a wide complex of irregularly irregular rhythm without a palpable carotid pulse. Along with the administration of epinephrine, which of the following pharmacological agents may be indicated in this case?

Sodium bicarbonate

Your 22-year-old patient is suspected of experiencing tricyclic antidepressant toxicity after beginning a new prescription ordered by her physician. Her current GCS is 8, and she is experiencing hypotension with tachycardia. Her heart rate is 138, showing a widened QRS complex. Per MCP, which of the following may be effective in helping this patient reverse the toxic cardiac effects she is experiencing?

Sodium bicarbonate

Your adult hemodialysis patient is in cardiac arrest one hour after completing a dialysis treatment. He is found to be apneic and asystolic with adequate CPR in progress. Which of the following should be administered during the resuscitation attempt?

Sodium bicarbonate and calcium chloride

You are on-scene with a chronic renal failure patient who is on home dialysis treatments and is complaining of general malaise. He has a history of hyperkalemia and is exhibiting tall tented T waves on the electrocardiogram. Which of the following medications are most likely indicated for this patient?

Sodium bicarbonate and/or calcium chloride

You are on-scene with a chronic renal failure patient who is on home dialysis treatments and is complaining of general malaise. He has a history of hyperkalemia and is exhibiting tall tented T waves on the electrocardiogram. Which of the following medications are most likelyindicated for this patient?

Sodium bicarbonate and/or calcium chloride

During your assessment of a patient with a suspected neurologic disorder, you ask him to shrug his shoulders and turn his head from side to side. Which of the following cranial nerves are you assessing?

Spinal accessory

You are on-scene with an unconscious adult patient. Bystanders report he fell from a third-story (> 40 ft) scaffolding while working on a building's exterior. His pulse is 120 beats per minute; his respirations are 16 per minute, and his blood pressure is within normal limits. The patient is lying supine with his arms flexed at the elbows and his hands in the anatomical position as if he were in the "hold up" position. An injury at what level of the spinal cord is most likelyto cause the limited findings above?

Spinal cord injury in the C5-C6 region

A 6-inch metal rod perforated a man's cheek and is impaled in the hard palate of his mouth. The patient is conscious and alert and is breathing without difficulty. There is a small amount of bleeding into his mouth. How should the paramedic care for this injury?

Stabilize the rod in place with bulky dressings and allow the patient to suction his own mouth

You are on-scene with a 12-year-old trauma patient who has a large laceration on the inner aspect of his upper right arm with an estimated blood loss of around 15%. The bleeding has now decreased while the patient remains conscious, alert, and anxious. His skin is warm; his heart rate is 96 bpm, and his blood pressure is 108/50. After assessing the child, you believe the patient may be in hypovolemic shock. If so, which stage of shock is the patient most likely experiencing?

Stage 1

While hiking at a local park, your adult patient has sustained a possible right tib/fib fracture with adequate distal pulses. He fell from one trail onto a lower trail (approximately 25-30 feet) and was knocked out briefly, per bystanders' reports. The trail that leads out of the area is narrow, uneven, rocky terrain and is 400 feet long. Which of the following extrication techniques would be most appropriate in this situation?

Stokes basket with full spinal immobilization and his right tib/fib immobilized using an air splint

Your adult patient is complaining of non-traumatic pain in his left upper abdominal quadrant (LUQ). He describes the pain as cramping, diffuse, and with varying intensity from six to ten on the pain scale. Upon assessment, you find there to be distension, pain, and guarding on palpation in the LUQ. Which of the following organs should you suspect is causing his pain?

Stomach

Which of the following medications is used to prevent blood clot formation in patients with a-fib or pulmonary embolism, and decrease the risk of MI in patients with atherosclerosis as well as reduce the risk of stroke?

Streptokinase

When assessing the airway patency in a patient with a suspected intracerebral bleed, the paramedic hears sonorous sounds with each inhalation. This indicates what type of airway obstruction?

Structural Structural blockageblockage

You are called to assist a 44-year-old male who was struck in the head with a large socket wrench at work. On arrival, the patient is conscious but confused; he complains he developed a sudden-onset severe headache moments after a wrench slipped off under pressure striking him in the temporal region of the skull. Co-workers state he was unconscious with abnormal posturing for about three minutes prior to EMS arrival. He states the headache went from the worst headache of his life to a dull throbbing headache and new-onset dizziness and nausea. His pupils are unequal with the right eye sluggish to respond while his grips remain equal but weak. As you continue your evaluation, he suddenly develops projectile vomiting and loses consciousness. Which of the following injuries is most likely to cause his presentation?

Subarachnoid hematoma

You are assessing an adult patient experiencing sudden-onset chest pain and dyspnea. He quickly exhibits jugular vein distension and cool, clammy skin. His trachea is midline, but there are palpable air pockets under the skin on his upper chest on the left side that feel as though they pop or vanish when you palpate them. What is this abnormal finding?

Subcutaneous emphysema

You are called to assist a 20-year-old male for a severe headache. On-scene, you learn the patient was involved in an accident that caused a potential closed head injury. However, at the time of the accident, the patient refused EMS care, stating he felt fine. Today, he is experiencing headache, confusion, and visual disturbances. Which of the following injuries is most likely to cause this type presentation?

Subdural hematoma

Which of the following is an absolute contraindication for fibrinolytic therapy?

Subdural hematoma 3 years ago

Upon arrival at a bar fight, you are directed to a male patient lying on the bathroom floor. As you rapidly perform your primary assessment, you note the following findings: unresponsive with motor posturing, blood and broken teeth in the airway, knife impaled over left chest, diminished alveolar breath sounds, absent peripheral pulses, and cool pale skin. With this information, what should you do first?

Suction the airway.

You arrive on scene and find your patient, a 70-year-old male, in respiratory distress. He has a stoma that is partially blocked by secretions. To administer oxygen to this patient, you should?

Suction the secretions in the stoma, then ventilate the stoma with a pediatric BVM.

Adult patients suffering from a thiamine deficiency are most likely to complain of which of the following?

Sudden onset of confusion and delirium

A 50-year-old man with a self-inflicted gunshot wound to the face is apneic. He has multiple fractures of the mandible, massive soft tissue damage, and severe oropharyngeal bleeding. Which of the following methods of airway control will be MOST effective for this patient?

Surgical cricothyrotomy

You are preparing to perform synchronized electrical cardioversion with a biphasic defibrillator on your unstable adult patient who is experiencing supraventricular tachycardia at 160 beats per minute on the monitor. Which of the following initial energy settings would be recommended if he was exhibiting a narrow complex, regular supraventricular tachycardia, in which his palpable carotid pulse matches the rhythm on the monitor?

Synchronized cardioversion at 50-100 joules

Your adult patient is experiencing paroxysmal supraventricular tachycardia at 166 beats per minute. He is hypotensive and short of breath with cool, clammy, and diaphoretic skin. Which of the following interventions would be indicated at this point?

Synchronized cardioversion beginning at 120 joules (synchronized) with a biphasic defibrillator or 200 joules (synchronized) with a monophasic defibrillator

You are on-scene with a chest pain patient who presents with hypotension and serious signs and symptoms of hypoperfusion. Once on the cardiac monitor, the conscious patient exhibits monomorphic ventricular tachycardia at a rate too fast to palpate manually and over 200 according to the monitor. Which of the following interventions would be mostappropriate for this patient?

Synchronized cardioversion starting at 100 joules

Which of the following conditions is most likely to cause a patient to present with potentially reversible pulseless electrical activity on the monitor?

Tension pneumothorax

You are on-scene with an unconscious adult female who you suspect may be intoxicated. The patient's vital signs are within normal limits; however, her blood glucose level is low. Which of the following should be administered first to prevent Wernicke-Korsakoff syndrome, after initiating oxygen therapy and IV access?

Thiamine

Your adult patient is complaining of dyspnea, anxiety, and confusion. He is found to have hypertension with reflex bradycardia. The findings and situation lead you to suspect the patient is suffering from acute cyanide poisoning. In which of the following situations would administering a cyanide antidote kit be contraindicated?

The patient suffered smoke inhalation from a structure fire

Confined space rescue requires special training and is usually a function of the fire department. However, all paramedics should be aware of the possibility of having to deal with some type of confined space rescue and the associated dangers. If atmospheric monitoring of the confined space in question reveals an environment of greater than 22% oxygen concentration, what does this most likely indicate to the rescue personnel involved?

The confined space is an environmental hazard that is highly combustible requiring specialized gear and fire training

A 23-year-old patient is complaining of shortness of breath. During a pre-hospital evaluation of this patient, which of the following would give the paramedic a good look at the patient's overall tissue perfusion?

The patient's skin temperature, color, and moisture level

An off-duty paramedic stops at the scene of a cardiac arrest on the highway. During the course of providing care to the patient, the paramedic successfully performs endotracheal intubation. Which of the following statements regarding this paramedic's actions is correct?

The paramedic could be held liable for practicing medicine without a license.

Some cardiac emergency medications are designed to slow conduction through the AV node. To administer these emergency medications safely, the paramedic must ensure which of the following?

The patient does not have a second-degree AV block type II

According to the Bohr effect, if a patient's capillary blood pH is lower than normal, what does this tell the paramedic about the patient's overall respiratory status?

The patient has an increased carbon dioxide level, and the hemoglobin affinity for oxygen is now reduced

Your adult patient is experiencing hyperventilation syndrome with carpal spasms that began on your arrival. Why is it so important to reduce the patient's rate and depth of breathing at this point?

The patient is beginning to show signs/symptoms of respiratory alkalosis that can worsen to hypocarbia and cerebral hypoperfusion

You are evaluating a cardiac patient's rhythm for abnormalities and axis determination. What can be said about the axis if the patient presents with positive QRS complex deflection in leads I and II but negative in lead III?

The patient is considered to have a physiological left axis deviation

You are evaluating a 20-year-old male patient experiencing respiratory problems. You apply an End-Line CO2-equipped nasal cannula to the patient and attach to your monitor. You notice a shark-fin-shaped graph on the capnography and the patient's EtCO2 at 45 mmHg. What is this most likely indicative of?

The patient is experiencing asthma exacerbation and needs to be treated accordingly

While on-scene with a 70-year-old complaining of chest pain, what is one of the first indicators that should alert the paramedic to the probability that an acute myocardial infarction is occurring?

The presence of persistent chest pain not relieved by nitroglycerin therapy

You are performing a quality assurance/quality improvement (QA/QI) audit on a cardiac arrest taken by your EMS company the day before. As you review the prehospital care report and times, you notice the paramedics had ALS patient contact for 20 minutes before calling the arrest. During the 20 minutes of ALS, they performed CPR, intubated and ventilated the patient, gave oxygen, and administered five epinephrine and one sodium bicarbonate. The patient was asystolic during the entire event. Based on this documentation, what, if anything, was NOT done correctly?

The use of sodium bicarbonate was not warranted.

You are called for a fall injury. As you arrive on scene, you find a 20-year-old male who fell off of his ladder and has obvious deformity on his right radial bone. His vital signs are: BP 132/88, respirations 22 per minute, heart rate 96, and skin is pink/warm/dry. Your patient rates his pain a 9/10. Medical direction has advised you to administer 2 mg of morphine sulfate. Ten minutes later, your patient states his pain has subsided and rates it a 3/10. This effect is known as?

Therapeutic

You are working for a fire department when you are called to a chemical spill in an industrial plant. Upon arrival, you don the appropriate personal protective equipment. You then are charged with working in the warm zone of the spill. What does this mean regarding your exposure to toxic materials?

There is a moderate chance of exposure

You are on-scene with a trauma patient who sustained a closed head injury. He has a decreased level of consciousness and confusion. During the neuro exam, it is noted that the patient's right pupil is somewhat constricted while his left pupil is dilated and fixed. Which of the following is most likely the cause?

Third cranial nerve dysfunction

Which of the following cardiac rhythms is associated with bradycardia, and is characterized by regular R-R intervals and greater ratio of P waves to QRS complexes

Third degree AV block

You have been called to the scene of a 70-year-old male patient who collapsed while working in his garage. He responds only to pain. You assess his vital signs and find a blood pressure of 70/30, a pulse of 38, and respirations of 28 that are shallow. His skin is pale, cool and clammy. You place him on a cardiac monitor and find the follow which you interpret as:

Third degree heart block

Which of the following would be indicated for an adult blunt trauma patient who has suspected active internal hemorrhage within the peritoneum?

Transport supine with head slightly elevated, high-flow oxygen therapy, intravenous infusion of an isotonic crystalloid solution titrated to maintain a blood pressure of 90 mmHg

During an MCI, which of the following positions is responsible for coordinating the movement of patients from the treatment area to ambulances?

Transportation officer

While performing a cranial nerve assessment on a patient, what is the reason for having him look straight ahead and follow your outstretched finger with his eyes only?

To assess eye movements controlled by cranial nerve IV

Which of the following ECG lead configurations is correct?

To assess lead II, place the negative lead on the right arm and the positive lead on the left leg.

Your adult patient is experiencing unstable paroxysmal supraventricular tachycardia. Why is it important to deliver synchronized cardioversion to the patient rather than defibrillation?

To avoid the R-on-T phenomenon

Your adult patient is showing signs and symptoms of being severely hyperkalemic. Medical control recommends the administration of a high-dose nebulized albuterol treatment as well as calcium chloride. Why is high-dose albuterol being recommended for this patient?

To help lower dangerous potassium levels

While administering normal saline to an adult patient experiencing hypovolemia, the medical command physician recommends the administration of warm normal saline, even though it is not a cold environment. Why would a physician (MCP) recommend warmed normal saline be administered to an adult hypovolemia patient?

To help maintain a normal body temperature during hypovolemia

You are treating a 55-year-old patient who presented with sinus bradycardia on the monitor. He has a history of hypertension, COPD, and Crohn's disease. He complains of shortness of breath, dizziness, and feels as if he is going to die. His skin is cold, pale, and dry with a delayed capillary refill time although his skin turgor remains relatively normal. After applying high-flow oxygen therapy, gaining intravenous access, and initiating a fluid infusion, you administer atropine per local protocol. Which of the following is considered a Class IIa pre-hospital intervention for symptomatic bradycardia after atropine fails to improve the patient's heart rate and/or condition?

Transcutaneous pacing

Your adult trauma patient has sustained a blunt force injury to the lateral aspect of his neck when he was struck by a baseball bat. He is conscious and alert, denies loss of consciousness, and dyspnea. His vitals are within normal limits, and there are no other obvious injuries. The patient is breathing well, and there are no signs of deformity, airway swelling, or compromise. The only obvious injury is the patient has a large hematoma over the injury site, leading you to suspect a venous injury may be present. Why is it important to transport the patient supine or in the slight Trendelenburg position?

To potentially prevent pulmonary embolus from occurring

You are treating a COPD patient for mild shortness of breath when you note the presence of pursed lips and sighing-type respirations at 26/minute. Why would the patient present with pursed lips and frequent sighing?

To prevent atelectasis from occurring at the end of exhalation

Your adult cardiac patient is experiencing bradycardia with shortness of breath, diaphoresis, and severe hypotension. Which of the following interventions is considered a class IIa intervention after the maximum dose of atropine fails to improve the patient's condition and heart rate?

Transcutaneous pacing

Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44, he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain. Which of the following would be most appropriate if the patient fails to respond to atropine?

Transcutaneous pacing

A 52-year-old male presents with unconsciousness and full body convulsions of paired muscle groups. Which one of the following types of seizures would best match his symptoms?

Tonic-clonic

You are evaluating a 60-year-old patient complaining of chest pain. Once on the cardiac monitor, it is evident he is experiencing a complete third-degree atrioventricular block with a palpable pulse of 44 beats per minute, consistent with the monitored rate. He is cool, pale, and weak. Which of the following would likely be more effective for increasing his heart rate and cardiac output?

Transcutaneous pacing in the demand mode beginning at 50 milliamps to gain electrical and mechanical capture

A patient relays to you a history of repeated episodes in which speech becomes garbled, walking becomes difficult, and the patient experiences a bad headache. If the patient also says the symptoms last only about 30 minutes before they resolve, what would be your field impression?

Transient ischemic attack

You are the first to arrive at a three-car motor-vehicle crash (MVC) in a remote area of your response district. Of the available resources listed below, which one would probably be least necessary during the extrication and initial management periods?

Towing service

According to the AHA Guidelines, there are six positions for a High-Performance Team. Which of the following is not a position on the team?

Transporter

You are called to assist a 66-year-old complaining of dyspnea. On arrival at the patient's residence, what is the first visual indicator you have of the level of her respiratory distress?

Tripod positioning

You intubated a supine pediatric patient and then moved her from the floor to the ambulance cot. Following the move, you reassess tube placement. You note breath sounds have diminished on the left side, but are still present on the right. What does this reassessment information tell you?

Tube has likely migrated deeper.

Which of the following medical conditions would require EMS personnel to wear high-efficiency particulate air (HEPA) respirators while delivering medical attention that requires personal contact?

Tuberculosis

Your trauma patient has sustained blunt force injury to his neck and has an obvious closed venous injury on the right side of his neck. After evaluation, you suspect the patient may have developed an air embolus from the injury. What is the best way to transport the patient to prevent the embolus from entering the lungs?

Turn the immobilized patient on his left side with the head of the spine board lowered 10 degrees

Which of the following is a criterion for transporting an adult patient to a trauma center capable of providing the highest level of care?

Two proximal long bone fractures

A patient with chronic bronchitis presents with respiratory distress. Upon completing the primary assessment, you note the patient to be in a tripod position, tachypneic, speaking in two- or three-word sentences, tachycardic, and slightly cyanotic in the extremities. Of all those findings, which one is most suggestive of inadequate breathing?

Two- or three-word sentences

A patient presents to you with clinical indications of diabetic ketoacidosis. Given this, what would you suspect about the patient's medical history?

Type I diabetes mellitus

Your response zone is in a metropolitan area with several large buildings in close proximity to one another. Which of the following frequency bands would offer less noise interference and penetrate buildings better?

Ultra High Frequency (UHF)

When assessing a patient's pulse, you note that it is fast and has an irregularly irregular pattern. On the basis of these findings, which of the following cardiac rhythms would MOST likely be seen on the cardiac monitor?

Uncontrolled atrial fibrillation

Auscultation is a key component of a respiratory assessment. It is even more important to know where to listen so you can auscultate properly. Where is the best place to listen on a pediatric patient for distal air movement?

Underneath each armpit

You are on-scene with a stable patient complaining of occasional palpitations. Once on the cardiac monitor, you record a sinus rhythm with an underlying occasional run of ectopic beats that originate in the ventricles. When the ectopic beats all appear the same and occur between each QRS complex, what is the arrhythmia called?

Unifocal premature ventricular bigeminy

You are on-scene with an elderly female; bystanders report she suddenly collapsed while walking through the mall. She is pulseless, apneic, and showing pulseless electrical activity on the monitor. When attempting to ventilate and intubate the patient, it is apparent she has a laryngeal spasm, and the ventilations are not getting into her lungs. At this point, what should you do to manage the patient's airway?

Use a forcefully upward pull on the lower jaw while ventilating with a bag-valve mask

MCP orders you to bolus your trauma patient with a liter of lactated Ringer's solution in an attempt to correct a dysrhythmia thought to be caused by the volume depletion. Which of the following will help the IV fluid run faster and more effectively?

Use a short, 14-gauge IV catheter with a short macro-drip infusion set with warm fluid

You are called to stage at a mass casualty incident involving exposure to possible chemical agents during the event. Knowing you will likely transport one or more patients from the scene that have been grossly decontaminated in the decontamination section, what measures can you take to minimize the possible contamination of your unit during the patient care/transport encounter?

Use disposable equipment as much as possible, remove all equipment that will not likely be needed during transport, cover the patient and stretcher with plastic

Pulseless electrical activity (PEA) is a group of rhythms that are organized in nature but lack a palpable pulse. All the following are examples of PEA except:

Ventricular fibrillation

What is the most common initial dysrhythmia seen in sudden cardiac arrest?

Ventricular fibrillation

Which of the following cardiac rhythms is appropriateto defibrillate?

Ventricular fibrillation

During resuscitation of a 60-year-old man with ventricular fibrillation, you restore spontaneous circulation following CPR, defibrillation, two doses of epinephrine, and one dose of amiodarone. The patient remains unresponsive and apneic. Which of the following represents the MOST appropriate post-arrest care for this patient?

Ventilate at a rate of 10 to 12 breaths/min, support blood pressure, and obtain a 12-lead ECG.

Which of the following medications works by relaxing smooth muscles to provide vasodilation, as well as reduce heart rate and stroke volume of the heart?

Verapamil

A 32-year-old male patient has overdosed on Vicoden, and presents bradypenic and hypopneic. The decision is made to provide endotracheal intubation in order to better control ventilation and oxygenation. Providing no contraindications exist, which one of the following methods should be attempted first?

Visual laryngoscopy

While helping to teach the company rules and regulations to a new EMT hire at your department, she asks if washing hands is all that important, as long as you wear exam gloves during patient contact episodes. What would be your best response?

Washing hands is always important. Research has shown that it is the single best defense against cross-contamination.

A firefighter was exposed to smoke during a structure fire. he is conscious, alert, and oriented, bu is experiencing respiratory distress. his oxygen saturation is 91% in room air and his heart rate is rapid and strong. which of the following is the MOST appropriate initial means of oxygenating this patient

nonrebreathing mask set 12-15 L/min

ST-segment elevation is one of the first electrocardiogram characteristics assessed when trying to determine if an acute myocardial infarction is occurring. However, there are situations when assessing a patient's ST-segment elevation is not used to determine the presence of a STEMI. In which of the following situations would assessing ST-segment elevation be contraindicated when trying to determine the presence of an ST-elevation myocardial infarction?

When the patient also exhibits a left bundle branch block (LBBB) on the electrocardiogram

You are on-scene with a patient that you feel is in impending cardiac arrest and may need to be intubated. When should you intubate a conscious or semi-conscious patient in the pre-hospital setting?

When the patient cannot protect his own airway

The etiology of a pseudo seizure is most likely:

a psychiatric crisis.

You are on-scene with a 28-year-old who has an extensive past medical history for her age that includes hypertension and some type of reentry tachycardia syndrome that makes her "feel like her heart is beating out of her chest." She denies actual chest pain. The unknown heart condition is currently controlled with medication that she doesn't remember the name of. Today she complains of palpitations, nervousness, and slight shortness of breath. She states the last time this occurred, she had to be shocked on the way to the hospital and that it hurt badly. You quickly explain to her that if that does occur this time, you will try to get orders to give her a benzodiazepine to help her relax during the procedure. Her heart rate is 148 beats per minute, showing rate consistent widened QRS complexes with delta waves and shortened PR intervals. Her blood pressure is 90 systolic, and her respirations are 26 breaths per minute. With the limited information provided, which of the following cardiac conditions is most likely to cause the patient's presentation?

Wolff-Parkinson-White syndrome (WPW syndrome)

EMS systems use a fractile response time standard, which mean that

a significant percentage of all responses must be achieved in an established time

Diabetic ketoacidosis is best treated in the prehospital setting with:

sotonic fluid administration at 1.5 to 2 times typical maintenance rates.

After intubating your apneic patient, you use the primary placement confirmation method to determine the ET tube is most likely in the trachea. Using mechanical confirmation means, such as a colorimetric capnography device, what color would confirm the tube is in the trachea?

Yellow

If a paramedic is using a disposable colorimetric device to ensure the endotracheal tube is properly placed in the trachea, what color would indicate the tube is properly placed in the trachea?

Yellow

You are managing a neonate with respiratory distress. During your assessment, you find a blood glucose level of 40 mg/dL. Will this finding require any intervention?

Yes, with D10, 10% dextrose in water

Which of the following is an example of informed consent?

You advise the patient of the potential complications of starting an IV.

A middle-aged man reports severe chest pain. He is conscious and alert to person, place, time, and event. As you are loading him into the ambulance, he tells you that he does not want to be treated or go to the hospital. Which of the following statements regarding this situation is correct?

You must realize that a mentally competent adult can withdraw consent at any time he or she chooses.

Mastoid bruising and cerebrospinal otorrhea following diffuse impact to the head are MOST indicative of

a basilar skull fracture

A child with respiratory failure would MOST likely present with:

bradypnea.

You are assisting in the delivery of a baby. As soon as the head delivers, you should:

check for the presence of a nuchal cord.

An adult patient without respiratory distress, who is breathing at a rate of 14 times per minute and has adequate tidal volume, will MOST likely:

eliminate adequate carbon dioxide from the body.

A 29-year-old female presents with lower abdominal pain and minor vaginal bleeding. She recently had a dilation and curettage (D&C) procedure following a spontaneous abortion. Her blood pressure is 108/68 mm Hg, pulse is 110 beats/min, and respirations are 20 breaths/min. Her temperature is 102.4° F. You should be MOST suspicious for:

endometritis.

After numerous attempts to convince a conscious and alert 50-year-old man with chest pain to consent to EMS assessment, treatment, and transport, he continues to refuse your help. Prior to asking him to sign a refusal of treatment form, it is MOST important to:

ensure that he is made aware of your proposed treatment and the potential risks of his refusal.

A known heroin abuser is found unresponsive by a law enforcement officer. Your primary assessment of the patient, a 24-year-old female, reveals that she is unresponsive, is breathing at a rate of 6 breaths/min and shallow, and has a pulse rate of 40 beats/min and weak. You should:

ensure that her airway is clear and begin assisting her ventilations.

You are transporting a woman who is 35 weeks pregnant. The patient complains of abdominal cramping, but denies vaginal bleeding. An IV of normal saline has been established and she is receiving supplemental oxygen. As you are reassessing her, she tells you that she is extremely lightheaded. Her skin is diaphoretic and her pulse is rapid and weak. You should:

ensure that she is positioned on her left side.

Prior to applying a nonrebreathing mask on a responsive patient with respiratory distress, you should:

ensure that the reservoir bag is fully inflated.

A 5-year-old male presents with labored breathing, stridor, and high fever. The child's mother tells you that his symptoms rapidly progressed over the last few hours. You should suspect:

epiglottitis

You are dispatched for a 7-year-old, 20-kg child who is ill. He is conscious and alert, and tells you that he is dizzy. He denies pain, shortness of breath, or any other symptoms. His breath sounds are clear and equal bilaterally, and his skin is pink, warm, and dry. The cardiac monitor reveals a regular narrow-complex tachycardia at a rate of 200 beats/min. His BP is 100/58 mm Hg and his respirations are 20 breaths/min. You ask him to bear down, but this has little effect on his heart rate. You should:

establish IV access and give 2 mg of adenosine.

In rare cases, intubation will be required to manage the airway of a patient suffering from a severe asthma attack. Immediate intubation should always be initiated in asthma patients who are apneic and should be considered at other times. Which of the following conditions should cause the paramedic to consider intubating an asthma patient

he patient's PO2 is less than 50 mmHg

If an unrestrained driver strikes a utility pole while traveling at 70 MPH:

his body will strike the interior of the vehicle while moving at 70 MPH.

a 40 yom experienced blunt abdominal trauma and presents with tachycardia weakly palpable radial pulses, diaphoresis and restlessness. Further assessment reveals that his blood pressure is 78/60 mm. After establishing vascular accessm you should administer crystalloid fluid until

his radial pulses are easily palpable

Paramedics are called to a nursing home, where they learn they need to transport a patient to the hospital emergency department because he has an electrolyte imbalance. He is weak, dizzy, lethargic, confused, has poor skin turgor, and decreased urinary output. He has had vomiting and diarrhea for two days. Given his symptoms, he likely has:

hypernatremia.

A 71-year-old female presents with an altered mental status. According to her husband, she has type II diabetes and hypertension, and was recently diagnosed with a urinary tract infection. Her medications include Glucophage, Zestril, and Bactrim. The patient is confused, and has slurred speech and poor skin turgor. Her blood pressure is 112/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 30 breaths/min and shallow. Her blood glucose level reads "high," but you do not notice any unusual odors on her breath. The primary cause of this patient's problem is MOST likely:

hyperosmolar hyperglycemic nonketotic state.

A patient with a blood glucose level of 650 mg/dL would be expected to present with:

hyperpnea, dehydration, warm skin, and tachycardia.

When reviewing risk factors for coronary artery disease (CAD), the paramedic recognizes the major modifiable risk factors as:

hypertension, obesity, and smoking

How does a unifies incident command system differ from a single inciden command system

in a unified incident command system, plans are made in advance by all agencies that assume a shared responsibility for decision making

Disequilibrium syndrome manifests with signs and symptoms of:

increased intracranial pressure.

A 21-year-old male has been ejected from a vehicle. Your primary assessment reveals massive trauma and displacement of anatomy to the lower jaw. There is no apparent air movement. You should:

initiate an immediate surgical airway.

A 70-year-old female woke with an inability to move her left side and has had a decreasing mental status over the last hour. On arrival you find her unconscious with the following vital signs: pulse 60, respiration 7, blood pressure 210/108. You should first:

initiate bag-valve-mask ventilations.

A 78-year-old female is complaining of shortness of breath, vertigo, and slight chest pain. When you attach your ECG, you notice she is in a bradycardic second-degree heart block (type II). Her vitals are pulse 44, respiration 30, and blood pressure 88/64. You should immediately:

initiate transcutaneous pacing.

You have been ventilating an unresponsive apneic 42-year-old male for approximately 12 minutes. After securing his airway with an endotracheal tube and confirming proper ET tube placement, you should:

insert an orogastric or nasogastric tube.

A 40-year-old man attempted suicide by shooting himself in the face with a shotgun. The scene is secure and law enforcement has the weapon. When paramedics arrive, they find him sitting up in a chair. There is massive soft tissue damage to his face; his mandible is gone and his upper airway structures are exposed. He is conscious and alert, his oxygen saturation is 96% on room air, and his respiratory rate is 22 breaths/min. The paramedics should:

keep him sitting up, suction his airway, and transpor

A 6-year-old boy fell off his bike and injured himself. His mother tells you that he was wearing a helmet at the time of the incident. The boy is sitting next to his mother on the couch, holding his left arm against his chest. He is conscious and alert, but appears scared. You do not see any obvious bleeding or other injuries. You should:

kneel down beside him and ask him what his name is.

the MOST effective way to minimize the risk of a single rescuer suddenly bearing unexpected, dangerous weight while lifting a patient is to

know where rescuers should be positioned as well as how to give and receive commands so that all rescuers lift simultaneously

A 70-year-old male presents with an altered mental status and severe weakness. According to his wife, he has had lower back pain and a fever for the past few days. His BP is 82/44 mm Hg, pulse is 160 beats/min, and respirations are 22 breaths/min. Treatment for this patient should include:

normal saline boluses and norepinephrine

The MOST practical and reliable way of ensuring that all pertinent times regarding an EMS call are properly documented is to:

notify the dispatcher each time an event occurs.

Normal breathing in a resting adult male

should be marked by only subtle changes in rate or regularity

A 39-year-old 120-pound woman sustained partial- and full-thickness burns to her head, face, and anterior chest. She is tachypneic, tachycardic, and hypotensive. When caring for her, you should:

suspect that she has internal hemorrhage from an occult injury.

You are assessing a 30-year-old male who is having an emotional crisis. The patient is crying and states, "I am losing it!" Which of the following statements is the MOST appropriate for you to make?

"I think that it's important for you to go to the hospital."

Which one of the following statements made by a patient with terminal liver disease indicates that she is in the bargaining phase as described by Kubler-Ross?

"If I have radiation therapy and chemotherapy, I will be able to attend my daughter's wedding next summer."

Which of the following statements is inappropriate to document on a patient care form?

"The patient appears to need psychiatric help."

The fire chief arrives on the scene of a multiple-patient incident. He notices multiple fire engines, police, and ambulances responding to the scene. He assumes the role of incident commander. According to the National Incident Management System (NIMS), his first action should be to announce publically over radios and a loud speaker to all responding agencies:

"This incident will use a unified command system from this point on."

Which of the following vehicle impacts will create the greatest amount of kinetic energy?

150-lb patient who is traveling at 60 mph

The initial dose of diltiazem for a 165-pound patient is approximately:

19 mg

Narcan (naloxone) would be most useful for which one of the following patients?

25-year-old homeless man found unresponsive with shallow respirations in the park

Of the following trauma patients, which one would be best treated at a Level I trauma center, according to the 1992 Panel on Trauma Care Systems papers?

19-year-old walking at the scene after being involved in a vehicle roll over, complaining of back pain

You are performing the 5-minute Apgar test on a newborn you just helped deliver in the field. What is the targeted SpO2 range at 5 minutes after birth?

80% to 85%

According to the American Heart Association, healthcare providers should not attempt to alter glucose concentration within a specific range because of the increased risk of hypoglycemia. What is the suggested range?

80-110 mg/dL

Which of the following patients could you legally treat and transport without his or her consent?

A 17-year-old conscious male who has a closed fractured femur

Of the following, which patient will require an unsynchronized shock?

A 39-year-old female presenting with polymorphic ventricular tachycardia

Which of the following vital signs is not within the normal range for the age of the patient?

A 4-year-old with a blood pressure of 138/88

When conducting a 12-lead EKG on a patient, what precordial lead axes would V1 evaluate?

+ 120 degrees

A 43-year-old woman was stung by a scorpion. Within 5 minutes, she developed swelling to her face and diffuse urticaria. She is confused and has a BP of 80/60 mm Hg. After administering supplemental oxygen, you should give:

0.1 mg of epinephrine 1:10,000 IV.

You are on-scene assisting another crew with a childbirth call that quickly turned into a neonatal resuscitation. The newborn does not have a palpable brachial pulse, but muffled heart tones and the monitor confirm a sluggish heart rate of 55 beats per minute. After reassessing him after a few minutes of high-quality chest compressions and effective ventilations with 100% oxygen concentration, the patient's heart rate fails to respond. Which of the following would be considered a class IIa intervention for this patient?

0.1 mg/mL of a 1:10,000 concentration of epinephrine delivered intravenously

What is the fraction of inspired oxygen (FiO2) delivered to an apneic patient who is receiving bag-mask ventilation without supplemental oxygen attached

0.21

Your adult patient is experiencing wheezing, urticaria, and tongue swelling following exposure to peanuts. The patient has a known allergy to peanuts but has never experienced a reaction this severe. Which of the following dosages and routes of epinephrine would be most appropriate for this patient?

0.3 mg of 1:1000 Epi delivered intramuscularly

Your adult patient is experiencing wheezing, urticaria, and tongue swelling following exposure to peanuts. The patient has a known allergy to peanuts but has never experienced a reaction this severe. Which of the following dosages and routes of epinephrine would be mostappropriate for this patient?

0.3 mg of 1:1000 Epi delivered intramuscularly

Paramedics are attempting to resuscitate a 71-year-old female who is pulseless and apneic. The cardiac monitor reveals ventricular fibrillation, which has persisted after four shocks, two doses of epinephrine, and two doses of amiodarone. Upon receiving information that the patient has chronic renal failure, the paramedic should administer:

1 g of calcium chloride.

In addition to CPR, the recommended treatment sequence for an unresponsive, apneic, and pulseless patient with a regular, wide-complex cardiac rhythm at a rate of 40 beats/min includes:

1 mg of epinephrine every 3 to 5 minutes and treating reversible causes.

Once a paramedic visualizes the endotracheal tube pass through the vocal cords, how far should the tube be advanced before inflating the cuff and assessing proper placement of the tube?

1 to 2 cm

A clinically unstable patient presents with an irregular narrow-complex tachycardia at a rate of 170 per minute. What is the recommended initial energy setting for synchronized cardioversion?

120 to 200 joules

Your newborn patient is in need of a fluid bolus to return his circulating blood volume to a near normal level after a bleeding injury has occurred, but the bleeding is now controlled. What is an acceptable fluid bolus amount for the newborn patient?

10 milliliters per kilogram of body weight over 5-10 minutes

In order to identify the correct dose of medication for your patient, you are required to convert grams into milligrams. Which of the numbers below is 10 grams converted to milligrams?

10,000

where should you position your ambulance when arriving at the scene of a mva on a two lane highway

100 feet past the scene on the same side of the road

Assessment of an injured man reveals that he opens his eyes when the paramedic speaks to him and pulls his arm away when it is palpated. He knows his name, but cannot remember what happened and does not know what day it is. He should be assigned a Glasgow Coma Scale (GCS) score of:

11

You are serving as the landing zone coordinator for an approaching helicopter. In what position should you be to help guide the pilot?

12 o'clock position

Your patient is found dead after missing in the woods for several days. The patient has full-body rigor mortis and independent lividity posteriorly. There is no obvious decay present, but a definite smell accompanies the patient. With the limited findings, how long do you feel the patient may have been deceased prior to finding him?

12 to 14 hours

Which of the following is MOST consistent with inadequate breathing in an adult?

14 breaths/min with reduced tidal volume

When using an electrocardiogram tracing to confirm the patient's heart rate, what can the paramedic expect the heart rate to be if the peak of the R wave appears regularly on every other dark red line on the graph paper?

150 beats per minute

For the management of a trauma victim in need of fluid resuscitation, which one of the following represents the best selection of fluid, angiocath size, and administration set?

16-gauge angio, macrodrip tubing, lactated Ringer's solution

Your adult patient was injured with steam and hot liquid from an overheated vehicle's radiator. He sustained a partial-thickness burn with blisters and reddening to the skin of his entire anterior chest wall excluding his groin. He denies shortness of breath or any current medical complaints. Your exam reveals no other injuries or burns, and your patient remains calm. According to the rule of nines, what percentage of the victim's total body surface area (TBSA) was burned?

18% TBSA

When were ambulances first used in the United States?

1800s

Dopamine infusions are administered in which one of the following dosing parameters?

2 - 20 mcg/kg/minute

A 20-kg child requires amiodarone for refractory ventricular fibrillation. Amiodarone is supplied as 150 mg in 3 mL. How many milliliters should you administer?

2 mL

You are performing CPR on a 20-kg child in asystole and have established intraosseous access. The correct dose and concentration of epinephrine for this child is:

2 mL of 1:10,000

The exchange of oxygen and carbon dioxide between inspired air and the pulmonary capillaries is called:

External respiration

A 50 yow complains of a rash and severe itching to her trunk and arms that began a day after she started taking penicillin. Her breath sounds are clear to ausculation bilaterally, she denies shortness of breath, her oxygen saturation is 96%, and her BP is 114/64 mm Hg. Treatment should include:

25 mg of diphenhydramine IM

Your adult asthma patient is experiencing a severe attack characterized by inspiratory and expiratory wheezes with potential airway compromise due to laryngospasm. Which of the following interventions would be most appropriate after oxygen therapy is applied?

2.5 to 5 mg of albuterol solution mixed with 3 mL of 0.9 normal saline and nebulized with 6-8 lpm of oxygen

A 140-pound male patient has burns to the anterior chest, and circumferentially to both arms as a result of the detonation of a make-shift bomb he was building. The patient is currently unresponsive with the following vitals: heart rate 110, blood pressure 68/40 mmHg, and respirations of 28 per minute. What should the fluid bolus be for this patient?

20 mL/kg milliliters

Magnesium sulfate is commonly administered in a two-grams-in-10 mL of normal saline admixture. This combination would give you a solution concentration of _____ in one mL.

200 mg

You have successfully resuscitated a 100 kg female cardiac-arrest patient. Her blood pressure remains critically low, despite an acceptable heart rate, so you elect to initiate dopamine for pressure regulation. You mix 800 mg of the drug into 250 mL and initiate the infusion at 5 mcg/kg/minute, but do not get the desired results until you titrate it up to 12 mcg/kg/minute. At this new rate, what are the drops per minute?

22.5 gtts/minute

A 43-year-old male patient presents with an acute change in mental status, tachycardia, tachypnea, diaphoretic skin, and a history of diabetes. What medication type do you administer, if the patient's blood glucose level (BGL) is 62 mg/dL?

25 g of D50%

a 22 yom experienced blunt abdominal trauma. he is conscious and alert, but appears anxious. his blood pressure is 100/62 mm his pulse is 118 beats, and his respiration are 22 bretahs. further assessment reveals that his radial pulses are easily palpable. What is the MOST appropriate IV fluid regimen for this patient>

25 mL/hr

You are ordered to administer a dopamine infusion to your 62-year-old, 75 kg, hypotensive, cardiac patient. The ordered dose is 10 mcg/kg/min, and you plan to use a micro-drip tubing set with the standard dopamine mixture of 800 mg in a 500 mL normal saline infusion bag. How many drops per minute will it take to deliver the ordered dose of dopamine properly

28 gtts/min

You are ordered to administer a dopamine infusion to your 62-year-old, 75 kg, hypotensive, cardiac patient. The ordered dose is 10 mcg/kg/min, and you plan to use a micro-drip tubing set with the standard dopamine mixture of 800 mg in a 500 mL normal saline infusion bag. How many drops per minute will it take to deliver the ordered dose of dopamine properly?

28 gtts/min

You are the first unit called to the scene of an MCI from a suspected carbon monoxide poisoning at a school after all the students were gone for the day. You have 2 unresponsive patients that are breathing, with no signs of trauma. Two more patients are ambulatory, conscious and alert, with no injuries. One last patient on the ground is speaking in inappropriate words. The triage tags you should apply are?

3 red, 2 green

You are on scene of an ATV crash where the patient was thrown 15 feet and hit a tree. Your patient's GCS is 7 (E: 2,V: 2, M:3). You suspect that this patient will most likely require which of the following?

Advanced airway

You are treating a patient in ventricular tachycardia with no pulse. You elect to administer amiodarone. What would be an appropriate dose for this situation?

300 mg IVP

What is the correct initial dose and rate of administration of amiodarone for a patient with refractory ventricular fibrillation?

300 mg via rapid IV or IO push

Your patient is a five-year-old male who has been struck by a car. He is suffering from a severe hemorrhage. The external hemorrhage is controlled, oxygen applied, and an IV established. For the fluid bolus, how much fluid should you administer?

320 mL

Which one of the following patients should be transported to a burn center, according to Advanced Burn Life Support guidelines?

37-year-old with 2% second- and third-degree burns to the face and hands

You are going to administer 80 mg of lidocaine to a patient. The lidocaine comes packaged as 100 mg in 5 mL. How many milliliters of solution would you administer?

4 mL

You have witnessed the endotracheal tube tip pass through the vocal cords of your apneic adult patient. After advancing the tube the proper distance, how much air should be used to inflate the balloon cuff that seals the perimeter of the tube?

5-10 mL of air

You are transporting to the hospital a female patient suffering what you believe to be an aortic dissection. Currently her vitals are stable, but she is having intense chest pain (sharp), and has pulse deficits between the upper extremities. Given this brief presentation, the paramedic should reassess the patient while en route to the hospital every:

5 minutes.

You arrive at a local community center where a 30-year-old man has been having a seizure for the past 20 minutes. After properly managing his airway and establishing vascular access, you should give:

5 to 10 mg of diazepam.

What is the normal respiration rate for a newborn (0-1 month)?

40-60 breaths per minute

a 4 yo child has partial thickness burns to the entire face and head, anterior torso and both anterior upper extremities. what percentage of the total body surface area does this represent

42%

EMTs are responsible for dispatching in a tiered EMS system. Three basic life support ambulances and one Advanced Life Support ambulance is available. The following calls are in queue waiting for response. Fire department first responders and police are available for all of the calls. Which patient of the patients described below should receive the ALS ambulance first?

44-year-old depressed patient who is threatening suicide by taking a bottle full of OxyContin

You are ordered to administer 3 mg/min of lidocaine via intravenous infusion to your cardiac patient who presents with a heart rate greater than 130 beats per minute as well as greater than 10 multifocal PVCs every minute. Therefore, you quickly but carefully mix 2 grams of the medication in 500 mL of normal saline and attach micro-drip tubing to the solution bag. Which of the following drip rates would effectively deliver the ordered dose of lidocaine?

45 gtts/min

Your 7-year-old female patient was taken from a burning house by firefighters. She has burns covering her legs and back. What percentage of body surface area was burned?

45%

Treatment for a patient with a severe migraine headache, nausea, and vomiting includes:

5 mg of prochlorperazine IV.

You are resuscitating a four-year-old female, who was found at the bottom of the family pool. You ask your EMT partner to prepare the endotracheal tube. She asks, "What size?" Your response is:

5.0, uncuffed.

You are on scene with a six-year-old who is unconscious and unable to protect his own airway. He is of average height, and his estimated weight is 23 kg. Which of the following endotracheal tube sizes would be most appropriate for this patient?

5.5-millimeter uncuffed endotracheal tube

Your patient has sustained a possible tib/fib fracture. The injury site is deformed with evidence of bruising and swelling, but he is not bleeding externally. How much blood could be lost internally, if a closed tib/fib fracture is present?

50-500 mL

For all vehicle crashes, the current scene-response guidelines call for establishment of a primary danger zone for rescuers. That zone is known as the "hot zone." When no fire or chemical hazards exist, the hot zone extends _____ feet, but when additional chemical hazards are present, that distance should increase to _____ feet.

50; 2000

Which of the following patients is at greatest risk for hypothermia?

55-year-old woman with hypothyroidism

All the following patients are in cardiac arrest, with a down time (without CPR) of seven minutes prior to advanced life support (ALS) arrival. Assuming all ACLS interventions are followed, which patient would have the highest likelihood of surviving this incident?

56-year-old female with history of congestive heart failure (CHF) and complaining of chest pain

A 24-year-old patient has threatened suicide. He is recently divorced and has a history of depression, having attempted suicide once before. He is employed as a store clerk and has earned an associate degree from the local community college. He has been living with his parents for several weeks. He currently smells of alcohol, but denies drug use. Based on this information, how many tangible risk factors does he have?

6

You are on scene at the local skate park for a 10-year-old male that crashed while not wearing a helmet. He does not open his eyes to verbal or painful stimuli, is making incomprehensible sounds, and has abnormal flexion to a sternal rub. What is this patient's GCS?

6

You are caring for a very young female patient who is the sole survivor of a motor-vehicle collision in which her parents died. There is no one present who can provide any information about your patient. What would be her estimated age if she sits without support, has a pincer grasp, and exhibits "object consistency"?

6 to 12 months

You are on scene with an eight-year-old drowning victim who is pulseless and apneic. Chest compressions are being conducted by fellow rescuers while you prepare to intubate the patient. Which of the following endotracheal tube sizes and styles would be most appropriate to intubate the patient orally?

6-mm ET tube without a distal balloon cuff on the distal end

You are setting up the transcutaneous pacemaker for a bradycardic patient unresponsive to atropine. At what rate would be most appropriate to set the pacemaker initially?

70/minute

A 39-year-old man, who weighs approximately 160 pounds, was trapped inside his burning house and sustained full-thickness burns to approximately 40% of his body. On the basis of the Parkland formula, how much IV crystalloid solution should he receive within the first hour?

730 mL

Which of the following frequency bands must EMS agencies share with cellular phone users in the area, congesting the frequency at times?

800 MHz frequency bands from 821 to 824 and 866 to 869 MHz

You usually work in a rural area, but today you are assigned to a unit that responds to medical emergencies in a busy metropolitan area nearby. Which of the following EMS frequency bands would be most effective for allowing you to communicate effectively with dispatch and other EMS professionals while working in this area?

800 megahertz band

A 12-kg child has sustained a burn to the entire head and entire left arm. Using the Parkland formula for fluid resuscitation, how much IV fluid per hour should be administered in the first few hours post injury?

81 mL per hour

Which of the following represents the low normal systolic blood pressure for a 6-year-old child?

82 mm Hg

In a 6 yo child, the low normal systolic blood pressure is _____mm Hg, the high norml systolic blood pressure is _____mm HG, and the average systolic blood pressure is ___mm Hg

82,102,92

What is the approximate minute alveolar volume of a patient who is breathing at a rate of 26 breaths with an estimated tidal volume of 450mL

8200

Using the adult Rule of Nines, the anterior thorax accounts for what percent of the total body surface area?

9

Your suspected chest trauma patient is found to be hypotensive with the classic signs and symptoms of hypovolemic shock. He is also complaining of severe abdominal distension and pain on palpation. What should be the target range for this patient's blood pressure in the pre-hospital setting?

90 mmHg systolic

You are about to test the peak flow on an asthmatic patient in respiratory distress. The patient is an average-size adult male. What would a "normal" value be for him?

>450 L/minute

You are preparing to intubate an apneic child who is 12 years old and weighs 29 kg. Which of the following endotracheal tube sizes would be most appropriate for this patient?

A 6.5 mm ET tube with a balloon cuff

You are monitoring the cardiac rhythm of your 60-year-old female patient with shortness of breath when you note the presence of a possible first-degree atrioventricular block in lead II on the EKG. Which of the following electrocardiogram abnormalities makes you think there is a first-degree AV block present?

A P-R interval greater than five small boxes (0.20 seconds) wide on the electrocardiogram tracing

Sighing is a slow, deep inspiration followed by a prolonged expiration and is thought to be a protective reflex. Which of the following is it thought to prevent?

Atelectasis

What is the best airway adjunct to quickly establish a clear means of air entry for a spontaneously breathing patient who has an intact gag reflex?

A nasopharyngeal airway (NPA)

When forced to deal with a fire, which type of fire extinguisher would be most effective for suppressing ordinary combustible material that smells like gasoline?

ABC all-purpose fire extinguisher

While assessing the patient's ventilatory status, you note the following: respiratory rate of 8/minute; no vesicular breath sounds; pulse oximeter reads 89%; chest excursion diminished. Of those findings, which one best represents that the patient is breathing inadequately?

Absent vesicular breath sounds

You have just returned to your station following a call in which a woman, eight months pregnant, died in a car crash. While restocking the ambulance, you notice that your partner is very agitated and seems excessively upset over the call. When you ask her what is wrong, she tells you her sister also died in a car wreck seven years earlier. What kind of stress reaction is she most likely experiencing?

Acute stress reaction

Which of the following clinical presentations is MOST consistent with dissection of the ascending aorta?

Acute tearing pain in between the scapulae, blood pressure discrepancy between arms, maximal pain severity from the onset

You are ventilating a severely dehydrated apneic 70 yom with a history of end-stage emphysema. In order to minimize the risk of lowering his cardiac output and blood pressure, you should

Adjust the ventilation rate to allow complete exhalation

You are on-scene with a 33-year-old male complaining of flank pain that radiates to his groin on the right side. He rates the pain at 10 on the pain scale; he is cool, clammy, and actively vomiting. His heart rate is 130, and his blood pressure is 160/100. He denies shortness of breath. Which of the following would be most appropriate when treating this patient?

Administer 2-4 mg of morphine sulfate for pain and 12.5-25 mg of promethazine for nausea and vomiting

You are on-scene with a 69-year-old male complaining of not feeling well. The patient states he has a cardiac history but has been healthy with no related medical problems for the past year until waking up this morning with severe congestion and difficulty breathing. He has cool, pale, and diaphoretic skin. His breath sounds reveal audible rales bilaterally with an SpO2 of 90%. His heart rate shows sinus bradycardia at 40 beats per minute. His blood pressure is 80 systolic. There is pitting pedal edema noted. Which of the following treatments is indicated a first-line treatment for this patient?

Administer Atropine 0.5 mg IVP

You are called to assist a 55-year-old male who complains of sudden onset chest pain, dyspnea, and palpitations. On arrival, he is found semi-conscious with a pulse rate too fast to palpate and a blood pressure of 80 systolic. Once on the monitor, he is exhibiting an irregularly wide complex tachycardia, with a polymorphic QRS appearance, at nearly 200 per minute. Which of the following would be the most effective intervention for this patient?

Administer defibrillation per protocol

You are caring for a 13-year-old female patient who is suffering from an allergic reaction after being stung by a bee. She has inspiratory stridor, body-wide hives, and an altered mental status. Attempts to start an IV are unsuccessful. In this situation, what should you do?

Administer epinephrine, 0.01 mg/kg, IM.

You are treating and transporting a 40-year-old male involved in an MVA with a possible closed head injury. He is conscious but confused. During your evaluation, you discover the patient is a diabetic with a current blood glucose level of 70. He is breathing at 26 respirations per minute and regular with a current SpO2 of 92%; his heart rate is 110, his blood pressure is 90 systolic, and he is complaining of a severe headache. Which of the following is most appropriate?

Administer high-flow oxygen, maintain SpO2 at least 94%, establish a large bore IV at KVO, and withhold glucose

A 56-year-old female patient is complaining of pain to her foot, ankle, and knee. She is also diaphoretic, warm to the touch, and very tired. She states she stepped on a nail about three days ago, and now has redness to her foot that is traveling up her leg. Vitals are stable. What should be your first medical intervention?

Administer low-flow oxygen via cannula.

When treating a patient suspected of experiencing a cold emergency involving hypothermia, there are three types of rewarming procedures: passive, active external, and active core. Active core rewarming procedures are considered invasive and reserved for the controlled environment of the hospital. However, some active core rewarming procedures are acceptable to initiate in the pre-hospital setting. Which of these procedures are paramedics permitted to initiate that are considered invasive?

Administer warmed intravenous fluid and humidified oxygen therapy

You are on-scene with a 92-year-old female experiencing chest pain. Her respirations are 20 breaths per minute with a SpO2 of 94. Her pulse is 100 beats per minute, and her blood pressure is 140 systolic. She allowed vital assessment but refuses treatment or transport to the hospital. Her daughter insists you transport her for evaluation anyway. The patient is alert, oriented, and capable of making her own decisions. What is the best way to handle this situation?

Advise the patient of the risks of refusing EMS care and have her sign a refusal

You are on-scene with a 20-year-old female patient who hit a tree at high speed in her car. She is conscious, alert, and has stable vital signs. She has some minor lacerations and abrasions to her arms and face but no obviously life-threatening injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. Which of the following would be most appropriate at this point?

Advise the patient that she should be transported to the hospital because of the seriousness of the crash

Sickle cell disease is most common to what patient population?

African-American

Which of the following is not a sign/symptom of mononucleosis?

Agitation

Which of the following hormones stimulates the kidneys to reabsorb sodium and excrete potassium?

Aldosterone

Which of the following is a naturally occurring steroidal hormone produced by the adrenal cortex to help regulate the sodium/potassium balance in the blood?

Aldosterone

Paramedics have been asked to work at a special event, a rock concert, which is being held in a large outdoor arena. Which one of the following is TRUE about the legalities of paramedic practice at large mass gatherings?

All of the rules and laws guiding paramedic practice typically still apply.

You are assisting a pregnant patient in the delivery of her baby in the pre-hospital setting after you find the mother in active labor and determine birth to be imminent. As the delivery progresses, you note the buttocks presenting first at the opening of the birth canal. How should you proceed?

Allow the frank breech delivery to progress naturally, and extract the legs downward gently after the buttocks deliver

You are treating a post femoral fracture patient with suspected deep vein thrombosis in his right upper thigh. What should be the main concern while treating and transporting the patient to the hospital?

Allow the patient to assume a position of comfort and monitor closely for a pulmonary embolism

Adequate oxygenation of red blood cells is dependent on what two basic physiological components?

Alveolar ventilation and pulmonary blood flow

You are transporting a 60-year-old woman with chest discomfort and shortness of breath. The 12-lead ECG indicates an acute anterior wall MI. The patient is receiving oxygen and an IV has been established. You have administered 324 mg of aspirin, 3 sublingual nitroglycerin, and 5 mg of morphine. Which of the following should concern you the MOST during transport?

An acute cardiac dysrhythmia

What is the name of the legal document in which an individual specifies what medical treatments should and should not be done for him in the event he is unable to make his own medical care decisions?

An advanced directive

You are on-scene with a 40-year-old patient with an extensive cardiac history for his age. Today, he is complaining of chest pain that radiates to his jaw and left arm. His vital signs are stable; however, once on the cardiac monitor, he exhibits ST elevation in leads II, III, and aVf. With the EKG finding, which of the following should you suspect?

An inferior wall myocardial infarction

While conducting an EKG on your post-myocardial infarction patient, you note the presence of consistently wide QRS complexes greater than 120 ms in duration. What does this most likely indicate?

An intraventricular conduction delay or right/left bundle branch block

Your adult patient was involved in a baseball accident in which a ball struck him in the face around the mandible. He is conscious and alert, denies loss of consciousness, but is not able to close his mouth. It appears as if he is yawning widely and is not able to return his face to a normal position. What is the most likely cause of this finding?

Anterior mandibular dislocation

A middle-aged male experienced partial-thickness splash burns to 36% of his body surface area. The burns are all located above his waist. What parts of his body have been burned?

Anterior torso and both arms

Your chest pain patient is likely experiencing an acute myocardial infarction. On your patient's 12-lead EKG, you note ST elevation in leads V3 and V4. Which area of the heart is most likely involved in the infarction?

Anterior wall myocardial infarction

A patient has ST and J-point elevation of 3 mm in leads V2, V3, and V4. What wall(s) of the heart does this pattern fit?

Anterior, with septal involvement

Your adult patient has a confirmed tension pneumothorax that requires pre-hospital decompression to increase his chance of survival. When performing needle decompression, where should the catheter be inserted to be effective?

Anteriorly in the second intercostal space, just above the third rib, in the mid-clavicular line

When loading a patient on a helicopter, which of the following procedures would be considered safe and appropriate?

Approach the helicopter from the front in a crouched position after making eye contact with the pilot and receiving a "go ahead" signal

You are interviewing your 38-year-old chest pain patient. When obtaining a history of the event, you know that open-ended questions:

Are questions that only ask the patient to describe their condition in more detail

A 4-year-old boy has a high fever and deep, rapid respirations. The child's mother states that she thinks her child got into the medicine cabinet. Which of the following medications has the child MOST likely ingested?

Aspirin

Medical command requests that you draw a blood sample from a suspected drug overdose patient for ER analysis. However, the conscious, alert adult patient refuses to allow the procedure, prompting you to restrain the patient and take the blood sample against the patient's will. Which of the following charges could be brought against you?

Assault and battery charges could be brought against you

You are performing triage on the patients at a mass-casualty incident when you encounter a responsive 20-year-old male with a respiratory rate of 22 breaths/min. What should you do next?

Assess radial pulses, tag the patient appropriately, and move on to the next patient

You are called to a conscious 28-year-old female lying supine on her front yard. She is restless and in obvious respiratory distress. After ensuring a patent airway, your next course of action is?

Assess respiratory quality, effort, and rate

Your adult epileptic patient experienced a seizure lasting several minutes per the bystanders and family. He is now postictal and unable to answer your questions. A family member informs you the patient has been on a prescribed medication for the seizures for a long time but is not sure what the name of the medication is or where the container is located. What is the paramedic's best way to check the patient for chronic phenytoin therapy?

Assess the patient's mouth for the presence of swollen gums

A S.O.A.P. pre-hospital care report consists of 4 distinct parts. What does the 'A' stand for?

Assessment

Which of the following is considered an effective method in reducing stressing an obviously anxious bystander at the scene of an emergency?

Assign the bystander minor, nonpatient care -related tasks

Which of the following is considered an effective method in reducing stress in an obviously anxious bystander at the scene of an emergency?

Assign the bystander minor, nonpatient care related tasks

You receive a call for an 18 yof who is not breathing. When you arrive at the scene, emergency medical responders are providing effective two-rescuer CPR. According to the child's father, she had a cough and runny nose for the past several days, but when he tried to wake her up from her nap, she was unresponsive. When you apply the cardiac monitor, you will MOST likely see:

Asystole

Which one of the following is characteristic of a wandering atrial pacemaker?

At least three different P wave configurations are present.

For which one of the following fractures would traction splinting be appropriate?

At the femoral diaphysis

You are on-scene with a trauma patient who is unconscious and has abnormal respirations and posturing. Which of the following respiratory patterns indicates the highest degree of severity in head-injured patients?

Ataxic respirations

Which abnormal respiratory pattern is associated with structural or compressive lesions in the medullary respiratory center characterized by an irregular, cluster-type respiratory pattern?

Ataxic respiratory pattern

A patient with a cardiac history is taking lanoxin (digoxin). After placing the patient on the monitor, which one of the following cardiac rhythms does the paramedic expect to find?

Atrial fibrillation

During your SAMPLE history of an elderly man, he tells you that his cardiologist told him that he has an "irregular heartbeat." His medications include warfarin sodium and digoxin. On the basis of this information, what underlying cardiac rhythm should you suspect?

Atrial fibrillation

Because of automaticity, cardiac cells can act as a fail-safe means of initiating electrical impulses if the chief pacemaker does not initiate a normal impulse. Which of the following intrinsic pacemakers would initiate an impulse if the SA node fails to fire?

Atrioventricular junctional tissue at 40 to 60 impulses per minute

You are on-scene with an adult who was possibly exposed to an inhaled vapor that contains a high concentration of organophosphate material. Which of the following medications may help block the adverse effects of the potential poisoning by antagonizing the actions of acetylcholine?

Atropine

Your adult patient is experiencing symptomatic bradycardia with a heart rate of 40 bpm. Once on the monitor, it reveals the patient has a complete third-degree atrioventricular block and is found to be hypotensive as well. Which of the following medications should be avoided, if possible?

Atropine

An unresponsive pediatric patient is found by his parents after he ingested unknown medications from the bathroom cabinet. You find the six-year-old child bradycardiac, with poor perfusion. You initiate oxygen, an IV, pulse oximeter, and cardiac monitoring. If there are no contraindications, what drug and dose is most appropriate?

Atropine, 0.02 mg/kg

During the management of a patient in cardiac arrest, the paramedic visualizes the glottic opening for intubation and sees an airway obstruction just distal to the vocal cords. What should her next action be?

Attempt removal of the obstruction with Magill forceps.

After intubating your apneic patient, what tube placement confirmation means should be assessed first?

Auscultate over the epigastric region for the presence or absence of breath sounds

Your partner, a new paramedic, is experiencing significant anxiety after a call involving a pediatric cardiac arrest in which the child died despite an appropriate resuscitative effort. How can you effectively help your partner?

Be prepared to spend extra time with your partner and allow him or her talk about the call.

You are treating a patient with a closed head injury. His initial vital signs reveal a blood pressure of 132/82 mm Hg, a pulse of 76 beats/min, and respirations of 28 breaths/min. Which of the following set of repeat vital signs is MOST suggestive of increased intracranial pressure?

BP 180/88, pulse 64 and bounding, respirations 36 and irregular

which of the following sets of vital signs is the MOST consistent with hemorrhagic shock?

BP 90/50 mm HG, pulse 120 beats/min, respirations 28 breaths/min

Which of the following parameters yields the lowest cerebral perfusion pressure

BP, 105/60 mm, intracranial pressure, 20 mm

Which of the following sets of vital signs is MOST indicative of neurogenic shock?

BP, 70/50 mm Hg; pulse rate, 56 beats/min; respirations, 24 breaths/min

Your adult patient complains of severe respiratory distress. He is cool, pale, and has distended neck veins. Which of the following best describes the cause of jugular vein distention (JVD)?

Back pressure of blood through the right side of the heart and into the venous system

A patient with Torsades de Pointes on the monitor and signs and symptoms of hypomagnesemia would mostbenefit from which of the following medications?

Magnesium sulfate

You are ventilating an intubated patient and note decreased compliance with each delivered ventilation. Which of the following conditions would be the LEAST likely cause of this?

Beta-2 receptor stimulation

You are called to assist a patient who may be experiencing an allergic reaction. On arrival, the patient complains of severe itching with angioedema and shortness of breath but denies the feeling of his tongue or airway swelling. Which of the following medication types would be indicated to improve the patient's alveolar ventilation?

Beta-agonists such as albuterol

You decide to administer CPAP to your spontaneously breathing patient who is complaining of dyspnea. What should the initial pressure valve setting be on a fixed rate FiO2 CPAP device?

Between 7 and 10 cm H2O

Which one of the following best describes the mechanism of action of atropine?

Blocks parasympathetic tone

You are on-scene with an unconscious 23-year-old male who has a possible closed head injury after a motorcycle accident. During your assessment, you determine the patient's blood pressure is elevated, his heart rate is slow, his pupils are reactive, and he is exhibiting Cheyne-Stokes type respirations. The patient reacts only to painful stimuli. Your assessment findings lead you to believe there is damage in what area of the brain?

Brainstem

While evaluating the pupils of your unresponsive trauma patient, you note his pupils have a dysconjugate gaze. What type of injury does this finding normally represent?

Brainstem damage or herniation has occurred

Assessment of a patient with respiratory distress reveals that his expiratory phase is 4 times longer than his inspiratory phase. Which of the following conditions would MOST likely cause this?

Bronchospasm

Treatment for an unresponsive 18-month-old child with a severe foreign body airway obstruction includes:

CPR, followed by attempts to visualize and remove the obstruction under direct laryngoscopy.

You respond to a baseball field where you find a 23-year-old male who was struck in the face with a baseball, causing an orbital fracture of the left eye. When you assess the patient, you find outward and downward deviation of the eye and dilation of the pupil. Which cranial nerve do you suspect has been damaged?

CN-III

Which of the following electrolytes moves slowly into the cardiac cell and maintains the depolarized state of the cell membrane?

Calcium

You are on scene, initiating care of a man with a deep laceration to his abdomen. You are approached by a bystander who instructs you to stop what you are doing or he will kill you and your partner. He is holding a large knife. You should:

Calmly leave the scene immediately, leaving your equipment behind

In contrast to an anaphylactic reaction, an anaphylactoid reaction:

Can occur without prior exposure to an offending agent

When assessing a patient with suspected cardiac-related chest pain, which of the following questions would be MOST appropriate to ask?

Can you describe the quality of the pain?

Which one of the following questions would provide you with the most pertinent information about a patient with chest pain?

Can you describe to me what the chest pain feels like?

Which of the following occurs when the right atrium pumps against a closed tricuspid valve sending waves of pressure through the jugular veins?

Cannon A waves

A neonatal patient has a three-day history of poor feeding and irritability. He is not sleeping well, and is now having trouble breathing. The capillary refill is four seconds, heart rate 220, and respiration 34. What is the most likely field impression?

Cardiac dysrhythmia

You have been dispatched for a suspected overdose. Dispatch has been informed that the patient took too many Nortriptyline, a tricyclic antidepressant. Which diagnostic aid will be priority in monitoring this patient?

Cardiac monitor

A 21-year-old male has been involved in a high-speed motor-vehicle collision. He presents with chest pain and bruising. You note he has distended neck veins and muffled heart sounds. Which one of the following would be the most likely problem based upon your findings?

Cardiac tamponade

Your adult chest pain patient presents with an elevated venous pressure, hypotension, and distant heart sounds. On the electrocardiogram, he exhibits various sized QRS complexes throughout each lead. Which of the following should you suspect until proven otherwise?

Cardiac tamponade

A patient with an acute lateral myocardial infarction displays the following vital signs: BP 74/56, P 109, R 28, O2 saturation 96% on 4 LPM oxygen. The paramedic has administered aspirin 324 mg and morphine 2 mg for the patient's pain. What condition should the paramedic suspect?

Cardiogenic shock

All of the following shock states require the pre-hospital administration of high-flow oxygen therapy as well as aggressive intravenous fluid replacement as an appropriate solution for shock except:

Cardiogenic shock

You have an intubated patient who is unconscious but has a pulse of 90 and a BP of 120/80. You have capnography in-line with your ET tube, and you have a CO2 reading of 30 mmHg. What should you do because of this reading?

Check your ventilation rate; you may need to slow it down

Which of the following types of weapon of mass destruction would cause the most immediate impact?

Chemical

Your adult trauma patient is not breathing effectively due to his injury. He is exhibiting the signs and symptoms associated with hypoperfusion including suspected acidosis. At this point, which of the following will attempt to correct the imbalance?

Chemoreceptors

Which of the following procedures is to be performed with extreme caution in patients with a left ventricular assist device (LVAD)?

Chest compressions during CPR

Which of the following interventions is MOST appropriate when treating an unresponsive adult with a severe foreign body airway obstruction?

Chest compressions, laryngoscopy and use of Magill forceps, and cricothyrotomy

Your adult motor vehicle accident patient has sustained a closed pneumothorax that is quickly approaching a tension pneumothorax while you are still twenty minutes from the trauma center. He is tachycardic, breathing rapidly with decreased breath sounds on the right side, and increasing jugular vein distension. At last reassessment, he begins showing signs and symptoms of shock and hypotension. What should be your next intervention in this situation?

Chest decompression using an 8 mm or larger, 10 or 14 gauge IV catheter inserted in the second intercostal space in the midclavicular line, just above the rib

Which of the following signs or symptoms occurs more commonly in patients with stable angina than in those with unstable angina?

Chest pain that begins during exertion

A trauma patient can sustain his own airway but has suffered an injury that damaged the neural pathways between the midbrain and medulla. What can the paramedic expect to find when evaluating the patient's respiratory status?

Cheyne-Stokes respirations

Why would you choose an uncuffed endotracheal tube for a six-year-old child who is apneic?

Children under eight years old have a natural narrowing at the level of the cricoid cartilage

Electrolytes, such as calcium, potassium, and sodium in the blood, are essential to normal cardiac function. What other electrolyte must be present in the blood for the electrolytes to help maintain normal cardiac function?

Chloride

Which of the following hazardous materials is described as a yellow-green poisonous substance that may smell like a mixture of pineapple and pepper?

Chlorine

Your adult anaphylaxis patient is suffering from hypotension that is not responding to epinephrine. Which of the following medications is capable of combating hypotension associated with anaphylaxis when epinephrine fails to improve blood pressure?

Cimetidine

While you are assessing an alert patient with abdominal pain, he tells you he has been passing unusually dark stools, and has been feeling very tired. Vitals are heart rate 112, respiration 20/minute, and blood pressure 92/76. The pulse oximeter is 92% on room air. What body system is likely failing?

Circulation

According to the classification recommendations for emergency cardiac care (ECC), which classification is given to a medication or therapy when it is thought to be more helpful than harmful or whose benefit outweighs the potential risk of causing harm?

Class IIa

In which of the following situations would it be MOST appropriate to insert a King LT supraglottic airway?

Comatose patient who ingested aspirin

You are treating a 20-year-old patient who sustained a full-thickness burn to his entire right lower leg. During your evaluation, it is quickly determined the patient has no sensation or distal pulses peripherally in the affected limb. If circulation is not quickly returned to the extremity, which of the following is most likely to occur?

Compartment syndrome

You are called to the scene of a patient who is under the influence of recreational drugs. Although the patient can respond with coherent speech, you find her to be confused and lethargic. The patient keeps muttering, "Leave me alone" and "I don't want to go to the hospital." In this situation, what criterion is the paramedic NOT able to establish for this patient?

Competence

While en route back to your station from a call, you discover that you forgot to include important patient information on your patient care report. Which of the following would be most appropriate at this point?

Complete an addendum, and return to the hospital to add it to the report

You are called to a residence for a 39-year-old woman, who, according to her husband, is "not acting right." She is confused, is experiencing hallucinations, and is repetitively smacking her lips. Which of the following should you suspect?

Complex partial seizure

Your adult patient presents with dyspnea that developed over the last few days and worsened today. During auscultation of the patient's lungs, his vocal sounds become louder over the left lower lobe of his lung. What does this likely indicate?

Consolidation (fluid, mucus) is present in the left lower lobe of the patient's lung

After administering epinephrine to a women in anaphylactic shock, her condition improves. The paramedic should recognize that her clinical improvement is because epinephrine:

Constricts the blood vessels and dilates the bronchioles

You are caring for a geriatric trauma patient after a motor-vehicle crash. An unidentified male approaches you and states he is a doctor. He orders you to start certain interventions. if the person orders inappropriate interventions, what is your best course of action?

Contact medical direction for guidance on how to proceed.

You arrive at a residence and find an elderly woman who is pulseless and apneic. Shortly after you and your partner begin CPR, the patient's husband hands you a crumpled piece of paper with the words "do not resuscitate" written on it, and asks that you stop CPR. How should manage this situation?

Continue CPR and notify medical control for guidance.

An elderly patient has gone unresponsive 15 minutes after correctly taking her scheduled dose of Lantus insulin. She had a full breakfast two hours ago. Which one of the following actions by the paramedic is most appropriate after ensuring ABCs have been addressed?

Continue to assess the patient to determine the cause of unresponsiveness.

You are called to a traffic accident in which a 10-year-old female has an open tibia/fibula fracture and is bleeding heavily. Her pulse is 150, BP 92/68, respirations are 30 and unlabored. Your first priority is to?

Control bleeding

You are called to the residence of a terminally ill patient, with Hospice and family present, to transport the patient to the hospital for confirmation of death. Once on scene, the family informs you the patient stopped breathing peacefully an hour prior to calling for EMS transport. They state he is an organ donor and present documentation to the fact. The patient is found asystolic and apneic with fixed, dilated pupils. There is also evidence of independent lividity and rigor mortis. Which of the following may qualify for organ donation?

Corneas

Which one of the factors listed below does NOT contribute to the heart's normal ventricular cardiac output?

Coronary perfusion

You suspect your unconscious adult trauma patient may have increased intracranial pressure from a closed head injury. Due to the compression forces of increased intracranial pressure, at what level of brain injury would be expected if the patient is exhibiting Cheyne-Stokes respirations and is presenting with increasing blood pressure readings and a decreasing, reactive pulse rate?

Cortex and upper brainstem

Addison's disease is a potentially life-threatening condition because it causes a deficiency in corticosteroid production. Which of the following corticosteroids are produced by the adrenal cortex and may be potentially fatal for the patient if the deficiency worsens?

Cortisol and aldosterone

You are treating a 24-year-old male who was found buried up to his waist by rocks and dirt. He is conscious and alert, but it's suspected that he was there for at least four hours before anyone discovered him. What is your greatest concern before he is unburied?

Crushing syndrome

An adult asthma patient is experiencing laryngospasm and ineffective respirations, making orotracheal intubation impossible. So, you quickly decide to perform nasotracheal intubation. Which of the following tubes would be mostappropriate for the procedure for an average height and weight adult?

Cuffed 6.0-6.5 mm endotracheal tube

Your adult patient has possibly sustained a closed-head injury following a motor vehicle accident that left him unconscious. He is exhibiting abnormal flexion of the arms and extension of his legs. What is the proper terminology for this finding?

Decorticate posturing

In neurological injury, decorticate posturing can sometimes occur. Decorticate posturing differs from decerebrate posturing in that:

Decorticate posturing is flexion, and decerebrate is extension.

A 120-pound patient in acute pulmonary edema has been intubated with a 7.0 mm ET tube, and is on a mechanical ventilator with the following settings: ventilator mode is A/C, tidal volume is 450, rate 10/minute, FiO2 of 1.0, PEEP 4 cmH20. Vitals are: heart rate 110, blood pressure 82/58, SpO2 94%. Given this scenario, what should the paramedic do with the ventilator settings?

Decrease PEEP.

In the following list, which change associated with aging has the greatest impact on the care provided by paramedics?

Decrease in creatinine clearance

Which one of the following would be considered a positive tilt test?

Decrease in systolic BP of 20 mm/Hg, and an increase in diastolic BP of 10 mm/Hg when moving the patient to the sitting position

You are preparing to transfer a patient from the emergency department of a small hospital to a larger teaching hospital. The patient is intubated and on a mechanical ventilator (A/C mode, Vt of 450 mL, rate of 15/min). Current blood gases show a PaO2 of 180 torr, PaCO2 of 25 torr, and a pH of 7.52. Given this information, what parameter should the paramedic consider adjusting on the ventilator?

Decrease the ventilation rate.

You are assessing a 70-year-old patient for mild shortness of breath. She is breathing 28 times per minute with an SpO2 of 90% on room air. What can you expect the elderly patient's partial pressure of oxygen (PO2) to do at this point?

Decrease to 60 mmHg

You are treating a 63-year-old female who you suspect may be experiencing a pulmonary embolus (PE) due to her signs, symptoms, and past medical history. If a PE exists, what can you expect to see when evaluating her capnography waveform?

Decreased angle for phase 2 and the slope of phase 3 may not reach its alveolar plateau

A woman who is 37 weeks pregnant complains of severe neck pain following a motor-vehicle crash. After applying full spinal precautions and loading her into the ambulance, the patient suddenly becomes pale, diaphoretic, and tachycardic. What is the MOST likely explanation for this?

Decreased cardiac venous return

Your adult apneic patient is becoming increasingly difficult to ventilate using a bag valve mask due to changes in thoracic and inspiratory pressures. What are these changes known as?

Decreased compliance

If the number of erythrocytes in a patient's blood drops, he may report shortness of breath with mild exertion. What causes this to occur?

Decreased oxygen molecules being delivered to the lungs and tissues

Which of the following is responsible for initiating the sympathetic response to shock during a traumatic event?

Decreased perfusion and increased acidosis

What is the therapeutic effect of aspirin when administered to a patient experiencing an acute coronary syndrome (ACS)?

Decreased thromboxane A2 production, which inhibits platelet aggregation

When a person hyperventilates, their minute volume?

Decreases, due to decreased air volume reaching the alveoli

A patient is bedridden, secondary to quadriplegia from an old all-terrain vehicle crash. The inherent lack of mobility she now experiences can put her at increased risk of what other medical emergency?

Deep venous thrombosis

Which of the following may a paramedic be held responsible for if he knowingly makes false statements about a co-worker that ruin her good reputation at her current workplace?

Defamation

Meconium is which one of the following?

Defecated material in the amniotic fluid

you and your partner are performing CPR on a 8 yof who is in cardiac arrest. you have reason to believe that the child ingester her mothers amitriptyline. reassessment after 2 minutes of CPR reveals that the child is ventricular fibrillation. You should

Defibrillate and immediately resume CPR

After assisting a full-term pregnant patient in the delivery of her newborn, the newborn remains bradycardic with a heart rate of 50 beats per minute and exhibits cyanosis around his mouth, nose, fingers, and toes. He is not responding well and appears lethargic following the five-minute APGAR assessment. What would be the best initial intervention at this point to increase his heart rate?

Deliver adequate artificial ventilation after ensuring a definitive airway

You are preparing to defibrillate a patient in cardiac arrest with a manual biphasic defibrillator, but are unsure of the appropriate initial energy setting. What should you do?

Deliver one shock with 200 joules and resume CPR.

Your partner tells you that his wife left him suddenly and unexpectantly. When you try to discuss it with him, he avoids all conversation on the subject and acts as if everything is normal. He is in which stage of the grieving process?

Denial

When determining an estimated time of death on-scene, what is the terminology used to describe blood and fluid leaving the areas of the face, nose, and chin assisted by gravity and allowed to settle in the lowest parts of the body?

Dependent lividity

In ACLS, what is the mnemonic of "H's and T's" used for?

Describing reversible causes of cardiac arrest

Which of the following is a defining factor in the transition from human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS)?

Development of opportunistic infections

If your patient with meningitis displays Kernig's sign, what would you expect to observe?

Difficulty in extending the lower leg when in a flexed position

Shortly after being stung by a scorpion, a 20-year-old female develops hives on her chest and arms. She is conscious and alert, but states that it is difficult to swallow. Her heart rate is 110 beats/min and her oxygen saturation is 94%. Which of her signs or symptoms should concern the paramedic the MOST?

Difficulty swallowing

A patient with a traumatic head injury is entrapped within a car and is in need of airway assistance and intubation. She has no gag reflex, but the entrapment in the vehicle precludes visual laryngoscopy. To secure the patient's airway, which one of the following options should the paramedic try first?

Digital intubation

You respond to a residence for a 68-year-old male with nausea, vomiting, and blurred vision. As you are assessing him, he tells you that he has congestive heart failure and atrial fibrillation, and takes numerous medications. The cardiac monitor reveals atrial fibrillation with a ventricular rate of 50 beats/min. Which of the following medications is MOST likely responsible for this patient's clinical presentation?

Digoxin

Which of the following would be the most appropriate pharmacological agent to treat a patient with atrial fibrillation accompanied by a rapid ventricular response when the patient does not have a history of Wolff-Parkinson-White syndrome in the pre-hospital setting?

Diltiazem

A 24-year-old woman presents with severe nausea and vomiting for the past 36 hours. She tells you that she is 12 weeks pregnant with her first child. She is tachycardic, lightheaded, and extremely weak. You begin transport, establish vascular access, and give her IV fluid boluses en route. Which of the following medications would MOST likely control her nausea and vomiting?

Diphenhydramine

When treating an adult patient for a mild allergic reaction, with no respiratory distress or dyspnea, which medication is routinely administered either IM or IV for the treatment of an allergic reaction?

Diphenhydramine

Which of the following medications may be effective in reversing the signs and symptoms of dystonia?

Diphenhydramine

You are attempting to gather a medical history from a six-year-old girl who accidently shut a car door on her fingers. She is crying uncontrollably. What is your best course of action?

Direct your questions to the patient's parents.

You are preparing to intubate an apneic patient and decide to use a Macintosh blade. When using a curved blade on an adult, where should the tip of the laryngoscope blade be placed?

Directly into the vallecula

Which of the following signs is LEAST suggestive of an underlying arterial injury in a patient with a closed extremity fracture?

Disproportionate pain

You are attempting to perform transcutaneous pacing on a symptomatic bradycardia patient. Which of the following would be appropriate when attempting to gain electrical capture of the patient's heart rhythm?

Do not activate pacing mode until a "marker" is located on the oscilloscope screen, following each and every QRS complex

Paramedics respond to the home of a female who called the ambulance because she was in labor. Upon arrival, which one of the following questions should be asked first?

Do you feel as if you need to have a bowel movement?

a woman is in labor and you are trying to determine if delivery is imminent. Which of the following questions would be the MOST pertinent to ask the patient?

Do you feel the urge to push?

It is late at night and raining when you are called to a one-car motor-vehicle crash on an isolated road. What is one thing the paramedic should do to help maintain safety and visibility while on scene?

Don a high-visibility, reflective safety vest

You are treating a 68-year-old woman with chest pressure and shortness of breath that started 2 days ago. Her BP is 76/52 mm Hg and her pulse is 130 beats/min and weak. The cardiac monitor reveals sinus tachycardia with occasional PVCs and auscultation of her lungs reveals diffuse coarse crackles. Which of the following treatment interventions is MOST appropriate for this patient?

Dopamine, 2 to 20 mcg/kg/min

A 58-year-old male patient has been experiencing substernal chest pain, with radiation to the jaw and left shoulder for three hours. The ECG shows sinus tachycardia at 118/minute, with occasional unifocal PVCs. The peripheral pulses are weak and the systolic blood pressure is 82/56. You note slight inspiratory rales with deep inhalation. Which one of the pharmaceutical agents below, and what dose, would be most appropriate for this patient following oxygen, IV, and aspirin therapy?

Dopamine, 7 mcg/kg/minute

You are en route to the report of an 8-year-old female with altered mental status. Upon arrival, your patient is lying on a couch with her eyes closed, but responds to verbal stimuli. Initial vital signs: BP 106/62, P 100, R 50, SpO2 94%. Lung sounds are clear and equal, bilaterally. There is no accessory muscle use, nasal flaring, or retractions present. What other diagnostic equipment will you use to help with your assessment of the patient's breathing?

ETCO2 cannula

You are assessing a patient with an injury to the left midshaft femur. Which of the following is the LEAST reliable indicator of an underlying fracture?

Ecchymosis and swelling

A 24-year-old pregnant woman has had a severe headache and blurred vision for the past week. Which of the following additional signs or symptoms would you expect her to have?

Edema and hypertension

You are about to complete an interhospital transport of a patient who has a tracheal tube and is on a ventilator. As you establish your initial vent settings, you remember she cannot tolerate high airway pressures. What kind of medical history does your patient have?

Emphysema

A 72-year-old male patient is experiencing an ST-segment elevation myocardial infarction (MI). What layer of the myocardium is most likely to infarct first?

Endocardium

You are called to the scene for an emotionally disturbed 38-year-old male. In the course of your assessment, he suddenly becomes violent and needs to be physically restrained. Law enforcement is not on-scene. Which of the following would be most appropriate during the restraint procedure?

Ensure that at least five rescuers are available to safely restrain him

At the scene of a multiple-casualty incident (MCI), you have been assigned the responsibility of "staging unit leader" by the incident commander. Which one of the following best describes your role?

Ensure the availability of all equipment until it is needed for patient care.

You and your partner are called to an elementary school for a nine-year-old child with a swollen, painful deformity to the right lower extremity. The parents are already on-scene. Which of the following would be mostappropriate?

Ensure the parents remain aware of what you are doing by communicating with them often throughout the treatment

You are on-scene with a six-year-old patient. His mother reports he has been ill for several days with general malaise and weakness, but she denies he has been actively vomiting or complaining of nausea. His skin is cool and clammy with a delayed capillary refill while his skin turgor remains within normal limits with a blood pressure of 56/30. His heart rate is found to be 48 beats per minute and regular with sinus bradycardia evident on the monitor. After initiating a patent IV line, which of the following would be administered first in an attempt to increase the patient's heart rate and blood pressure?

Epinephrine at 0.01 mg/kg of a 1:10,000 concentration

CPR is in progress on a 3-year-old child with asystole. The airway is being properly managed and vascular access has been obtained. Which of the following drug-dose combinations is MOST appropriate to give via the IV or IO route?

Epinephrine, 1.4 mL 1:10,000

Your trauma patient is combative with a decreased level of consciousness and a current coma score of less than 8. His spontaneous respirations are between 26 and 30/minute, and his heart rate is 130 bpm with a blood pressure of 90 mmHg/systolic. Which of the following agents will medical command likely recommend to sedate the patient prior to an intubation attempt?

Etomidate

You have a neonate who is bradycardic (heart rate of 48) following birth. Of the following interventions, which one would be most appropriate to administer first?

External cardiac compressions

Which of the following clinical presentations is consistent with significant insecticide exposure?

Excessive salivation and severe bradycardia

You are on-scene with a cardiac history patient experiencing unstable ventricular tachycardia that is not responding well to prehospital interventions. The patient and family want the patient transported to a hospital across town; however, there is a facility more capable of handling the cardiac event much closer. Which of the following would be most appropriate?

Explain the situation to the patient and family, then transport him to the closer facility to benefit the patient

You are treating a 23-year-old male that had a 1" diameter branch go into his abdomen. The patient's shirt is saturated with blood. How should you proceed?

Expose the area, control bleeding, stabilize the object in place with bulky gauze

In the United States, the federal agency that regulates telecommunications is the?

FCC

When in utero, the alevoli in a fetus' lungs are filled with?

Fetal lung fluid

The Health Insurance Portability and Accountability Act (HIPAA) details the requirements for the handling and storage of sensitive patient information. According to HIPAA, which one of the entities listed below should NOT routinely receive sensitive patient data?

Field training officer

While monitoring your adult cardiac patient in lead II, you note the presence of an upward deflection just as ventricular systole ends. Which of the following is most likely the cause of the positive deflection?

Final stage of ventricular repolarization

You are working in a remote area of the United States where transport times to hospitals are typically hours in length. You are treating a severely injured trauma patient who needs transport to a level-one trauma center, 230 miles away. If weather or access is not at issue, what is the best mode of transportation?

Fixed-wing aircraft transport

Of the following methods to deliver positive pressure ventilation to an apneic patient, which technique is most recommended per current American Heart Association and National Safety Council guidelines?

Flow-restricted oxygen-powered ventilatory device (FROPVD)

During your physical assessment of a patient with a chest complaint, you percuss the lungs and find the dependent regions of the left thorax to be hyporesonant. What does this finding mean?

Fluid may be accumulating in the lower hemithorax.

Your adult patient called for help after he began to vomit bright red blood. On arrival, the patient is found to be tachycardic and bleeding freely from his mouth. His respirations are shallow, and his skin is cool with a blood pressure is 68 systolic. His only history involves liver disease from chronic alcoholism. He denies drinking recently. What should be the goal of your pre-hospital intervention with this patient after ensuring his airway and applying oxygen therapy?

Fluid resuscitation to maintain a systolic blood pressure of 80-90 systolic

Opioid antagonists reverse the symptoms of an opioid overdose. Which of the following medications would be effective in reversing the adverse effects of a benzodiazepine overdose?

Flumazenil

Your 68-year-old female has a history of CHF. She tells you she has been prescribed a loop diuretic to treat her "fluid". Which of the following is a loop diuretic?

Furosemide

You are working in an EMS system where there is significant gang violence and trauma. What is the paramedic's best protection from accidental contamination from a trauma victim?

Hand washing

While caring for an unresponsive patient who was stabbed in the chest, you notice a knife underneath the patient's left shoulder. Which of the following actions would be MOST appropriate for you to take?

Have a police officer secure the knife as you continue to treat the patient.

While functioning at a mass-casualty incident, a paramedic falls and fractures his femur. He is conscious and alert, is breathing adequately, and has no open injuries. Which of the following should occur?

He should be assigned an immediate triage category and removed from the scene as soon as possible

A 2-year-old child fell from a second-story window. Based of the mechanism of injury and the anatomic differences between children and adults, you should expect that the primary impact occurred to the:

Head

Which of the following is characterized by sudden onset malaise, weakness, anorexia, intermittent nausea, vomiting, and jaundiced skin?

Hepatitis

You are on-scene with a 60-year-old patient complaining of dyspnea, chest pain, and nausea/vomiting. Once on the monitor, it is clear the patient is experiencing pronounced polymorphic ventricular tachycardia with a weak, thready carotid pulse and a blood pressure of 60 mmHg. Which of the following is the most appropriate initial intervention?

High-energy unsynchronized shocks

An adult patient who presents with uncontrollable movements, a loss of intellectual functioning, and emotional problems that develop from a condition that causes degeneration of neurons within the brain is most likely suffering from which of the following?

Huntington's disease

Which of the following common toxic substances is a colorless, flammable, and extremely hazardous gas that smells like rotten eggs and is capable of affecting several body systems, especially the nervous system?

Hydrogen sulfide

You and your team are performing CPR on a 70 yom. The cardiac monitor reveals a slow, organized rhythm. His wife tells you that he goes to dialysis everyday, but has misses his last three treatments. She also tells you that he has high blood pressure, hyperthyrodism and had cardiac bypass surgrey 3 years ago. Based on the patient's medical history, which of the following conditions is the MOST likely underlying cause of his condition?

Hyperkalemia

Your adult patient was entrapped by dirt up to his mid-abdominal area for a few hours while rescue crews worked to free him. Once on the cardiac monitor, why would tall, tented T waves become evident quickly?

Hyperkalemia caused by the sudden influx of potassium

Acute hyperfunction of the thyroid gland can cause a thyroid storm. It is characterized by the rapid onset of restlessness, agitation, tachycardia, and/or delirium with warm skin and may result in a coma. Which of the following disorders are capable of causing similar signs and symptoms?

Hypoglycemia

While assessing a 60-year-old chronic renal failure patient for chest pain, you note the presence of U waves on the EKG tracing as well as flat T waves. What is the most likely cause of this abnormal electrocardiogram finding?

Hypokalemia

Your pediatric patient has been ill for several days leading you to suspect he may be dehydrated. Once on the electrocardiogram, it is evident the patient has an accelerated heart rate and abnormally flattened T waves. What is the most likely cause of this finding?

Hypokalemia

A patient was stabbed in the left chest by an assailant. You find the knife still embedded in the 4th intercostal space, midaxillary line. You note the patient is struggling to breathe. Breath sounds are markedly diminished in the basal and posterior zones on the left. Apical breath sounds are present and clear. What other clinical findings would you expect?

Hyporesonance

A 60-year-old woman was just extricated from her badly wrecked automobile. She is unresponsive and has multiple extremity fractures. Which of the following will afford your patient the BEST chance for survival?

Immediate transport

You are called to assist a 55-year-old male who possibly sustained a snake bite. On arrival, your patient is calm but concerned that a poisonous snake envenomation may have occurred. He states the bite took place less than 15 minutes prior to your arrival. He has two fang marks with minimal bleeding noted on his right lower leg, posteriorly. His vitals remain within normal limits while his skin tone/color is unchanged. Which of the following interventions would be most appropriate after ensuring an adequate airway, breathing, circulation, and initiating oxygen therapy

Immobilize the extremity in the neutral position with a pressure immobilization bandage

Which one of the following statements about cricoid pressure is most accurate?

In adults, pressure is applied to the cricoid cartilage with a thumb and finger placed just lateral to the midline.

When using a Kendrick extrication device (KED) to extricate a sitting adult patient from a motor vehicle after an accident, which of the following should be accomplished first in the proper immobilization and extrication of the patient?

Initiate/maintain manual in-line C-spine immobilization, and apply an appropriately-sized cervical collar before placing the KED

Which of the following statements regarding sickle cell disease is correct?

In sickle cell disease, misshapen red blood cells can lodge in the spleen, causing it to swell and rupture.

A patient is found unresponsive and hypothermic after being stranded in a car during a blizzard. Providing there are no scene hazards threatening you with immediate physical harm, where should the majority of care you render take place?

In the patient compartment of the ambulance

In which of the following situations would evaluating the ST segment elevation of a patient suffering from a suspected myocardial infarction not be indicated to determine if an infarction exists?

In the presence of a left bundle branch block

A trauma victim displays the following findings after being in a car crash: no pain perception to the left leg, and no motor function or light touch perception to the right leg. But she can feel pain in the right leg. What kind of injury did she sustain?

Incomplete cord transection

In compensated shock states, the body attempts to maintain a viable blood pressure when a decrease in circulating blood volume is detected. How does the body initially respond to the decreased volume?

Increasing catecholamine production in an attempt to increase the blood pressure

Your patient was stung by a bee. She is very agitated and shows all of the symptoms associated with anaphylaxis. She tells you she thinks she is going to die. While you begin to treat her symptoms, she deteriorates further, exhibiting loss of consciousness and seizure activity. What is the most likely cause of this rapid progression?

Increasing cerebral hypoxia from hypoxemia

A patient is found to have new onset, rapid ventricular response atrial fibrillation. The patient has no previous cardiac history and is unsure how long he has had the palpitations, but states he has not been well for at least two days. He is currently hemodynamically stable. Which one of the following interventions would be included in the initial management of this patient?

Initiation of IV heparin

Which of the following statements regarding compression injuries of the chest is correct?

Injury tolerance to compression decreases as velocity increases.

You are on scene at a motor vehicle accident, and your 20-year-old patient is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take another twenty minutes. After having your partner maintain cervical spine stabilization, which of the following would be the bestchoice for securing the patient's airway?

Insert a King LTD and begin assisting ventilations with a bag-valve mask

You have attempted orotracheal intubation on a cardiac arrest patient, but were unsuccessful after two attempts. When you resume bag-mask ventilations, you are unable to maintain an adequate mask-to-face seal. What should you do?

Insert a multilumen or supraglottic airway device

You are attempting to intubate an adult patient who is not breathing spontaneously. When using a Miller blade on the laryngoscope where should you place the tip of the blade to safely lift the structures of the airway to allow the passage of the ET tube?

Insert the tip under the epiglottis and exert gentle upward traction on the handle

Retrograde intubation involves passing an endotracheal tube through the patient's glottic opening after?

Inserting a guide wire into the trachea via the cricothyroid membrane

As you are gathering a history from an anxious patient with abdominal pain, the patient keeps saying to you, "Are you listening? Are you getting this?" What could you do to help ease their anxiety?

Interject, "I'm listening" or "Please continue."

A patient is suffering from poor peripheral perfusion secondary to gastrointestinal bleeding, and has a systolic blood pressure of 92 mmHg. What effect will this have on the body's ability to maintain cellular oxygenation?

Internal respiration will be decreased.

Which of the following statements regarding the length-based resuscitation tape measure is correct?

It is used in children up to 34 kg to estimate their weight based on their height.

You are preparing to initiate a rapid sequence intubation on a pediatric patient who is exhibiting a borderline hypotensive state with a decreased level of consciousness and hypoventilation. He is quickly becoming hypoxic with a SpO2 of 77% and a delayed capillary refill. Which medication would be most effective in sedating this patient for the procedure?

Ketamine

Which of the following is the primary organ for the elimination of most orally taken medications?

Kidneys

Which of the following advanced airway procedures is considered a supraglottic airway device?

King LTD airway

You are about to administer morphine to a chest-pain patient. Of the following considerations, which one would hold the LEAST importance on whether or not you actually administer the drug?

Knowing the drug expires in nine months

Which of the following respiratory patterns is most likely to be present with an adult patient suffering the adverse effects of diabetic ketoacidosis?

Kussmaul respirations

Which of the following respiratory patterns is most likelyto be present with an adult patient suffering the adverse effects of diabetic ketoacidosis?

Kussmaul respirations

A diabetic patient experiencing diabetic ketoacidosis presents with Kussmaul respirations. What is the body's purpose for initiating this type of spontaneous breathing pattern?

Kussmaul respirations are initiated by the body in an attempt to blow off high levels of carbon dioxide that have accumulated

A patient with diabetic ketoacidosis develops a fast and rapid respiratory pattern with no periods of apnea. His breathing appears labored. His respiratory pattern would most accurately be described as:

Kussmaul's.

Your adult patient has a past medical history of hypertensive encephalopathy. He is complaining of right-sided weakness and headache. He states the headache began last night and the right-sided weakness began today. He is found to have a current heart rate of 98, respirations of 22, and a blood pressure of 220/120. Transport to the hospital is expected to be delayed due to weather. Which of the following medications may medical command recommend in this case?

Labetalol

According to Haddon's matrix, which of the following is an environmental factor that has a direct effect on the event phase of a motor-vehicle crash?

Lack of guardrails

You are on-scene with a 20-year-old trauma patient. Regardless of the findings, which of the following intravenous fluid replacement agents would be mostappropriate in this case?

Lactated Ringer's solution

You are preparing to perform fluid replacement on an adult trauma patient who lost a significant amount of his circulating blood volume when you note the presence of a drastic systolic blood pressure decline from 100 mmHg to 86 mmHg systolic after the patient's bleeding is controlled. The patient has no obvious new bleeding, but his abdomen is distended and is painful on palpation. There are no obvious masses, bruises, or deformity, and he has active bowel sounds over the epigastric region. Which of the following intravenous fluids would be most appropriate in this situation if the medical command physician recommends a fluid challenge?

Lactated Ringer's solution

Your adult trauma patient is exhibiting the signs and symptoms associated with hypovolemic shock. What is the intravenous fluid of choice for adult patients with significant blood loss?

Lactated Ringer's solution

As shock continues, a trauma patient's systolic and diastolic blood pressures continue to fall causing cellular hypoxia to ensue. If this process continues without intervention, which of the following is most likely to occur from the switch to anaerobic metabolism?

Lactic acid production

Your 49-year-old COPD patient is unconscious and exhibiting ineffective respirations. You quickly decide to attempt to control his airway and provide positive pressure ventilations. Which airway adjunct has a large distal end with an inflatable cuff that presses against the patient's esophageal sphincter while the proximal border of the airway device rests against the patient's tongue?

Laryngeal Mask Airway (LMA)

Which of the following injuries pose the MOST immediate threat to a patient's life

Laryngeal fracture

You are on-scene with the driver of an automobile in a single-vehicle crash with major front-end damage. You note the smell of alcohol as you introduce yourself to the ambulatory patient. The driver was not wearing a seatbelt, and airbags are not a feature of the automobile he is driving. There is blood in his mouth, though his teeth appear uninjured. He is hoarse when he answers your questions and appears confused. Which of the following should you suspect is causing the hoarseness in his voice?

Laryngeal injury

Which of the following describes the typical sequence of events that precedes cardiac arrest in a drowning episode?

Laryngospasm, hypoxia, dysrhythmias

During the history-taking phase of assessment, you gathered that your patient has congestive heart failure (CHF). Which one of the following statements should alert you to the possibility that she could become unstable rapidly?

Last time this happened at the hospital, they had to put a tube into my windpipe.

If a patient is experiencing a myocardial infarction (MI), with occlusion of the left common coronary artery, what other two major arteries may be involved?

Left anterior descending and left circumflex

Which of the following electric conduction blocks is capable of looking like an ST elevation myocardial infarction on the electrocardiogram, making it impossible to use ST elevation to determine the existence of an acute infarction?

Left bundle branch block

You are performing a routine electrocardiogram on an ACLS medical patient when you note QRS complexes are somewhat normal, but the QRS terminates in an S wave. What is this indicative of?

Left bundle branch block

Which of the following coronary arteries is responsible for delivering 85 percent of the required oxygen-rich blood to the myocardium?

Left main coronary artery

You are treating a 68-year-old cardiac history patient experiencing chest pain. If it is determined at the hospital that he experienced an acute myocardial infarction of the septal wall, which of the coronary arteries was most likely occluded?

Left main coronary artery

If the city council in your area enacts a law concerning the classification of first responders, what type of law allows this to occur in the US?

Legislative law

A 4 yom presents with audible stridor, a barking cough, and increased work of breathing. He is conscious and alert, has pink, warm skin; and has a heart rate of 120 beats/ min. Further assessment reveals clear and equal lungs sounds bilaterally, an oxygen saturation of 97% and a temperature of 99.2 F. You should:

Let him assume a position of comfort. offer oxygen via the blow-by technique, and administer a 2.25% solution of racemic epinephrine via nebulizer

Which classification of personal protective clothing offers the highest respiratory system protection but a lower level of skin protection?

Level B

You are treating a victim at a MVC who has sustained multiple traumatic injuries. You have been on scene for 15 minutes, stabilizing and immobilizing your patient. You are in a region which contains a Level I trauma center 50 minutes away and a Level III trauma center 10 minutes away. What is your choice of treatment facilities and why?

Level III because it will be able to stabilize and transfer serious patients, if needed

Your adult patient may be experiencing a gastrointestinal bleeding event causing nausea, vomiting, and cool, clammy skin. While obtaining IV access, which blood sample tube would give the hospital staff the mostinformation about the possibility of a GI bleed?

Light blue top with sodium citrate

Your 50-year-old patient is confused and unable to tell you much about his extensive cardiac history, but he does hand you a list of his medications. Which of the following medications is prescribed to control hypertension?

Lisinopril

You are on-scene with a patient with a respiratory rate of 8 breaths per minute. Which of the following conditions is most likely to cause a decrease in spontaneous respiration?

Metabolic alkalosis

The self-contained breathing apparatus (SCBA) that maintains positive pressure in the face mask during inhalation and exhalation protects the respiratory system of the rescuer in most hazardous material situations. Which of the following hazardous materials is capable of penetrating the seal of an SCBA?

Methyl bromide

You are managing a patient with dizziness, severe nausea, dyspnea, and ischemic changes indicative of a septal wall myocardial infarction (MI) on the 12-lead. Vitals are: blood pressure 102/palpated, heart rate 60, respiration 20, and SpO2 94% on room air. In treating this patient, which medication would most likely NOT be administered?

Metoprolol

A 22-year-old female complains of a unilateral headache, photophobia, and nausea. Based on her symptoms, which one of the following types of headaches would be the most likely?

Migraine

After attempting to slow the bleeding associated with natural childbirth by non-invasive means, your patient continues to bleed significantly. Per medical direction, after ensuring a second fetus is not present, which of the following would be the most appropriate intervention for the new mother?

Mix 10 units of oxytocin to 1 liter of lactated Ringer's solution and run at 20-30 gtts/min

Which of the following injury mechanisms and clinical findings would MOST likely warrant transport to a facility that provides the highest level of trauma care?

Motorcycle crash; pelvic instability; systolic BP of 100 mm Hg

You are on-scene with a 15-year-old male patient with difficulty breathing and possible airway burns from an accidental ingestion of a caustic material. As his spontaneous respirations and level of consciousness continue to decrease, you quickly note he still has an intact gag reflex. Fearing he may not be able to control his own airway, which airway control device would be most appropriate for use with this patient?

Nasopharyngeal airway (NPA)

Which of the following is not a toxidrome?

Neuroleptic malignant syndrome

When an advanced airway is in place during a cardiac arrest resuscitation, after how many compressions should you pause to give ventilations?

Never pause for ventilations

Which of the following statements regarding the concentration of gases is correct

Nitrogen accounts for approximately 79% of atmospheric air

Which of the following cardiac medications is mosteffective in reducing ischemic chest pain and is the class I intervention for this type of pain?

Nitroglycerin

Which of the following neurotransmitters is responsible for naturally stimulating a positive chronotropic effect as well as a positive inotropic effect on the heart?

Norepinephrine

You are treating and transporting a 26-year-old female involved in an MVA. She has multiple injuries, but all associated hemorrhage is controlled. The patient is exhibiting signs and symptoms of hypovolemic shock. During treatment and transport, you infuse one liter of lactated Ringer's solution, and the patient remains hypotensive. Once at the hospital, which of the following is most likely to be administered immediately upon arrival?

O-negative packed red blood cells

Abnormal respiratory sounds often indicate that a patient is in respiratory distress. When these abnormal respiratory sounds are found with retractions, what may your patient be experiencing?

Obstruction

Your adult trauma patient has a possible right tib/fib fracture with moderate blood loss, a large bruise with rigidity in the right lower abdominal quadrant, a right-sided tension pneumothorax, and a decreased level of consciousness. He is found to be profoundly hypotensive and shows signs and symptoms of shock. Which of the following types of shock is most likelypresent?

Obstructive shock

Your three-week post-tib/fib fracture patient had surgery to help realign the bones of his lower leg. Today, he presented with sudden onset shortness of breath with cold, clammy, and diaphoretic skin. He is hypoxic and hypotensive rapidly. Which of the following types of shock is most likely to cause this patient presentation?

Obstructive shock

Your adult patient is experiencing a prolonged episode of paroxysmal supraventricular tachycardia but remains stable at the present time. He denies chest pain, shortness of breath, and his skin is warm and dry. He has failed to convert to a normal sinus rhythm after receiving the max dosage of adenosine in succession. What is your next step?

Obtain expert consultation about diagnosis and treatment

According to his family, an 83-year-old male patient has started to display bizarre behaviors. They state he was fine earlier in the day, but in the afternoon he became very paranoid and anxious, and shut himself in his bedroom. What is the most likely cause for this sudden change?

Organic disorder

Your adult patient was possibly exposed to an unknown toxic agent at work in a chemical plant that specializes in agricultural insect control. He presents with confusion, CNS depression, bradycardia, bronchoconstriction with wheezing, and diaphoresis. Exposure to which of the following agents is most likely to cause the patient's current signs and symptoms?

Organophosphate and/or carbamate agents

You are on-scene with a 40-year-old male complaining of a severe headache and palpitations. The patient reports he was recently diagnosed with autonomic hyperreflexia syndrome and prescribed sublingual nifedipine as needed (PRN) to manage his condition. Which of the following best describes autonomic hyperreflexia syndrome (AHS)?

Overactivity of the autonomic nervous system that causes an abrupt onset of extremely high blood pressure

In your patient assessment you want to observe how well your patient is perfusing. Perfusion refers to which of the following?

Oxygen being carried by the blood's hemoglobin and delivered to the tissues

Your 40-year-old patient was involved in an ATV accident. He is ambulatory on your arrival but complains of abdominal pain and nausea. The patient is conscious and alert with an unremarkable physical exam except for abdominal tenderness, mild abdominal rigidity, and bruising around the patient's umbilicus. Which of the following should be suspected until proven otherwise at the trauma center?

Pancreatic hemorrhage

Patients experiencing hyperventilation must have their respiratory rate decreased to prevent an excessive loss of exhaled carbon dioxide. If the ventilatory rate is not quickly regulated, the decrease in carbon dioxide leads to hypocapnia. If a patient is experiencing hypocapnia, what signs and symptoms can the paramedic expect to occur?

Paresthesia, dizziness, and lightheadedness/euphoria

You are on-scene with a 70-year-old female who complains of being awakened in the middle of the night by sudden onset dyspnea and sweating. She is breathing 32 times per minute with inspiratory/expiratory wheezing and rales auscultated in all fields bilaterally, with an SpO2 of 88 percent on room air. Her heart rate is 136 beats per minute, showing an irregularly irregular sinus tachycardia on the monitor. Which of the following is most likely causing the patient's current signs and symptoms?

Paroxysmal nocturnal dyspnea

What is one limitation to be considered in rotor-wing transport not present in other modes of patient transport?

Patient weight

You arrive on-scene to a two-vehicle MVA. One vehicle is already being attended to by another ambulance, so you head to the other car. Your patient is a 40-year-old male, standing outside of his car. Immediately, you can see your patient slightly swaying on his feet, and his breath smells of alcohol, but he has no noticeable injuries. There is slight crumpling on the driver's side of his car, and airbags have been deployed. Your patient adamantly says that he is not injured, but upon an assessment of his mental faculties, he is unsure of what month it is or what city he is in at the time. The patient does admit that he has only had two beers and is not inebriated. What C-Spine precautions, if any, should you take?

Patient will need full C-spine precautions, including a backboard. The patient will also immediately need your partner to administer manual C-spine and apply a cervical collar when possible.

Preexcitation syndrome conditions, such as Wolff-Parkinson-White (WPW) or Lown-Ganong-Levine (LGL), do not pass through the AV node, so they can become life-threatening arrhythmias when tachycardia is present. What is the distinguishing feature of LGL notpresent in WPW patients?

Patients with Lown-Ganong-Levine have normal-appearing QRS complexes

Which of the following arrhythmias should be treated as an ST-elevation myocardial infarction when presented with chest pain and associated with the signs and symptoms of a myocardial infarction?

Patients with new-onset left bundle branch blocks

You are on-scene with an adult patient who has recently been diagnosed with diabetes but is unsure of what type. What is the primary difference between type 1 and type 2 diabetes?

Patients with type 1 diabetes usually take insulin and have an onset of the disease early in life, whereas patients with type 2 diabetes usually take oral medications to combat insulin resistance and have an onset later in life

Which one of the mechanisms of injury described below would be considered significant?

Pediatric male who falls six feet from a tree, but does not remember the fall occurring

A female patient of child-bearing age presents with lower abdominal/pelvic pain. Of the following disorders, which one is most likely to be life threatening in the prehospital setting?

Pelvic inflammatory disease

You are treating a 34-year-old female patient who is experiencing hypoxia from a suspected accidental overdose. Her respirations are 8 bpm, are shallow, and she has an oxygen saturation of 78% ORA. The patient has an intact gag reflex and an altered mental status. Which of the following is your best option to ensure adequate oxygenation and ventilation?

Perform a nasotracheal intubation and ventilate with a bag valve mask

You are called to assist an adult with chest pain. The patient has a cardiac history of two-posterior myocardial infarctions. He is conscious and alert, stating he is having a hard time breathing, and the chest pain worsens when he attempts to lay flat on his back. His skin is pale and hot, while auscultation of his lung sounds reveals mild crackles. He reports the pain worsens on deep inspiration and movement. Based on the patient's history, and signs and symptoms, which of the following should you suspect?

Pericarditis

You arrive on-scene of a seizure call to find an adult patient postictal. He is conscious, and his level of consciousness is improving. He reports that he has an epilepsy history and suffers from grand mal seizures. He says he was recently prescribed medication for the condition, but he does not like to take it. Which of the following medications is he most likelyprescribed for epileptic seizures?

Phenytoin

While applying direct pressure to a right mid-thigh injury with profuse bleeding, your initial bulky dressing becomes soaked with blood. Which of the following should you do at this point?

Place a clean, dry dressing on top of the blood-soaked dressing while maintaining direct pressure on the wound

A child has a deep laceration to the leg following a cycling accident in which he was hit by a car. Bleeding is severe. You have implemented direct pressure, but the hemorrhage has not slowed. What should you do next?

Place and tighten a tourniquet

You are treating a patient with a history of congestive heart failure who presented with acute pulmonary edema. What is the best way to ensure adequate ventilation?

Place the patient on CPAP

Your pregnant adult patient presents with a headache, blurred vision, and upper right quadrant pain that she rates at 8 on the pain scale. She denies trauma, bleeding, and/or any other complaints not listed. Her skin is warm and dry with +2 pitting edema noted peripherally. Her pulse is 100 per minute, and her blood pressure is 188/120, confirmed in both upper extremities. The patient denies any past medical history or problems throughout the pregnancy but states she has been unable to acquire prenatal care. Evaluating her fundal height, you estimate the patient is around the 24th week of pregnancy. Due to the patient's signs, symptoms, and complaints, which of the following conditions is most likely to cause the abnormal findings in this case?

Preeclampsia

Your adult patient is experiencing a prolonged episode of paroxysmal supraventricular tachycardia but remains stable at the present time. He denies chest pain, shortness of breath, and his skin is warm and dry. He has failed to convert to a normal sinus rhythm after receiving the max dosage of adenosine in succession. What other medication is a class Ia intervention and may be effective in safely treating the patient?

Procainamide at 20-50 mg/minute, IV infusion

Your patient is complaining of chest pain. She states it started about an hour ago when she was mowing the lawn. She describes the pain as a dull pressure radiating into her back and left shoulder. "It's very strong," she adds, rating it a "9" on a "1 to 10" scale. What is still missing from this standard verbal evaluation?

Provocation

You are called to assist a 23-year-old female patient with chest pain and dyspnea. On-scene, the patient reports she was taking care of her three-day-old newborn when the episode began suddenly. She is tachycardic, tachypneic, and has a current systolic blood pressure of 88 mmHg. Which of the following should you suspect may be causing her signs and symptoms until proven otherwise at the hospital?

Pulmonary embolus

Your patient developed sudden-onset difficulty breathing and diaphoresis. He has a past history of atherosclerosis and a recent hip replacement surgery. Which of the following should be suspected until proven otherwise?

Pulmonary embolus

While intubating a 44 year old man is respiratory arrest, you note that his pulse rate increases during the procedure. What should you do

Recognize this as a normal reponse during intubation and monitor the pulse rate

When using the SMART tagging system to prioritize trauma patients involved in a mass casualty incident, what color tag would a 22-year-old female who was breathing but unresponsive to all stimuli receive during the initial triage?

Red

Recent studies have shown that inducing hypothermia in patients who have a return of spontaneous circulation but remain unresponsive after a cardiac arrest interval may increase the chance of survival significantly. How does induced hypothermia increase the chance of survival in some instances?

Reduces the intracranial pressure, cerebral metabolic rate, and the patient's cerebral oxygen demand

Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient?

Relative to body weight, a smaller amount of hemorrhage will result in shock

Treatment for a patient with an acute asthma attack should focus on which of the following goals?

Relief of the bronchospasm and improved ventilation

A 30-year-old man overdosed on codeine and has respirations of 6 breaths/min and shallow. Which of the following conditions will he develop initially?

Respiratory acidosis

You are called to a public building for a suspected terrorist attack. Upon your arrival, employees exiting the building are coughing, their eyes are burning, and they say something about an overpowering smell. What should you do first?

Remain outside until the fire department arrives.

Although there are many techniques a paramedic can employ in order to reduce the likelihood of a back injury while lifting, which one of the techniques listed below offers the greatest level of protection?

Remaining physically fit with exercise

Which one of the following habits should paramedics develop?

Remind drivers and passengers to use seat restraints during transport.

You are transporting a female patient with a gunshot wound to the right anterior chest. She was initially stable and had bilateral breath sounds. Management included oxygen, IV therapy, and occlusive dressing over the wound. En route, the patient suddenly deteriorates, and breath sounds diminish on the right side. What should you do first?

Remove the occlusive dressing upon exhalation (burp wound).

Your adult patient was involved in an accident with a truck hauling organophosphate chemicals. If the patient was exposed to a potentially toxic amount of inhaled organophosphates, which of the following is most likely to occur?

Respiratory and heart rate decrease due to cholinergic stimulation

Which of the following will not be provided by using a pulse oximeter attached to a monitor?

Respiratory rate

You are called to the scene of a fight where injuries are suspected. The police have controlled the scene, but as you approach the injured patient, the crowd begins to become unruly and is directing their anger at you and your partner. What is the best course of action?

Retreat

Which of the following statements regarding isoimmunization(Rh disease) is correct?

Rh disease is most prominet with subsequent pregnancies and occurs when an Rh-negative mothers becomes pregnant by a man with Rh-positive blood.

Which of the following is an active intervention that helps prevent injury?

Routine use of seat belts when driving

A unified incident command system has been established at the scene of a chemical spill with multiple employees of the plant injured and trapped. Which command staff positions should the incident commander establish immediately?

Safety

You are responding to a mutual aid call with a neighboring community when the EMS providers on scene radio you. They tell you the patient's initial vital signs are pulse 122, respiration 20, and blood pressure 230/110. This means they have at least completed what phase of patient assessment?

Secondary assessment

A 9 month old male has had numerous episodes of vomiting and diarrhea. On assessment, the infant is listless. He has unlabored tachynea; absent radial pulses and weak brachial pulses and cool mottled extremities. The infant is experiencing?

Severe dehydration with decompensated shock

An unresponsive 37 year old male has been home one week post-kidney transplant. His family tells you his urine output is adequate. What should you suspect is a likely cause of his unresponsiveness?

Sepsis

Which one of the following is not a subcategory of antihypertensive agents?

Seratonin reuptake inhibitor

While assessing a 78-year-old woman who fell, you note crepitus and pain to her pelvis. The patient is conscious but restless, and her skin is dry. Her blood pressure is 82/42 mm Hg and her pulse rate is 66 beats/min. Her medical history is significant for hypertension and congestive heart failure. Which of the following would BEST explain her vital sign findings?

She takes a beta blocker medication for hypertension.

A 25 yom who is 38 weeks pregnant tells you that her bag of waters ruptured 2 hrs ago, that she is now experiencing contractions every 6 minutes. Based on your assessment, you determine that delivery is not imminent. During transport, you should tell your partner to stop the ambulance and assist you with the patient if:

She tells you that she needs to move her bowels.

A woman began experiencing contractions 30 minutes ago. She is 38 weeks pregnant. You determine that she is gravida-5 and para-3. Which of the following statements regarding this patient is correct?

She will become para-4 when she delivers her baby

MCP has recommended administering 5 mg of verapamil via slow IV bolus over two minutes to your adult cardiac history patient who has apparent atrial fibrillation with a rapid ventricular response at greater than 160 beats per minute in two leads on the electrocardiogram. Prior to the administration of verapamil, which of the following medications may be recommended to prevent the possibility of hypotension and bradycardia?

Slow IV administration of 500 mg of calcium chloride to reverse the possible adverse effects of verapamil

You are on-scene with an unconscious 23-year-old trauma patient who presents with serious injuries including a now controlled femoral artery hemorrhage from an open femur fracture. The patient has a current GCS of 2/2/2 for a total of 6. He is pale, cool, and diaphoretic with a weakening carotid pulse at 90 bpm. There are no palpable radial pulses bilaterally, and he has a blood pressure of 66 systolic. After quickly controlling his airway with orotracheal intubation, you determine the patient is experiencing hypovolemic shock. With these findings, which stage of hypovolemic shock is the patient most likely currently experiencing?

Stage 3

When evaluating the electrocardiogram tracing of a patient's heart, which lead configuration records the electrical potential between the left leg (+) and the right arm (-) electrodes?

Standard limb lead II

You are called to assist an adult diabetic who was found unconscious in bed. On arrival, your patient is unresponsive with snoring respirations and cool, clammy skin. Your glucometer will not power up, so blood glucose analysis is impossible at the present time. Which of the following would be mostappropriate after controlling the patient's airway and delivering high-flow oxygen therapy?

Start an intravenous line, draw blood samples, and administer one amp of dextrose 50 percent (D50)

You have intubated a 5-week-old infant in respiratory arrest. During ventilation, the infant becomes blue and his pulse rate drops into the lower 50s. You should immediately?

Start chest compressions

You are transporting an 80 yof to the hospital and are preparing to call in your radio report. Which of the following is an example of a practice that will maximize the receiving facility's ability to understand your transmission?

State the patient's age as 80, that is eight-zero

You are transporting a 20-year-old pregnant female from a local hospital to a medical facility that specializes in high-risk pregnancies when you note the patient is experiencing unexplained hypotension and bradycardia. The patient has a patent IV and is being administered magnesium that was initiated by hospital staff. On the cardiac monitor, the patient presents with a lengthening PR interval and signs of an impending high-degree nodal block. Which of the following interventions would be mostappropriate in this case?

Stop the magnesium sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity

You are preparing to initiate rapid sequence intubation on a pediatric patient who is exhibiting a borderline hypotensive state. Which medication would be indicated as the first paralytic given, following sedation of the patient for the procedure?

Succinylcholine

While responding to a call for a patient who is in cardiac arrest, you approach an intersection in which you have a red light. What is the MOST appropriate action for the ambulance operator to take?

Stop to look for oncoming traffic, and then proceed cautiously.

When writing a patient care report using the SOAP format to organize the data, in which section would the paramedic want to include any statements made by the family or bystanders concerning the patient?

Subjective data section

A patient undergoing dialysis has suffered a stroke and requires rapid sequence intubation (RSI) to ensure a definitive airway. Which one of the following medications would be contraindicated prior to or during the intubation of this patient?

Succinylcholine

You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation?

Supine hypotension

The pneumatic antishock garment (PASG) is thought to be effective in assisting with the prehospital treatment of hypovolemic shock in some cases. Which of the following would be the best indication for the use of PASG in the treatment of a prehospital trauma patient?

Suspected pelvic fracture with a blood pressure of 80 mmHg while there are no other potential injuries and no past medical history

Many pharmacological terms are used synonymously. Which one of the following pharmacological terms does NOT mean inhibition of the parasympathetic nervous system?

Sympatholytic

Your 50-year-old patient is complaining of substernal chest pain that she rates at eight on the pain scale. She has a cardiac history and presents with paroxysmal supraventricular tachycardia. Her heart rate is 168 beats per minute, and she is hypotensive with a blood pressure of 90 systolic. Which of the following interventions would be mostappropriate in this case?

Synchronized cardioversion

COPD patients may present with electrocardiogram changes due to the chronic hypoxemia. Which of the following EKG changes would you expect to see in an end-stage COPD patient with right atrial enlargement?

Tall, peaked P-waves

You are transporting a woman with diabetes who was initially unresponsive but improved after the administration of 50% dextrose. The patient is now repeatedly asking you what happened. How should you respond to her question>

Tell the patient what happened each time she asks

You are assessing a 56-year-old male patient who is acting "weird" according to his friends. They were out mountain biking together when he quickly became altered. His friends deny any traumatic injury. Your patient is unable to provide any information to your assessment. Which of these vitals signs should be acquired last (due to least importance)?

Temperature

Your patient is a 24-year-old male who was struck by a vehicle on a 30 mph road. He is alert and complaining that "he can't breathe." His respiratory rate is very rapid and labored, he has no radial pulse, and his skin is cool, pale, and diaphoretic. As you expose the patient you notice his jugular veins are distended. Upon examination of his chest you notice significant bruising on his left chest wall and feel subcutaneous air near his neck and clavicle. Lung sounds on the right side are clear in the upper and lower fields, while lung sounds on the left side are diminished in the upper field and absent in the lower field. Which life threat must be addressed before you manage secondary injuries?

Tension Pneumothorax

Which one of the following injuries is most likely to produce unilateral changes in breath sounds?

Tension pneumothorax

You are assessing a 23-year-old male with difficulty breathing after a motor vehicle collision. He indicates that it's getting harder and harder to breathe, and appears to be increasingly anxious. Vitals: BP - 90/62, P 124, R 20, SpO2 93%, CBG 72, Lungs - absent on the left side. What do you suspect is occurring with this patient?

Tension pneumothorax

You are treating a 38-year-old male who was the driver of a small SUV that impacted a full-sized truck head-on. First responders have your patient secured to a long spine board with c-collar in place. Your patient is anxious and complaining of difficulty breathing. There is notable bruising to the right chest. Vital signs are BP 148/99, HR 138, RR 28, shallow. Which of the following is your patient most likelysuffering from?

Tension pneumothorax

which of the following injuries would MOST likely cause obstructive shock

Tension pneumothorax

Your patient has a return of spontaneous circulation after being successfully defibrillated while in pulseless ventricular fibrillation. The patient has a heart rate of 50 beats per minute and is breathing 12 times per minute on his own but remains unresponsive. According to the American Heart Association, at what level should the patient's serum glucose level be maintained in the field?

The AHA guidelines do not recommend any specific target range of glucose management in adult patients with ROSC after cardiac arrest

A trauma patient is being transferred from one facility to another. The patient is intubated and is on a mechanical transport ventilator. During transport, the high-pressure alarm sounds on the ventilator. Which of the following would MOST likely cause this?

The ET tube is in the right mainstem bronchus

a trauma patient is being transferred from on facility to another. The patient is intubated and is on a mechanical transport ventilator. During transport, the high pressure alarm sounds on the ventilator. Which of the following would MOST likely cause this

The ET tube is in the right mainstem bronchus

Your adult patient is hypoxic and struggling to breathe. What can be said about the patient's partial pressure of oxygen?

The PaO2 is likely below 80 mmHg

Narrowing of the blood vessels causing ischemia of myocardial tissue in times of high oxygen demand would best be described as:

angina pectoris.

If an adult patient is experiencing the signs and symptoms of a myocardial infarction with perfusing arrhythmias, which of the following pre-hospital interventions will help to reduce the patient's cardiac preload and afterload?

The administration of sublingual nitroglycerin therapy

What can the paramedic expect to occur if a diabetic patient has an elevated blood glucose level due to his inability to produce insulin?

The body will burn fat as energy, leaving fatty acids behind to cause ketoacidosis due to the body's inability to use the available glucose for energy

A dissecting aortic aneurysm patient is most likely to present with bradycardia that is not necessarily related to the blood loss. Why is this the case?

The dissecting aneurysm causes vagal stimulation

While stopped at an intersection, a 47-year-old driver and 43-year-old passenger were involved in a T-bone type motor-vehicle collision. The second car struck your patients' vehicle at a low rate of speed. Using the study of the kinematics of trauma, which vehicle assessment item would lead the paramedic to suspect a liver injury in a patient?

The driver was restrained and damage occurred to the driver's side door.

On the electrocardiogram, a normal P-R interval is considered 0.12 to 0.20 seconds. What can the paramedic determine from evaluating a P-R interval within four small boxes on the graph paper?

The electrical impulse has been successfully conducted through the atria, AV node, and the bundle of His without conduction delay or abnormality

The family members of a patient sue a paramedic driver for negligence after he crashed the ambulance into a parked car after running a red light. At the time, EMTs were performing CPR on the patient being transported. The patient subsequently died at the hospital. The paramedic is found not guilty. Why?

The family could not prove the death was caused by the crash

Why should the paramedic apply high-flow oxygen to a pregnant trauma patient, who appears to be clinically stable despite mild tachycardia and tachypnea?

The fetus is deprived from blood flow and oxygen as the mother's body compensates for any bodily disruptions

Your trauma patient was struck in the face accidentally by a large piece of concrete while at work. He has a large laceration on his lower jaw with bleeding controlled on your arrival. The patient is ambulatory on-scene but complains of not being able to open his mouth properly and dysphagia. What is the term "dysphagia" used to describe?

The inability to swallow appropriately

What is the most likely cause of cardiac-related pulmonary edema?

The left ventricle of the heart has lost its ability to be an effective forward pump, allowing fluid to back up and leave the vascular system

You are on-scene with an adult patient exhibiting unusual activity and appears to be intoxicated. He is anxious and hyperactive. His heart rate and respirations are fast, but his blood pressure remains within normal range for his age. The patient denies alcohol or drug consumption but reports he has diabetes. His blood glucose level is found to be 54 milligrams per deciliter. How would hypoglycemia cause the patient to present with the above findings?

The low blood sugar levels stimulate the sympathetic nervous system to trigger the release of epinephrine into the bloodstream to promote liver glycogenolysis

You are called to assist an adult female with a possible allergic reaction. You arrive to find a 22-year-old patient who is just beginning to have difficulty breathing. She has itching, urticaria, and hives after a bee-sting. During the possible allergic reaction, what is occurring at the cellular level?

The mast cells have degranulated, releasing serotonin and histamines into the general circulation

You are the first unit to arrive on the scene of a train accident where two trains crossed paths and one struck the other. One train carries passengers while the other carries an industrial solvent of some type. On-scene, you attempt to identify the chemical involved from a good distance upwind from the accident with binoculars. You note the placard on the cargo car identifies it as a Class 4, division 4.3 hazardous material. What does this tell you about the material involved?

The material involved becomes dangerous when it gets wet

Lidocaine, a medication that dissolves in fat, is given to an elderly patient. How will the physiological effects of aging impact the dosing of this medication?

The medication will stay in the body longer because of higher body fat levels.

Which of the following findings would lead the paramedic to suspect pericarditis when assessing a 40-year-old male with chest pain and no cardiac history?

The pain decreases when the patient sits forward

Which of the following assessment findings should alert the paramedic that a patient with a closed lower extremity fracture is developing compartment syndrome?

The pain is greater than one would expect for the injury

A paramedic's radio call to the receiving hospital includes the following line: "The patient is eupneic and has S1, S2, and S3 sounds present." What does this statement indicate?

The patient has respirations and abnormal cardiac findings.

Which information given by the patient being transported for cardiac catheterization will help the paramedic confirm the diagnosis of chronic stable angina?

The patient indicates that the pain is resolved after taking one sublingual nitroglycerin.

Your adult patient has sustained a blunt force, closed head injury while playing football at a family reunion. Which of the following symptoms leads you to believe the patient is suffering from an epidural hematoma?

The patient lost consciousness immediately following the injury, but regained consciousness quickly. He lost consciousness again just prior to calling 911.

Which one of the statements listed below best documents the mental status of a patient experiencing a hemorrhagic cerebrovascular accident (CVA)?

The patient responds to painful stimuli with purposeful motion.

You are completing your patient care report (PCR) after caring for a middle-aged woman who experienced a syncopal episode. Which of the following items is a pertinent negative and should be documented on the PCR?

The patient stated that she does not have a cardiac history.

You are on-scene with an adult patient who is hypoglycemic with a current blood glucose level of 60 mg/dL. However, he is conscious, alert, and refusing EMS treatment. Although the patient is compensating well for the low blood sugar level, what can you expect to occur if his blood sugar levels continue to fall?

The patient will appear intoxicated and develop cold, clammy skin

When a patient is deceased, who must give the final consent for organ tissue donation?

The patient's next of kin

Your adult trauma patient is showing the signs and symptoms of shock following a closed-head injury, but you are unsure if the shock state is due to a neurological or hemorrhagic problem. Which of the following findings should lead you to believe the patient may be experiencing neurogenic instead of hemorrhagic shock?

The patient's skin remains warm and dry

Which of the following scene size-up findings is MOST indicative of an unsafe environment when approaching a residence?

The sound of breaking glass coming from the residence.

The statements listed below are about the operation of emergency lights and sirens. For the EMS provider, which one is least accurate?

The use of lights and sirens provides civil immunity in the event of a collision.

Which of the following statements regarding Cheyne-Stokes respirations is correct?

They are not considered ominous unless grossly exaggerated or in the context of a traumatic brain injury.

You suspect an unconscious adult patient may be intoxicated or a chronic alcoholic. He is found to have a blood glucose level of 60 milligrams per deciliter. Which of the following interventions would be indicated first?

Thiamine

You are on scene with a patient in need of rapid extrication from an unstable vehicle. How many rescuers must be involved in order for the procedure to be safely carried out?

Three trained rescuers must be present to safely perform rapid extrication

Your assessment of a patient reveals a diffuse petechial rash. Which of the following hematologic disorders does this indicate?

Thrombocytopenia

What is the most important reason to only perform chest compression at 100-120 compressions per minute in an adult cardiac arrest patient?

To allow for proper time for the heart chambers to refill with blood to provide adequate perfusion

You are on the scene of a vehicle accident with entrapment. Why is it so important to ensure the battery has been disconnected before attempting to enter the vehicle or extricate the driver?

To ensure any undeployed airbags do not discharge and cause an injury to the patient or anyone involved

Which of the following would be your mostappropriate action after the administration of 1mg of atropine fails to increase the heart rate of your symptomatic bradycardic patient's heart rate and cardiac output?

Transcutaneous pacing (TCP)

Concerning triage of patients, which one of the following statements is true?

Triage should be an initial, efficient system of sorting patients by acuity, and does not preclude additional assessments.

Prehospital treatment for cutaneous exposure to hydrofluoric acid includes:

antacid preparations, such as Mylanta or Maalox.

You are first to arrive on scene for a motor-vehicle collision (MVC). When you reach the vehicle, what should be your first action?

Turn off the ignition, if the engine is still running.

Which of the following stages of shock is responsible for the development of a decreased systolic and diastolic blood pressure?

Uncompensated shock

While orienting a new paramedic to your EMS system, you cover radio communications, including when to notify dispatch of ambulance and EMS crew operations. Of the following, which instance would EMS advisement to dispatch most likely NOT be warranted?

Upon giving a medication

Your patient is suffering from hypotension that you suspect is due to a lower GI bleed due to the signs, symptoms, and your patient interview. Per MCP, you are ordered to administer one liter of lactated Ringer's (LR) solution as rapidly, yet safely as possible. You have a single large bore (16g) saline lock established and are preparing the IV delivery set. Which of the following would help you accomplish the order best?

Use short macro-drip tubing, ensure the fluid is warm, and pressurize the IV delivery system between 100-200 mmHg maximum

you have copious amounts of secretions noted in the lower airway of your intubated patient, making ventilation ineffective. Which would be the mostappropriate action to clear the secretions?

Using a sterile technique, insert the suction catheter and apply suction while withdrawing the catheter with a rotating or twisting motion

You are assisting a full-term pregnant patient in the delivery of her newborn at home. However, once the baby's head delivers and turns to accommodate the shoulders, the next few contractions fail to produce the newborn's shoulder. In this case, what should you do next?

Using gentle pressure, guide the infant's head downward to facilitate the anterior shoulder and then upward to release the posterior shoulder

You are preparing to perform a 12-lead electrocardiogram on your 55-year-old cardiac history patient who presented today with substernal chest pain and shortness of breath. When placing the electrodes on the patient's chest, where should the electrodes be placed for V1 and V2?

V1 is placed in the 4th intercostal space just to the right of the sternum while V2 is located in the same intercostal space just to the left of the sternum

The paramedic is ventilating an unresponsive intubated patient and can clearly see her chest rise with each ventilation. His partner reports that the patient's blood pressure has decreased from 130/80 mm Hg to 90/60 mm Hg. Which of the following would BEST explain this?

Ventilations are being delivered too quickly or with too much volume

You are attempting to resuscitate a 50 yom in cardiac arrest. the patient has a history of chf, hypertension, and cirrhosis of the liver. the cardiac monitor reveals a slow. wide complex rhythm. CPR is ongoing and the patient has been intubated. in addition to looking for potentially reversible causes of the patient's condition, futher treatment should include

Ventilations at a rate of 10 breaths. min and 1 mg of epinephrine 1:10000 every 3-5 min

EMS communication over open airways is normally conducted through two-way radios of varying frequencies and controlled by the FCC. Of the frequency bands listed below, which one is strictly assigned to two-way communication or one-way paging, operating in the simplex mode?

Very High Frequency (VHF), low and high bands between 32-170 MHz

Which of the following is an obvious clinical indicator of decompensated shock in an infant?

Weak brachial pulses

You are completing your patient care report on a patient who called EMS for shortness of breath. The patient stated that she felt weak. She had cyanosis to her nail beds, diffuse rhonchi in all lung fields, and an oxygen saturation of 89%. Which of these findings should be documented in the "history of present illness" section of your narrative?

Weakness

Paramedics are caring for a child who is allergic to bees and was stung. He is having trouble breathing. If left untreated, this child will likely die from:

asphyxia.

A patient suffering from an ST-elevation myocardial infarction or a presumably new-onset left bundle branch block may benefit from the use of fibrinolytic therapy if the agent is given promptly. How long does a patient have to receive the first fibrinolytic agent to salvage ischemic heart tissue?

Within 12 hours of symptoms onset

Your adult patient sustained a right index finger amputation at work. On arrival, first responders have the bleeding controlled with sterile dressings, and the patient is conscious, alert, and oriented. What is the best way to manage the patient's amputated finger during transport to the hospital?

Wrap the finger in gauze (moistened with normal saline), and seal the finger in a plastic bag before placing it on ice

You are caring for a 44-year-old female who experienced a closed head injury. She is responsive only to pain, has a respiratory rate of 8 breaths/min and irregular, a pulse of 120 beats/min and weak, and a blood pressure of 80/50 mm Hg. Which of the following statements regarding this patient is MOST correct?

You should intubate the patient and give IV fluid boluses to maintain a systolic blood pressure of at least 90 mm Hg.

A 30-year-old female is found unresponsive by her roommate. According to the roommate, the patient, who has type I diabetes, was fine 30 minutes ago. On assessment, the patient has rapid, shallow respirations; pallor and diaphoresis; and a weak, thready pulse. Additional assessment of this patient will MOST likely reveal:

a blood glucose level less than 70 mg/dL.

A 52-year-old man has a headache and visual disturbances that have progressively worsened over the past 3 months. These symptoms are MOST consistent with:

a cerebral neoplasm

During your assessment of a patient with a closed head injury, you note the presence of a pinkish fluid draining from the nose. This is MOST indicative of:

a cribriform plate fracture.

Which of the following assessment findings is MOST indicative of peritoneal irritation?

a decrease in pain when drawing the knees into the abdomen

If a small child accidentally pulled a pot of boiling water off of the stovetop, you would MOST likely encounter:

a downward splash pattern of superficial and partial-thickness burns to the anterior aspect of the body.

Which of the following conditions would a woman MOST likely develop if she does not take prenatal vitamins throughout her pregnancy?

anemia

You and your team have been attempting to resuscitate a 68-year-old male in cardiac arrest for the past 20 minutes. The patient's initial cardiac rhythm was asystole, which has remained unchanged despite four doses of epinephrine, high-quality CPR, proper airway management, and a thorough assessment for potentially reversible causes. The patient's wife tells you that her husband does not have a living will. You should:

advise the wife that her husband is dead and that further resuscitative efforts will not change the outcome.

Which of the following actions demonstrates a paramedic's knowledge of crime scene preservation

advising a law enforcement officer after moving a coffee table to access a critically injured patient

a 60 yom with chronic alcoholism oresents with an acute onset of hematemesis. His blood pressure is 80/40 mm, pulse is 130 beats and weak, and respirations are 28 breaths and shallow. what pathophysiologic process is MOST likely respinsible for his condition

abnormally enlarge esophageal veins secondary to impaired clood flow to the liver

While attempting to intubate a 30-kg child, you note that his heart rate has dropped to 50 beats/min and his oxygen saturation is 75%. You should:

abort the intubation attempt and ventilate with a bag-valve-mask device.

A 39-year-old female, who is 35 weeks pregnant, presents with acute abdominal pain, irregular contractions, and vaginal bleeding. She is confused, her blood pressure is 70/48 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and shallow. Her abdomen is tender to palpation and her uterus feels rigid. She is MOST likely experiencing:

abruptio placenta.

A medication entering the bloodstream from a skin patch would be an example of:

absorption.

You are evaluating a regular cardiac rhythm in lead II. The rate is 90 beats/min, the QRS complexes consistently measure 0.16 seconds, and inverted P waves are seen immediately following each QRS complex. The rhythm described is MOST characteristic of a/an:

accelerated junctional rhythm with ventricular aberrancy.

A 40 yow who was recently discharged from the hospital reports a sudden onset of difficulty and sharp chest pain that increases with breathing. Her skin remains cyanotic and her oxygen saturation remains low, despite high flow oxygen. Which of the following is this patient MOST likely experencing

acute pulmonary embolism

a 49 yom complains of generalized weakness that began about a week ago. He is conscious and alert and is breathing adequately. His blood pressure is 138/78 , pulse is 130 beats and irregular and respirations are 14 breaths. You adminster supplemetal oxygen and apply the cardiac monitor, which reveals atrial fibrillation, a 12 lead ecg tracing reveals the same. The patient denies any significant medical problems and takes no medication. After establising Iv access, you should

administer 0.25 mg/kg of diltiazem and transported evaluation

When treating an adult patient with a blood pressure of 60/40 mm Hg, confusion, a heart rate of 40 beats/min, and sinus bradycardia on the cardiac monitor, you should administer supplemental oxygen, establish vascular access, and then:

administer 0.5 mg of atropine sulfate and consider transcutaneous cardiac pacing.

A 70-year-old male complains of palpitations and shows ventricular tachycardia on the monitor. He is AOX3 and his vitals are pulse 200, respiration 28, and blood pressure 96/70. The most appropriate treatment for this patient would be to:

administer 150 mg of amiodarone over 10 minutes.

A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side weakness. According to his daughter, he has high blood pressure and has had several "small strokes" over the past 6 months. Your partner applies supplemental oxygen; assesses his vital signs, which are stable; and assesses his blood glucose level, which reads 35 mg/dL. You attempt to perform the Cincinnati Prehospital Stroke test, but the patient is unable to understand your instructions. After establishing IV access, you should:

administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities, and transport.

A 20-kg child has been running a fever for the past 2 days. Today, he is lethargic and his skin is pale. His heart rate is 190 beats/min and his respiratory rate is 40 breaths/min. You should:

administer a 400 mL normal saline bolus.

Following delivery , a newborn has a thick dark green substance around it mouth. The newborn has a strong cry, peripheral cyanosis, and a pulse rate of 120 beats. You should

administer blow-by oxygen and continue your assessment

A 5-year-old child has been seizing continuously for the past 25 minutes. The paramedic should:

administer midazolam 0.1 mg/kg IM.

A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you should:

administer up to 325 mg of aspirin

All of the following are key components in the treatment of an adult patient who is experiencing respiratory distress with bronchospasm EXCEPT:

administering epinephrine, 0.3mg 1:1000 s.q. every 20 minutes as needed.

Assessment of a patient with acute respiratory distress reveals that he is conscious and alert, but wheezing on exhalatio. In addition to oxygen, management should include

administration of an inhaled beta-2 agonist medication

Your assessment of a 33-year-old man with generalized weakness and nausea reveals a blood glucose level of 39 mg/dL. The patient is conscious and alert to person, place, time, and event. As you are preparing the IV equipment and dextrose, the patient tells you that he will not allow you to start an IV on him or give him any drugs; he will only allow you to transport him to the hospital. You should:

advise him that if you don't give him glucose, his condition could potentially deteriorate and he could die.

You are assessing the 12-lead ECG of a man who presents with chest discomfort. The ECG reveals a normal sinus rhythm without evidence of ischemia, injury, or infarct. The patient tells you that he saw his cardiologist 2 weeks ago, was told that he had a heart attack in the past, and then asks you if you agree. You should:

advise the patient that he should seek consultation from his cardiologist.

A 65-year-old man has crushing chest pain that persists after taking three of his nitroglycerin tablets. He is conscious and alert to person, place, time, and event. You assess his vital signs and find him to be significantly hypertensive. As your partner is preparing the stretcher, the patient tells you that he does not want to go to the hospital. After multiple attempts to convince the patient to allow you to transport him, he still refuses. You should:

advise the patient that his refusal could ultimately result in death.

After delivering an 80-year-old female to the emergency department, you give your verbal report to the attending physician. As you are completing your patient care report, you hear the patient give the physician information that is vastly different from what she told you. You should:

advise the physician of the information that the patient gave to you and consider the possibility that she is confused due to a significant underlying problem.

Which of the following medications is used to sedate a patient prior to performing orotracheal intubation?

amidate

A 33-year-old female was stung by a wasp 45 minutes ago. She is conscious and alert, and presents with diffuse urticaria. She denies chest tightness or difficulty breathing. Her breath sounds are clear and equal bilaterally. Her BP is 134/82 mm Hg, pulse is 88 beats/min and strong, respirations are 16 breaths/min and unlabored, and her SpO2 is 97% on room air. Treatment for her should include:

an IV of normal saline at 25 mL/hr and 25 mg diphenhydramine.

a 78 yof experienced a syncopal episode. She is now conscious, but complains of dizziness and generalized weakness, and her pulse is 150 beats and irregular. The paramedic should recognized that this patient's syncope was MOST likely the result of

an acute cardiac dysthythmia

Multiple sclerosis is a disease caused by:

an autoimmune disorder in which the body attacks the myelin sheath of the neurons in the brain and spinal cord.

Rheumatoid arthritis is caused by:

an autoimmune disorder.

The MOST significant complication associated with an open book pelvic fracture is

an increase in pelvic volume with more internal blood loss than pelvic fractures caused by lateral compression

A 72-year-old male presents with an acute onset of confusion, slurred speech, and decreased movement of his right arm. The patient's wife tells you that this began about 20 minutes ago, and that he was fine before that. He has type II diabetes, hypertension, and atrial fibrillation. Given this patient's clinical presentation and past medical history, you should be MOST suspicious that he has:

an occluded cerebral artery.

You are called to transport a patient from an urgent care clinic to the emergency department. When reviewing the lab results from the clinic you note that the patient's thyroid stimulating hormone level is very high. this indicates

an underactive thyroid

Which of the following conditions would a woman MOST likely develop if she does not take prenatal vitamins throughout her pregnancy

anemia

One drug interfering with the action of another drug is referred to as:

antagonism.

A patient presents with permanent loss of motor function, pain sensation, and light-touch sensation to the lower extremities following a diving accident; however, he continues to be able to sense motion, position, and vibration. He likely is suffering from:

anterior cord syndrome.

You are assessing a 50-year-old man with acute chest pressure, diaphoresis, and nausea. The 12-lead ECG tracing reveals 3-mm ST segment elevation in leads V3 through V6. This indicates:

anterolateral injury.

A patient has repetitive motions of the mouth, including lip smacking and chewing. The physician suspects that these assessment findings indicate tardive dyskinesia. Paramedics should question the patient about:

antipsychotic drug use.

Jugular vein distension (JVD) in a trauma patient may typically suggest all of the following EXCEPT:

aortic dissection.

While transporting a man with severe respiratory distress, he pulls the oxygen mask from his face and frantically attempts to get off of the stretcher. You should:

apply a nasal cannula and try to calm the patient.

An older woman presents with respiratory distress. She is conscious and alert and is able to answer your questions with slight difficulty. Her respirations are 24 breaths/min and labored and her oxygen saturation is 89%. Further assessment reveals slight cyanosis around her mouth. You should:

apply a nonrebreathing mask at 15 L/min.

You are treating a young male with an arterial hemorrhage from a large laceration to his inner arm. Despite direct pressure with a sterile dressing, the wound continues to bleed heavily. You should:

apply a proximal tourniquet until the bleeding stops.

Paramedics preparing to transfer a ventilator-dependent patient on 100% oxygen from his bed to the stretcher accidently displace his tracheostomy tube. The tube falls to the floor and is no longer usable. In the short term, all of the following devices and action are acceptable EXCEPT:

apply an occlusive dressing to the stomal opening and then a nonrebreather.

a woman was involved in a motor vehicle crash and is still in her car. she is conscious but restless and is breathing rapidly. there is a large volume of blood coming from her groin area, you should

apply direct pressure to the wound

You respond to a residence for an overdose. While en route, the dispatcher advises you that CPR is in progress. A second paramedic unit is dispatched, but their response to the scene will be delayed. When you arrive at the scene, an emergency medical responder is performing CPR on the patienr, a 30 yom, who apparently ingested an unknown quantity of Darvon. After confirming apnea and pulselessness, you should direct resumption of CPR and then

apply the ECG electrodes and assess the patient's cardiac rhythm

A newborn's mouth and nose are initially suctioned:

as soon as the head delivers, but before the next contraction.

You are caring for a middle-aged female with acute chest pain. She is conscious and alert to person, place, time, and event. You have administered aspirin and obtained a 12-lead ECG tracing. As your partner is retrieving the ambulance stretcher, she states that she does not want to be transported by EMS and would prefer that her husband take her to the hospital. You should:

ask her why she does not want to be transported by EMS.

you and your partner arrive at the scene of a motorcycle crash. You find the patient lying supine approximately 30 feet from his bike. As you approach him, you can see that he has bilaterally closed femur fractures and multipe abrasions and lacertions to his arms and legs. Bystanders removed his helmet prior to your arrival. You should

ask your partner to stabilize the patient's head as you assess his airway.

A 27 year old female overdosed on an unknown type of drug, her skin is hot and flushed and her breathing is rapid and deep. her bp is 98/64 mm and her heart rate is 120 beats. Which of the following drugs would MOST likely explain her clinical presentation

aspirin

Your cardiac patient has an unstable angina history and is suspected of experiencing an ischemic event. He presents with chest pain, cool and clammy skin, and diaphoresis. If the event is being caused by unstable angina pectoris, which medication may be used to prevent an increase in the size of a thrombus if one is present?

aspirin

You are triaging first-grade students at a school bus crash and encounter a small child who is unresponsive and apneic. After opening the child's airway, he remains apneic. You should:

assess for a palpable pulse.

A 60-year-old female presents with acute respiratory distress. The patient has a tracheostomy tube in place, but is able to breathe spontaneously. She is conscious, but restless. Her heart rate is 120 beats/min and her oxygen saturation is 82%. You should:

assess for secretions in the tracheostomy tube and suction the tube if needed.

Immediately after establishing a return of spontaneous circulation in a woman with ventricular fibrillation of short duration, you should:

assess her ventilatory status and treat accordingly.

You are called to a local supermarket where a customer collapsed. When you arrive, two bystanders are performing CPR on the patient. You should:

assess the patient to confirm pulselessness and apnea.

A 3-year-old girl is experiencing respiratory distress following an upper respiratory infection. Assessment reveals that she is listless and pale, and she has a pulse rate of 70 beats/min. You should:

assist her ventilations with a bag-valve-mask device.

A 6-year-old male fell from a second-story balcony and struck his head on a concrete sidewalk. He is unresponsive; has slow, irregular respirations; and has a slow pulse. Your rapid assessment reveals a fixed and dilated left pupil and a large hematoma to the right side of his head. His blood pressure is 138/88 mm Hg. You should:

assist his ventilations, establish vascular access at a keep vein open rate, intubate him, and guide your ventilations by capnography.

During your rapid assessment of a semiconscious man who sustained blunt trauma to the anterior chest, you note paradoxical movement to the left hemithorax. you should

assist the patient's ventilations with a bag-valve-mask deivce

a 23 yom is found unresponsive, According to a friend the patient had a headache and said that he was going to take a nap. his breathing is rapid and shallow, his pulse is rapid and weak, and he is profusely diaphoretic. which of the following represents the MOST appropriate treatment for this patient

assist ventilations with a bag valve mask device, assess his blood glucose level, apply the cardiac monitor, obtain vital sighs and establish vascular access

a 23 yom is found unresponsive. According to a friend, the patient had a headache and said that he was going to take a nap. His breathing is rapid and shallow his pulse is rapid and weak, and he is profusely diaphoretic. Which of the following represents the MOST appropriate treatment for this patient

assist ventilations with a bag-valve-mask device, assess his blood glucose level, apply the cardiac monitor, obtain vital signs, and establish vascular access.

a 34 yof overdosed on amitriptyline. She is unresponsive and slow, shallow breathing, Her BP is 70/40 and her heart rate is 140 beats. The cardiac monitor reveals sinus tachycardia. Initial treatment for her should include

assisted ventilation with a bag-value-mask and 20 mL/kg normal saline boluses

A COPD patient presents with severe respiratory distress; cyanosis to the face, neck, and chest; a decreased level of consciousness; and a heart rate of 160 beats/min. The MOST appropriate treatment for this patient includes:

assisted ventilation with a bag-valve-mask device.

Common signs of a maxillofacial fracture include all of the following, EXCEPT:

asymmetric pupils.

You receive a call for and 18 month old female who is not breathing. when you arrive at the scene, emergency medical responders are providing effective two rescuer CPR. According tot he child's father she had a cough and runny nose for the past several days, but when he tried to wake her up from her nap, she was unresponsive. when you apply the cardiac monitor you will MOST likely see

asystole

A paramedic is assisting a life guard in performing CPR on a drowning victim at the community swimming pool. In addition to decreasing the risk of transmitting infection, the bag-valve-mask (BVM) device is preferred over the pocket face mask because:

at room air, the BVM can deliver a higher percentage of oxygen than the pocket face mask.

The ECG you have attached to your 66-year-old male patient shows a narrow complex, regular tachycardia with what looks like a sawtooth pattern before the QRS complexes instead of p-waves. This rhythm would most likely be:

atrial flutter.

When moving a patient from a house without a carrying device, you should:

avoid twisting when moving around a corner.

When an adult is struck by an automobile, a typical sequence of events includes the person turning:

away from the vehicle and being thrown onto the hood.

In differentiating between a cluster headache and a migraine headache, the paramedic recognizes that:

cluster headaches occur primarily in males.

You are treating a patient with suspected cardiac chest pain and elect to start an IV line; however, you did not advise the patient of this in advance. As a result, you could be held liable for:

battery.

You and your partner arrive at a residence for a patient with shortness of breath. As you enter the residence, you find the patient, an elderly male, sitting in a recliner in his living room. He is agitated, diaphoretic, and in obvious respiratory distress. As he is rudely commenting about your lengthy response time, you see a handgun on a table next to his recliner. You should:

back your way out of the residence and request law enforcement assistance.

You respond to a daycare center for a 2-year-old female who is having a seizure. Upon arrival, you find the child lying in a bed. She is no longer seizing, but her level of alertness is decreased. Her skin is hot to the touch and she is tachypneic and tachycardic. According to a daycare center employee, she picked up the child after the seizure stopped, but the child began crying uncontrollably. You should suspect that this child has:

bacterial meningitis.

Which of the following is the MOST appropriate and effective method of oxygenating a semiconscious patient with slow, shallow breathing?

bag-valve-mask device

An incident command system has been established at the scene of a building explosion in which there are approximately 30 casualties. According to the incident commander, there is no evidence of any hazardous materials or chemicals. As victims are removed from the building, they should:

be taken to the triage area, which should be a safe distance from the building.

Upon arriving at the residence of an unresponsive patient, you find a middle-aged male lying on the couch. He is unresponsive, apneic, and pulseless. His wife tells you that she does not want you to attempt resuscitation, and further states that he has high blood pressure. The patient's skin is warm and there is no evidence of lividity. You should:

begin CPR, apply the ECG electrodes, ask her if he has a living will, and contact medical control for guidance.

A middle-aged man is found unresponsive, pulseless, and apneic. His cardiac arrest was not witnessed, although his skin is still warm to the touch. You should:

begin immediate high-quality CPR.

A 60-year-old female presents with confusion, shortness of breath, and diaphoresis. Her blood pressure is 70/40 mm Hg and her heart rate is 40 beats/min. The cardiac monitor reveals a slow, wide complex rhythm with dissociated P waves. After applying supplemental oxygen, you should:

begin immediate transcutaneous pacing.

A 19-year-old male experienced a syncopal episode after several hours of vigorous exercise in the heat. Upon arrival at the scene, bystanders direct you to the patient, who they moved under a tree. The patient moans in response to painful stimuli, and his skin is flushed, hot, and moist. After ensuring airway and breathing adequacy, your MOST immediate action should be to:

begin rapid cooling measures.

a 54 yom presents with chest pressure, confusion, and profuse diaphoresis. As your partner administers supplemental oxygen, you apply the cardiac monitor. In lead II, you observe a wide QRS complex rhythm with dissociated P waves and a ventricular rate of 35 beats. You should

begin trnscutaneous pacing at once

When arriving at the scene of a chemical plant explosion with injuries, the incident commander should ask a plant representative to present a/an:

bill of lading (freight bill).

You are dispatched to a truck stop for a 35-year-old female, reportedly acting very unusually in the restaurant, causing the staff to call 911. The police have called your EMS unit for consultation. The woman tells you that she does not know where she is, appears disheveled, and says she has not slept in three days. She is talking rapidly and appears somewhat agitated. While you are completing her blood sugar, one of the police officers brings in a pill bottle with the medication Eskalith. This patient likely has a history of:

bipolar disorder.

After you deliver an abdominal trauma patient to the emergency department, the physician rapidly performs a FAST exam, and announces there is blood in Morison's pouch. This refers to:

blood accumulation in the upper dependent abdomen

A patient develops descending paralysis and coma after eating a home canned tomato sauce. Paramedics suspect ingestion of the _____ toxin.

botulin

You are caring for a patient with an open fracture of the forearm in which the bone is protruding from the wound. The MOST appropriate care for this type of injury includes:

brushing away any obvious debris on the skin surface before applying a dressing

after completing an assessment of a patient with a blunt chest injury, the paramedic tells her partner that she suspects a pericadial tamponade. Which of the following did the paramedic MOST likely encounter during her assessment

chest wall crepitation

Diarrhea, marked bradycardia, miosis, and hypersalivation are MOST consistent with a/an _____________ toxidrome.

cholinergic

General assessment and treatment guidelines for a patient with a large avulsion injury include all of the following, EXCEPT:

cleaning the wound with betadine solution.

Upon delivery of an infant's head, you note that its face is encased in the amniotic sac and a nuchal cord is present. You should:

clear the membrane away from the infant's face and attempt to slip the cord from around the neck.

You are treating a victim of cardiac arrest with an AED at the local mall. Pending ambulance arrival, you attach the AED and push the analyze button. The AED has charged and gives the shock indicated message. Your next step should be:

clear the patient.

You are called to the residence of an elderly man whose daughter states that he is not acting right. The patinet becomes combative when you attempt to assess him. He refuses supplemental oxygen and states that your are not taking him anywhere. What is the MOST appropriate course of action

calmly talk to him and try to obtain a glucose reading

Epinephrine is useful in cardiac arrest because it:

can improve coronary artery perfusion pressure and can stimulate spontaneous contractions when asystole is present.

A man was trapped in his burning house for approximately 20 minutes before being rescued by firefighters. Assuming that he was exposed to carbon monoxide (CO), cyanide, or both, it is important for the paramedic to remember that:

carbon monoxide and cyanide are chemical asphyxiants that displace oxygen and impair tissue oxygenation.

When administering a sympathomimetic medication, you must be alert for

cardiac dysrhythmias

You are treating a 50-year-old male who ingested a significant amount of his prescribed propranolol. He is unresponsive, bradycardic, hypotensive, and has poor respiratory effort. In addition to assisting his ventilations, applying a cardiac monitor, and establishing vascular access, the MOST appropriate treatment for him includes:

cardiac pacing, glucagon, and a vasopressor.

A 56-year-old man has had chest pain for the past 2 days, but refused to go to the hospital. His wife called EMS when she noticed that he was not acting right. He is conscious, but confused, and is diaphoretic. His BP is 80/40 mm Hg and his pulse is rapid and weak. The patient's history and your assessment findings are MOST consistent with:

cardiogenic hypoperfusion.

The leading cause of death in the elderly population is:

cardiovascular disease.

A patient has pinpoint pupils likely caused by a morphine overdose. The cause of the pupil change is that morphine:

causes parasympathetic stimulation, which results in constriction

Paramedics are using the Cincinnati Stroke Assessment tool and identify an arm and hand drift as part of the assessment. This test assesses pronator drift, a component of the:

cerebellum.

you have difibrillated a patient who presented with ventricular fibrillation. After 2 minutes of CPR, you reassess the patient's cardiac rhythm and see a wide-complex tachycardia. you should

check for a carotid pulse and defibrillate if a pulse is absent

You are responding to a call for an unconscious child. As you approach a four-way stop, you see a vehicle sitting at the stop sign to your right, and the driver of the vehicle is waving for you to proceed. You should:

come to a complete stop, look to the left, and cautiously proceed.

Upon returning to your station following a call in which an infant was killed in a motor-vehicle crash, your partner immediately goes into his dorm room, closes the door, and begins to cry. He will not let you open the door and tells that he just needs some time to himself. You should:

comply with his request and notify your supervisor.

A 19-year-old college football player sustains a head injury. Paramedics respond and assess the patient. They find the patient has had a brief loss of consciousness, has a vacant stare, is slow to respond verbally, has slurred speech, repeats comments frequently, and has difficulty focusing. Pupils are equal and reactive, and vital signs appear normal. The paramedics suspect:

concussion.

A 56-year-old man presents with the cardiac rhythm. He complains of chest discomfort, shortness of breath, and is profusely diaphoretic. His blood pressure is 84/64 mm Hg and his radial pulses are barely palpable. You should:

consider sedation and perform cardioversion.

A 70-year-old man presents with the cardiac rhythm shown below. He is confused, is slow to answer your questions, and is profusely diaphoretic. His blood pressure is 76/54 mm Hg, his pulse is rapid and weak, and his respirations are 22 breaths/min and labored. He is receiving high-flow oxygen and your partner has established a patent IV line. You should

consider sedation and then cardiovert with 100 joules.

Unlike a second-degree AV block type I, a second-degree AV block type II is characterized by:

consistent P-R intervals following conducted P waves.

Your EMS supervisor arrives at the scene of a motor-vehicle crash, assesses the patient, and requests air-medical transport. You and your partner are 6 minutes away from the scene. As the responding paramedic, you should:

contact the on-scene supervisor to inquire about the extent of injuries.

a 66 yom presents with labored breathing. He is conscious and alert; however he is tachypneic, and is experiencing difficulty speaking. He has a history of hypertension and congestive heart failure. Ausculation of his lungs reveals diffuse coarse crackles and his oxygen saturation is 86%. Which of the following interventions will be of MOST benefit to this patient?

continuous positive airway pressure

A slow onset of a low-grade fever and respiratory distress in a 3-year-old child is MOST characteristic of:

croup

When administering crystalloid solutions to a patient in hemorrhagic shock, it is important to remember that:

crystalloids do not increase the blood's oxygen-carrying capacity.

You are providing emergency care to a patient who has deep-tissue pain following skeletal trauma. As a paramedic, you may use both opioid and non-opioid drugs. Their combined effect is known as the:

cumulative effect.

a 49 yof complains of severe neck pain. her head is turned to the side and appears locked in that position. You also note that her eyes are clenched shut. she is conscious, but agitated. her husband tells you that she started taking lithium the day before after being diagnosed with bipolar disorder.Based on the patient's clinical presentation, which of the following medications would MOST likely be indicated

diphenhydramine

A middle-aged female with a history of hypertension presents with an acute onset of tearing abdominal pain. She is conscious and alert, but restless. Her BP is 86/56 mm Hg, pulse rate is 120 beats/min, and respirations are 28 breaths/min. The paramedic should:

determine if her femoral pulses are of equal strength.

Which of the following statements regarding physiologic dead space is correct

diffuse alveolar collapse increases the size of the physiologic dead space

a 49 yom is unresponsice and his skin is cool, diaphoretic, and pale. His wife states that he has diabetes and that he wears an insulin pump. His respirations are rapid and shallow and his blood glucose level reads 22mg/dL. The paramedic should

deactivate his insulin pump

You are dispatched to a residence for a 65-year-old female whose husband reports a change in her behavior over the past several days. He states that initially she seemed forgetful, but today she is confused. Your assessment reveals an obese patient who has slow respirations; cold, dry skin; a heart rate of 50 beats/min; and a blood pressure of 90/50 mm Hg. The patient's husband tells you that his wife does not have any medical problems that he is aware of, but remarks about her weight gain over the past few months. This patient's history and clinical presentation are MOST likely the result of:

decreased thyroid hormone production.

Which of the follwoing is an example of providing treatment based on standing orders

defibrillating a patient with pulseless V-tach, performing CPR, administering epinephrine and contactting medical control

If paramedics could initially take two pieces of equipment to the side of a patient in cardiac arrest, which of the following should they select?

defibrillator and suction device

A patient takes a medication that is enteric coated. The purpose of this coating is to:

delay breakdown of the medication until it gets into the duodenum.

A 50-year-old woman is pulseless and apneic. Your partner and an emergency medical responder are performing well-coordinated CPR. After 2 minutes of CPR, the cardiac monitor reveals coarse ventricular fibrillation. You should:

deliver a single shock and immediately resume CPR.

You are dispatched to a residence for a patient with respiratory distress. The patient, a 59-year-old female, has a tracheostomy tube in place and is ventilator dependent. She has marked respiratory distress, perioral cyanosis, and an oxygen saturation of 80%. You should:

disconnect her from the mechanical ventilator and provide manual positive-pressure ventilation.

The paramedic established an IV of normal saline on a 30-year-old female with abdominal pain. During transport, she begins complaining of severe chills, a backache, and nausea. Her skin becomes flushed and is abnormally warm to the touch. The paramedic should:

discontinue the IV fluid.

Controlling increasing intracranial pressure (ICP) in the prehospital setting is critical because if left uncorrected, increased ICP results in:

displaced brain tissue

You respond to a call for a 4 yog who has had a seizure. when you arrive, you find that the child is in her mothers arms and crying. Which of the following questions would be the MOST pertinent to ask the mother initially?

does the child have a history of seizures

You are preparing to transport a middle-aged male, who is likely experiencing a myocardial infarction, to the hospital. You will be using your lights and siren. The patient's wife, who is calm, tells you that she will follow the ambulance in her personal vehicle. You should advise her to:

drive at the posted speed limit, obey all traffic signals, and not try to keep up with the ambulance.

you are assessing a 21 yom who was stabbed in the left anterior chest. his blood pressure is 84/58 mm, pulse rate is 118 beats and weak, and respirations are 28 breaths and shallow. Further assessment reveals that he is profusely diaphoreticm had engorged jugular veins and bilaterally equal breath sounds. what additional clinical finding is MOST consistent with this patients injury

electrical alternans

You are treating a patient with ventricular fibrillation. As the defibrillator is charging, you should

ensure that CPR is continuing until the defibrillator is charged.

A patient is completely unresponsive after complaining to family members of severe headache, fever, and nausea for two days. Family members relate that the patient had been disoriented just prior to going unconscious. On physical exam, he has positive Kernig's and Brudzinski's signs. Blood glucose is 104, and vital signs are BP 104/60, P 63, R 14, and T 101deg F. Prehospital treatment should consist of:

ensuring respiratory and droplet isolation.

After determining that an elderly man is pulseless and apneic, you and your team begin CPR and briefly pause to assess his cardiac rhythm, which is shown below. After resuming CPR, you should:

establish vascular access and give 1 mg of epinephrine

A 65-year-old woman remains in asystole after 20 minutes of attempted resuscitation, including high-quality CPR, adequate airway management, appropriate drug therapy, and assessment for potentially reversible causes. The patient's husband and son are present and have observed your resuscitative efforts. At this point, it would be MOST appropriate to:

explain the situation to her husband and son and recommend cessation of resuscitative efforts.

Paramedics using the Cincinnati Prehospital Stroke Scale should assess:

facial droop, arm drift, and speech.

External bleeding would be the MOST difficult to control in a patient who has a laceration to the:

femoral artery and a blood pressure of 160/90 mm Hg.

Which of the following injuries would MOST likely results from a motorcycle striking a fixed object

femur fractures and head injury

A 6-month-old infant with bacterial meningitis would MOST likely present with:

fever, paradoxical irritability and poor feeding

a 41 year old man has a large open wound to his upper thigh that is bleeding profusely. You should immediately:

find his femoral artery with your finger and compress it against a solid structure.

Immediately following delivery, your patient is experiencing heavy vaginal bleeding. In an attempt to control the bleeding, you should:

firmly massage the fundus of her uterus.

The temperature at which a liquid fuel gives off sufficient vapors to cause a fire when an ignition source is present is called the:

flash point

During the delivery of a newborn's head, you note the presence of a nuchal cord. You should:

gently slip the cord over the newborn's head.

Law enforcement calls you to a nearby alley, where they found an unresponsive young female. One of the officers states that the patient is a known drug abuser. The patient has slow, shallow breathing; a slow, weak pulse; and bilaterally constricted pupils. As your partner begins assisting her ventilations, you apply the cardiac monitor, which reveals sinus bradycardia. After establishing vascular access, you should:

give 0.4 to 2 mg of naloxone.

You have just delivered an infant born at 37 weeks gestation. After drying and warming the infant, you assess him and note that his respirations are rapid and irregular, his pulse rate is 90 beats/min, and his face and trunk are cyanotic. you should

give positive-pressure ventilations for 39 seconds and then reassess the newborn

Paramedics are dispatched to a nursing home for an 80-year-old female who is running a fever. When they arrive, the nurse advises them that the patient's physician wants her to be taken to the hospital, and that her daughter is en route to the nursing home. The patient is conscious, alert, and oriented, and refuses to go to the hospital. In this case, consent to treat and transport this patient:

has not been obtained because the patient has decision-making capacity.

You are called to a local park where a 30 yom has collapsed. When you arrive , you find that the the patient is disoriented. His skin is hot and moist and his respirations are rapid and shallow. YOu should suspect

heatstroke

In contrast to the pneuomotaxic center of the medulla, the apneustic center:

influences the respiratory rate by increasing the number of inspirations per minute.

A 46-year-old woman was found unresponsive on her couch by a concerned neighbor. According to the neighbor, the patient uses heroin, but recently boasted that she has "been clean." The patient is unresponsive; has rapid, shallow breathing; and slow, weak radial pulses. You should:

insert an oral airway, assist her ventilations with a bag-valve-mask device, apply the cardiac monitor, consider transcutaneous pacing, and establish vascular access.

Initial management of an unresponsive 20-year-old patient with respirations of 14 breaths/min and adequate depth should include:

inserting an airway adjunct and administering supplemental oxygen.

You are assessing a 67-year-old female with chest discomfort when she becomes unresponsive, apneic, and pulseless. The cardiac monitor reveals coarse ventricular fibrillation. You achieve return of spontaneous circulation after 4 minutes and the cardiac monitor now reveals a narrow complex rhythm. The patient is still unresponsive, has occasional respirations, a blood pressure of 70/40 mm Hg, and a weak pulse of 70 beats/min. The MOST appropriate postresuscitation care for this patient includes:

insertion of an airway adjunct, assisted ventilation with a bag-valve-mask device, vascular access, a 500- to 1,000-mL crystalloid fluid bolus, and an amiodarone infusion at 1 mg/min.

The advantage to a central unified command is it:

integrates all responders into one system, and maximizes efficiency.

A trauma patient has signs of shock, but no external signs of injury. Which of the following should you suspect

intraabdominal hemorrhage

Neurological deficits secondary to an occlusive stroke are most likely caused by:

ischemia and injury of brain tissue.

After placing an endotracheal tube in a cardiac arrest patient, large amounts of vomitus immediately begin flowing out of the tube. You should:

leave the ET tube in place, fold it to the side so the vomitus can drain, and resume bag-mask ventilations.

an older man is suddenly awakened in the middle of the night, gasping for air. he is extremely restless an pale and is coughing up blood. his clinical presentation is MOST consistent with

left side heart failure

Which of the following patients would MOST likely benefit from air-medcial transport

man who fell 20 feet and cannot feel or move his legs

Following delivery of a newborn and the placenta, a 24-year-old female has continued vaginal bleeding. She is conscious and alert, is breathing adequately, and has a heart rate of 110 beats/min. As your partner places her on supplemental oxygen, you should:

massage the fundus of her uterus.

Common clinical signs of a hemothorax include all of the following, EXCEPT:

mediastinal shift.

The mother of a 2-year-old girl reports that the child has had a fever for the past 2 days and that she screams every time she tries to pick her up. You note that the child is grabbing both sides of her head. These findings are MOST suggestive of:

meningitis

Which of the following drug overdoses could be reversed with the administration of naloxone

meperidine

A 30-year-old unrestrained woman struck the steering wheel when her car hit a tree while traveling at 40 miles per hour. She reports pain to the midsternal area, which is point tender to palpation. Her blood pressure is 100/60 mm Hg, pulse is 118 beats/min and irregular, and respirations are 26 breaths/min and shallow. The remainder of your assessment is unremarkable. You should suspect:

myocardial contusion

That component of an assessment which contains purely factual information, and is not influenced by opinion or any other nonfactual assessment, is known as

objective.

A 17-year-old female was ejected from her car during a motor vehicle crash. You find her in a supine position lying motionless. She is conscious, but confused, and her skin is warm and dry. Her blood pressure is 76/50 mm Hg, her pulse rate is 54 beats/min, and her respiratory rate is 26 breaths/min. You should treat this patient for:

neurogenic shock

A 59-year-old male presents with chest pressure and nausea. His BP is 106/60 mm Hg, his pulse is 68 beats/min and regular, his respirations are 16 breaths/min and unlabored, and his oxygen saturation is 97%. The 12-lead ECG reveals a sinus rhythm with 3-mm ST elevation in leads II, III, and aVF, and ST depression in leads I and aVL. After administering aspirin, the paramedic should:

obtain a right-sided 12-lead ECG and establish IV access.

In infants, seizures:

often present as automatisms such as lip smacking or eye blinking.

An infant or child with cardiogenic shock:

often presents with increased work of breathing and an enlarged liver.

A 44-year-old man presents with the rhythm shown below. He complains of nausea, but denies vomiting. He is conscious and alert with a BP of 122/62 mm Hg, a pulse rate of 98 beats/min, and respirations of 16 breaths/min and unlabored. Treatment for this patient would MOST likely include:

ondansetron, 4 mg

A 30-year-old male has had a seizure. Bystanders state he just stopped his tonic-clonic movements. He is now unconscious with snoring respirations You should first:

open his airway to improve air movement.

a 60 yom was injured when his tractor rolled over on him. The tractor has been stabilized by rescue personnel. When you assess the man, you note that he is responsive to pain only, You should

open his airway with the jaw-thrust maneuver

Atropine sulfate exerts its therapeutic effect by:

opposing the vagus nerve.

A 44-year-old male was struck across the face with a steel pipe during an assault. Your assessment reveals marked swelling and ecchymosis to his midfacial area. He has nasal discharge, blurred vision, and is unable to follow your finger above the midline with his left eye. These clinical findings are MOST indicative of a/an:

orbital skull fracture.

You are dealing with a patient who has non-traumatic musculoskeletal pain. He states his elbow hurts severely, as a result of "working down at the plant for so many years, using my arm." With this type of history, a logical field impression may be:

osteoarthritis.

A woman was struck by lightning while working in her garden. Her husband tells you that when he first found her, she was unconscious and not breathing. Your assessment reveals that she is conscious and alert, but has no recollection of the event. Her airway is patent and her breathing is adequate. Her blood pressure is 134/74 mm Hg, pulse is 88 beats/min, and respirations are 20 breaths/min. The cardiac monitor reveals a sinus rhythm without ectopy. She is moving all of her extremities and has no obvious burns or musculoskeletal injuries. She refuses to allow you to apply a cervical collar and place her onto a backboard, but consents to other treatment and transport. The MOST appropriate treatment for this patient includes:

oxygen via nasal cannula or nonrebreathing mask, 12-lead ECG acquisition, continuous cardiac monitoring, an IV line set to keep the vein open, and transport.

A 72-year-old female slipped on a throw rug and fell, landing on her left hip. She is conscious and alert and in severe pain. Her left knee is flexed and she has a strong pedal pulse. Further assessment reveals no other obvious injuries and her vital signs are stable. The MOST appropriate method for splinting this patient's hip involves:

padding beneath the knee, placing her onto a scoop stretcher, padding around her hip, and securing her to the scoop stretcher.

During your assessment of a patient, you might identify the effects of norepinephrine engaging alpha receptors by discovering:

pale skin

Which of the following signs and symptoms should the paramedic expect to encounter in a patient with severe anemia

pallor and shortness of breath

You are transporting a 44-year-old man with shortness of breath. He is conscious alert and is receiving supplemental oxygen. A patent IV line has been established. Suddenly, he develops the rhythm shown below. He is now responsive to pain only; is profusely diaphoretic; and has weak radial pulses. You should:

perform synchronized cardioversion with 100 joules.

In which of he following traumatic injuries would you MOST likely encounter pulsus paradoxus?

pericardial tamponade

A transient ischemic attack is different from a cerebral vascular accident in that the TIA:

persists for less than 24 hours.

When arterial oxygen levels in the body fall, chemoreceptors in the brain send messages to the diaphragm via the:

phrenic nerve

While attempting to ventilate an apneic patient with a stoma, you note minimal rise of the chest and can hear air escaping through the upper airway. You should:

pinch the nostrils closed, ensure the mouth is closed, and reattempt to ventilate.

to maintain neutral alignment of the airway structures in an 18 month old child, you should

place padding under the shoulders

If, for some reason, you are unable to place a contaminated needle and syringe in a puncture-proof sharps container while in the back of the ambulance, you should:

place the needle cover on a stationary surface and then slide the needle into the needle cover with one hand.

When attempting visualization of the vocal cords with a curved laryngoscope blade, you should:

place the tip of the blade in the vallecula, and lift the jaw, tongue, and blade gently at a 45° angle.

A 29-year-old female, who is 32 weeks pregnant, presents with a blood glucose level of 305 mg/dL. This is MOST likely the result of:

placental hormones blocking the action of insulin.

Management of a woman who has been sexually assaulted should include:

placing any clothing items in a paper bag.

Percussion of the chest is a useful assessment tool, particularly when used to differentiate thoracic injuries. A hyper-resonant (or tympanic) sound indicates _____; whereas a dull percussion sound points to ______.

pneumothorax, hemothorax

A 66-year-old man tripped on a throw rug and fell on his outstretched left hand. He presents with swelling, ecchymosis, and severe pain to his left shoulder. He is conscious and alert, and denies striking his head or losing consciousness. His blood pressure is 148/88 mm Hg, pulse is 76 beats/min and strong, and respirations are 20 breaths/min and adequate. Pulse, sensory, and motor functions are grossly intact in all of his extremities. The MOST appropriate treatment for this patient includes:

premedicating with fentanyl or ketamine and splinting his shoulder in a comfortable position.

Albuterol (Proventil) may be helpful in the treatment of crush syndrome because it:

promotes movement of potassium to the intracellular space, resolving vascular hyperkalemia.

A 44-year-old male was found unresponsive by his wife. According to the wife, he had been drinking bourbon whiskey all day. He is unresponsive; has slow, shallow respirations; and a slow, weak pulse. You should:

promptly intubate his trachea and support his ventilations.

Compared to adults, children can maintain their blood pressure longer following an injury because they have a:

proportionally larger blood volume.

In contrast to an adult, an infant or child has a:

proportionately large tongue.

A 50-year-old man has an open abdominal wound with a small loop of bowel protruding from the wound. He is conscious and alert and is in severe pain. His blood pressure is 146/92 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 20 breaths/min with adequate depth. All of the following treatment interventions would be appropriate for this patient, EXCEPT:

protecting the exposed viscera from injury by covering it with a dry, sterile dressing and stabilizing it in place.

You receive a call for a 55-year-old female who is ill. The patient's husband tells you that she is an alcoholic, and has been "on the wagon" for about a week. The patient is conscious, but confused and restless. Her skin is hot to the touch, she is profusely diaphoretic, and her hands are shaking. Her blood pressure is 180/90 mm Hg, pulse is 120 beats/min, respirations are 24 breaths/min, and oxygen saturation is 98% on room air. You should:

provide emotional support, establish vascular access, monitor her cardiac rhythm, assess her blood glucose level, and transport.

A 56-year-old male presents with respiratory distress. He appears tired and is slow to answer your questions. He is taking a series of quick breaths, followed by prolonged exhalation. On the basis of these clinical findings, you should:

provide some form of positive-pressure ventilation.

An 16-year-old male presents with acute respiratory distress. His mother tells you that he recently lost his job. He is conscious and alert, but obviously anxious. He has a respiratory rate of 40 breaths/min and an oxygen saturation of 98% on room air. Further assessment reveals carpopedal spasms to his hands. Initial management for this patient should include:

providing coaching to slow the patient's breathing.

In the context of an acute coronary syndrome, the presence of dyspnea should make you MOST suspicious for:

pulmonary congestion.

You are readying for administration of adenosine to a 27-year-old female who presents with supraventricular tachycardia (SVT) and a heart rate of 220. Proper administration of this medication includes pushing the medication:

rapidly into a large peripheral vein.

When assessing a patient with sinus tachycardia at a rate of 135 beats, you should recall that

rate-related symptoms are uncommon in patients with a heat rate less than 150 beats`

When administering isotonic crystalloid boluses to a hypotensive patient who lost a significant volume of blood from a lacerated femoral artery, you should:

recall that isotonic crystalloids are not capable of carrying oxygen.

A hunter has been lost in the woods for several days and nights. He is found by paramedics who suspect hypothermia. Which one of the following temperature assessment techniques and devices should be used?

rectal glass thermometer

You are assessing the cardiac rhythm of a 9-year-old child who says his chest is "fluttering." P waves are not visible, the QRS complexes measure 70 ms in duration, the heart rate is 200 beats/min, and there is no variation in the R-R intervals when the child moves. These findings are MOST consistent with:

reentry supraventricular tachycardia.

You are transporting a 43-year-old male who experienced partial- and full-thickness burns to his head, face, anterior torso, and both upper extremities. When calling your radio report to the hospital, it is MOST important that you:

relay the anatomic locations of his burns.

Advance directives, such as living wills, are often called "durable" powers of attorney because they:

remain in effect once a patient loses decision-making capacity.

You are assessing an 18-month-old female with a high fever. The child is crying, and is tachypneic and tachycardic. There is no evidence of a rash, her rectal temperature is 102.6° F, and her capillary refill time is 1 second. The child's mother states that her daughter has not experienced vomiting or diarrhea, and further denies any past medical history. You should:

remove her clothing to minimize heat retention, give ibuprofen, and transport.

A 29-year-old male began acting strangely after working in the heat for several hours. His speech is slurred and he does not know where he is. His skin is hot and moist, his pulse is rapid and weak, and his respirations are rapid and shallow. The paramedic should:

remove his clothes and apply ice packs to his groin and axillae.

A 29-year-old male was exposed to a dry powder chemical. He is conscious and alert, but is restless and in intense pain. You should:

remove his clothing, brush the chemical off his skin, and then irrigate his skin with copious amounts of water.

a 50 yom was found unresponsive in his greenhouse; an empty container of pesticide is found lying next to him. his respiration are severely labored, his pulse is slow and weak, he is incontinent of urine, and he is producing copious oral secretions.. after removing the patient from the greenhouse, you should

remove his clothing, suction his oropharynx, assist his ventilations with a bag valve-mask, apply a cardiac monitor, establish vascular access and administer 2-4 mg of atropine sulfate

A 25-year-old male has a large knife impaled in the precordial area, just to the left of the angle of Louis. He is unresponsive, apneic, and pulseless. You should:

remove the knife, control bleeding, and begin CPR.

A 51-year-old male experienced partial thickness burns to his face, chest, and arms while trying to ignite a brush pile using gasoline. Upon arriving at the scene, the patient is found sitting on the ground in a safe area. He is conscious and alert and complains of intense pain. He is still wearing his shirt, but there are areas of smoldering fabric that have adhered to his skin. You should:

remove the part of his shirt that is not adhered to the skin and apply water to the adhered fabric to ensure the burning process has stopped.

you are transporting a patient who has chest pressure that is unrelieved by nitroglycerin. You contact the receiving physician for direction and are ordered to administer 25 mg of morphine. You should

repeat the medication order back to the physician word for word

Upon arriving at a mass-casualty incident, the paramedic is assigned to the treatment area. Upon completion of duties in the treatment area, the paramedic should:

report to the treatment officer for further instructions.

An unresponsive man is brought to the emergency department by his wife. Initial arterial blood gas analysis reveals a pH of 7.1, a PaO2 of 81 mm Hg, and a PaCO2 of 60 mm Hg. These findings are MOST consistent with:

respiratory acidosis.

Cardiopulmonary arrest in infants and children is MOST often secondary to:

respiratory failure.

You are transporting a patient from a small community hospital to a larger university teaching hospital for ongoing management of a severe crush injury. While transferring the patient to your cot, you notice the urine in the Foley catheter bag is a brownish-reddish color. This is indicative of:

rhabdomyolysis.

a 64 yom presents with an acute onset of left-sided weakness, right-sided facial droop, and slurred speech. He is conscious, but confused. You should be MOST suspicious for:

right-sided ischemic stroke

A patient struck the steering wheel when his vehicle crashed into a tree. Assessment reveals respiratory distress, diminished breath sounds to the left lower hemithorax, a scaphoid abdomen, and jugular venous distention. This clinical presentation is MOST consistent with a:

ruptured diaphragm.

The EMS crew is requested by a local group home to transport a resident with a longstanding history of mental illness. The home's manager reports to the EMS unit that the patient they will be transporting has been "acting out" and "hearing voices" lately, and the voices have told him to kill some of the staff members. This patient is likely suffering from:

schizophrenia.

Paramedics are called to the scene of a water main break for a man down. On arrival they are told that the walls of a trench have collapsed and the patient's legs are trapped beneath the collapsed area. Additional workers and construction equipment are available on scene. Paramedics should:

secure the perimeter of the hole and request rescue to shore the sides of the trench before proceeding.

19 yof ingested an unknown quantity of Elavil and Ativan approximately 3 hr ago.She is slow to answer your question and her speech is slurred. Her BP is 80/60 mm , her pulse is 150 beats and her respirations are 22 breath/ Teh ECG reveals sinus tachycardia with QRS complexes that measure 0.08 seconds. Treatment should include

sequential 20 mL/kg IV fluid boluses

In which of the following conditions would you MOST likely detect a drop in systolic blood pressure during inhalation

severe asthma

When approaching a vehicle at night, in which a patient is slumped over the steering wheel, you should:

shine a spotlight in the side view mirror until you determine it is safe.

ECG indicators of Wolff-Parkinson-White (WPW) syndrome include:

short PR intervals, delta waves, and QRS widening.

Occlusion of the right coronary artery would MOST likely result in:

sinoatrial node failure.

Your ECG presents a rhythm that is regular, has a rate of 58, has p-waves for every QRS and a QRS for every p wave, has a P-R interval of 0.18 and has narrow QRS complexes. This rhythm could be defined as:

sinus bradycardia.

Law enforcement requests your assistance at a convenience store for a combative patient. You arrive at the scene and find the patient, a 49-year-old male, sitting in the back of the police car; his hands are cuffed behind him. One of the police officers tells you that the clerk of the store called 9-1-1 because the patient was acting strange. The patient is conscious and has a patent airway; however, he is agitated, has disorganized speech, and is tachypneic. Further assessment reveals that he is diaphoretic and tachycardic. You should:

sit him forward and perform a finger stick to assess his blood glucose level.

When assessing a patient with a preexisting mental illness which of the following observations would be the MOST suggestive of the potential for violence

sitting, vlenched fist, erratic speech

a 40 year old patient has a blood glucose level of 800mg and is breathing deeply at a rate of 34 breath. Which of the following should the paramedic expect to observe

small capnograhic waveforms; low end-tidal CO2 reading

a 49 yom presents with acute shortness of breath. he is conscious, but confused, and is gasping for air. The pulse oximeter reads 79% on room air. Initial management should consist of

some form of ventilator assistance

a 49 yom presents with acute shortness of breath. He is conscious nut confused, and is gasping for air. The pulse oximeter reads 79% on room air. Initial management should consist of

some form of ventilatory assistance

In addition to CPR, treatment for a patient in cardiac arrest with a core body temperature of 90° F includes:

spacing epinephrine doses at longer than standard intervals.

A congenital condition in which part of the spinal cord is exposed because of malformation of the vertebral body and spinal cord development is:

spina bifida.

You respond to a lake at a state park where bystanders pulled a 44-year-old male from the water and are performing CPR on him. According to a park ranger, the water temperature of the lake is 85° F. No one witnessed the patient's submersion; however, one of his friends tells you that he is a diabetic and had been drinking beer all day. The cardiac monitor reveals a wide-complex bradycardic rhythm. In addition to CPR, treatment should include:

spinal precautions, intubation, gastric tube insertion, vascular access, 1 mg of epinephrine, blood glucose assessment, and thermal management.

A 19-year-old male fell during a basketball game and landed directly on his right elbow when his arm was flexed. He is in moderate pain. Your assessment reveals obvious deformity to the elbow. You are unable to feel a radial pulse, and his forearm is cool and pale. You should:

splint the injury in the position found and transport without delay.

You are assessing an injured football player who you suspect has injured his achilles tendon. To determine if the achilles tendon is intact, you should

squeeze the calf muscle of the injured leg and observe for plantar flexion of the foot

Following assessment of a patient with trauma to multiple body systems, it is MOST important to:

stabilize the most immediate threats to airway, breathing, and circulation, and transport without delay.

After performing synchronized cardioversion on an unstable patient with a wide-complex tachycardia, you look at the monitor and see coarse ventricular fibrillation. The patient is unresponsive, apneic, and pulseless. You should:

start CPR, ensure the synchronize mode is off, and defibrillate.

Factors that increase the amount of energy needed for ventilation include all of the following, EXCEPT:

stimulation of beta-2 receptors.

A 21-year-old man is unresponsive and has shallow, gurgling respirations. After manually opening his airway, the paramedic should:

suction the oropharynx.

You are assessing a 75 yom who experineced a sudden onset of slurred speech, a right sided facial droop and left sided hemiparesis approximately 45 min ago. his blood pressure is 170/94, pulse rate is 68 and irregular and respirations are 14 breath and unlabored. his oxygen saturation is 92 % on room air. the MOST appropriate treatment for this patient includes?

supplemental oxygen via nasal cannula monitoring, blood glucose assessment, and IV of normal saline set to keep the vein open and prompt transport

Diltiazem (Cardizem) is contraindicated for all of the following EXCEPT:

supraventricular tachycardia.

A 59 yom with a monomorphic wide-complex tachycardia at a rate of 220 beats, a blood pressure of 80/50 and a decreased level of consciousness should be treated with

synchronized cardioversion

You are assessing a seriously ill patient when you suddenly become nervous and feel as though you are about to hyperventilate. you should

take a deep breath in through your nose and out through your mouth

Standard treatment for an infant born at 34 weeks' gestation, regardless of its appearance at birth, includes

taking extra measures to prevent rapid heat loss.

You have obtained a 12-lead ECG tracing on a middle-aged male with chest discomfort. The ECG shows obvious ST elevation in leads II, III, and aVF. The patient, who is obviously anxious, asks you if the ECG looks okay. You should:

tell him that his 12-lead ECG shows an abnormality and that EMS transport to the hospital is necessary.

a 44 tom was near a building when it exploded. He presents with widespread burns, hemopysis, and blunt head trauma with signs of increased intracranial pressure. The patient MOST likely experienced his head injury during the ______phase of the explosion.

tertiary

The most effective way to verify placement of the nasogastric (NG) tube in an intubated patient in the prehospital setting is to:

test the pH of aspirated liquid from the tube.

Paramedics are called to the local high school to transport a 16-year-old track athlete complaining of severe testicular pain. It started after running around the school's track. He is pale and diaphoretic, and denies fever or penile discharge. This patient likely has ____ and treatment should consist of _____.

testicular torsion; IV initiation and emergent transport in an attempt to save the testicle

You would expect to encounter trismus in a patient with:

tetanus.

During your assessment of an unresponsive 21-year-old male with a suspected spinal injury, you test for a Babinski reflex. A Babinski reflex is present if:

the big toe turns upward when a blunt object is stroked along the sole of the foot.

In assessing an elderly patient, paramedics learn that she has a history of open-angle glaucoma. The significance of this is:

the disease impacts the ability to give many medications normally given by paramedics.

Increased parasympathetic tone, bradycardia, shunting of blood to the brain, and hypotension describes:

the diving reflex.

which of the following statements regarding fetal circulation in utero is correct

the ductus arteriosus and foramen ovale divert blood flow away from the fetus's lungs

The risks of vomiting and aspiration are greater in unresponsive pregnant women than non-pregnant women because:

the enlarged uterus displaces the stomach and intestines upward and laterally.

You are assessing an injured 4 year old child and suspect that his injury was intentionally inflicted. Which of the following findings should increased your suspicion of this

the injury occurred several hours before EMS was called

When the body's blood glucose level falls, such as following strenuous exercise:

the pancreas secretes glucagon, which stimulates the liver to convert glycogen to glucose.

You are ventilating an intubated patient who has been in cardiac arrest for approximately 15 minutes. Despite the presence of bilaterally equal breath sounds, quantitative capnography persistently reads less than 10 mm Hg. This MOST likely indicates that:

the patient is not producing carbon dioxide.

Following a spinal injury, your patient experiences a loss of proprioception. This means that:

the patient is unaware of one body part in relation to another.

The initial trauma sustained by a person because of an explosion is usually the result of:

the pressure wave.

While en route to a call for an injured person, the dispatcher advises you that law enforcement personnel are at the scene. This information should tell you that:

the scene is potentially unsafe.

Sudden infant death syndrome (SIDS) is defined as:

the sudden and unexpected death of an infant under 1 year of age for whom a thorough postmortem exam fails to demonstrate an appreciable cause of death.

When passing an endotracheal tube in between the vocal cords, the paramedic should recall that

the trachea descends into the chest cavity just beyond the vocal cords

The model or type of system in which EMS providers operate as an entity of a city, but not within other emergency service departments, is known as:

third-service.

As you are assessing the skin color and condition of a newborn, you note that it is red and abnormally warm to the touch. Suspecting fever, you should recall that:

this is an uncommon finding and suggests a serious illness.

a 59 yof with a hx of graves disease presents with an altered mental status. Her skin is hot to the touch and her pulse is 160 beats. These findings are MOST consistent with

thyrotoxic

A 24 year old female complains of severe abdominal pain after crashing her bicycle. Her vital signs are P 130, R 26, and BP 74/54. You should

titrate fluid administration to a systolic pressure of 80 mmHg.

A 27-year-old female complains of palpitations. The cardiac monitor reveals a narrow-complex tachycardia at 180/min. She denies any other symptoms, and states that this has happened to her before, but it typically resolves on its own. Her blood pressure is 126/66 mm Hg, pulse is 180 beats/min, and respirations are 16 breaths/min. After attempting vagal maneuvers and giving two doses of adenosine, her cardiac rhythm and vital signs remain unchanged. You should:

transport at once, reassess her frequently, and perform synchronized cardioversion if necessary.

A 39-year-old female presents with an acute onset of lightheadedness. The cardiac monitor reveals a tachycardic rhythm at 185 beats/min with QRS complexes that measure 0.08 seconds in duration. Despite vagal maneuvers and adenosine, her cardiac rhythm remains unchanged. She is conscious and alert, has a blood pressure of 118/72 mm Hg, and denies shortness of breath or chest discomfort. You should:

transport immediately and monitor her en route.

A 26-year-old complains of severe chest pain, weakness, and fatigue for two days. He has no cardiac history or respiratory complaints. Vitals are BP 109/65, P 124, R 22, T 100.1deg F, and O2 saturation of 97% on 4 LPM nasal cannula. Prehospital 12-lead EKG reveals a sinus tachycardia with diffuse 1 to 2 mm elevations in Leads I, II, III, AVR, AVF, V1, V2, V3 - V6. Given this history and physical findings, the paramedic should plan to:

transport rapidly to the nearest facility.

A well respected and knowledgeable paramedic administers 0.3 mg of epinephrine intramuscular (IM) after reading an article that this is now the preferred route for anaphylaxis. The paramedic's protocols and on-line medical control both require subcutaneous (SQ) administration. The patient suffers no adverse outcome. The paramedic defends his actions, citing this as accepted practice in many jurisdictions. In this case, the paramedics actions are likely:

unethical and illegal; the actions did not conform to expected professional behaviors.

The best location to park emergency vehicles at the scene of a vehicle crash is:

uphill and upwind.

An unresponsive 45 year old female has thick oral secretions. As you begin to suction her, she becomes tachypneic, restless, and has increased accessory muscle usage. You should

use caution while continuing to suction

Ventilation of an adult patient with a stoma and no tracheostomy tube is MOST effectively achieved by

using an infant- or child- size mask attached to an adult size bag valve mask device

When administering epinephrine to a patient in cardiac arrest, the MAIN desired effect is:

vasoconstriction, which improves coronary and cerebral perfusion.

Which of the following clinical presentations is MOST indicative of a severe upper airway obstruction

weak cough and cyanosis

You are transporting a woman with a history of COPD, who called EMS when her difficulty breathing suddenly worsened. She is receiving oxygen at 4 L/min via nasal cannula, is on a cardiac monitor, and has an IV line in place. During your reassessment, you note that she is responsive to pain only, is increasingly tachycardic, and is developing cyanosis around her mouth. You should:

ventilate her with a bag-valve-mask device.

You are dispatched to a residence for a patient having a seizure. Upon arriving at the scene, you find that the patient, a 39-year-old male, is experiencing a generalized tonic-clonic seizure and is cyanotic. His wife tells you that he has been like this for the past 25 minutes. You should:

ventilate him with a bag-valve-mask device, establish IV access, and administer 5 mg of diazepam.

a 4 yof presents with lethargy, weak intercostal retractions and heart rate of 70 beats. you should

ventilate the child with high-flow oxygen

You are ventilating an unresponsive, apneic 50-year-old man. He has a pulse, but it is rapid and weak. When ventilating this patient, it is MOST important to:

ventilate until the chest visibly rises.

A 1-year-old child presents with a decreased level of alertness, bradypnea, cyanosis, and a heart rate of 50 beats/min. You should:

ventilate with a bag-valve-mask device.

When assessing a responsive patient with a suspected pulmonary embolism, it is important to remember that

ventilations continues, but oxygenation is inadequate

You are assessing the cardiac rhythm of a 6-year-old child. The rhythm is regular, the rate is 170 beats/min, the QRS complexes measure 0.11 seconds, and P waves are not visible. You should suspect:

ventricular tachycardia.

Viruses differ from bacteria in that:

viruses lack organelles, so they are dependent on the host to survive, whereas bacteria can survive without a host.

Which of the following is the MOST reliable immediate indicator that you have successfully placed an endotracheal tube into the trachea

visualization of the ET tube passing between the vocal cords.

You are assessing a patient who presents with a melena and abdominal pain. Which of the following medical history findings is the MOST clinically significant?

von Willebrand disease

A febrile seizure would MOST likely occur in a child:

with a fever that acutely spikes.

During an attempted resuscitation of a 78-year-old woman in cardiac arrest, you apply the defibrillation pads and turn on the cardiac monitor. Her cardiac rhythm reveals asystole. Suddenly, the machine shuts off and will not turn back on when you push the power button. You continue resuscitative efforts and transport the patient to the hospital, where she was pronounced dead. Upon returning to quarters, you learn that the crew before you also had a cardiac arrest call, but did not replace the batteries in the monitor/defibrillator. In this case:

you and your partner may be held legally accountable for her death.

If a patient has a pH of 7.28, the most general term to describe their body's current state would be?

Acidotic

Calculate the APGAR score for the following newborn: - Appearance: pink - Pulse: 120 - Grimace: sneeze - Activity: active - Respiratory: vigorous cry

10

Stage 1 hemorrhage is characterized by a blood loss of up to what percentage of the circulating volume?

15%

A fractured femur can account for up to how much blood loss?

2,000 mL

What would be the expected normal PaCO2 for a healthy adult who is breathing normally?

35-45 torr

What is the cause of digital clubbing?

Chronic hypoxia

You have been performing CPR on a patient for 25 minutes. You are unsure how long the patient was in arrest, prior to your arrival. The patient most likely has had a retention of carbon dioxide because he was apneic for some time. You know this will lead to:

A decrease in pH and Respiratory Acidosis

Sodium bicarbonate is indicated for certain conditions such as hyperkalemia and tricyclic antidepressant overdoses. What is the mechanism of action for sodium bicarbonate?

Alkalizing agen

You are assessing a patient with chest pain. After obtaining a 12-lead you notice there is ST-segment elevation in leads V3, V4, V5 and V6. What type of myocardial infarction is this patient most likely experiencing?

Anterolateral MI

Emphysema causes the breakdown of bronchioles and alveoli. This can lead to a loss of surfactant and cause the alveoli to collapse. Alveolar collapse is called?

Atelectasis

You find a 52-year-old male who presents with flushed skin, uses home oxygen at 2 liters per minute via nasal cannula, and is significantly underweight. Your patient states he has emphysema. The destruction of his alveoli is known as?

Atelectasis

What does the PR interval on an EKG represent?

Atrial depolarization and delay at the AV node

Your 3-year-old patient presents with a high grade fever and is coughing up mucus. Her mother reports that the child has recently had croup. The child also has a hoarse voice and sore throat. A physical exam reveals expiratory stridor. The child is most likely suffering from?

Bacterial tracheitis

Your 38-year-old male patient is exhibiting an abnormal breathing pattern after head trauma. The pattern is rapid, deep and gasping respirations with short pauses between sets. What is this breathing pattern called?

Biot's

You and your partner arrive on scene to a patient who has been involved in an MVA. As you approach the patient you notice the patient breathing in sequences of uniformly deep gasps, apnea, then more gasps. What is the name of the respiratory pattern?

Biot's Respirations

You are on scene with a 67-year-old female in severe respiratory distress. Which of the following will give you the most accurate assessment of your patient's ventilatory status?

Capnography

You respond to a local nursing home for a male complaining of generalized weakness. The patient's wife tells you the patient has been unable to move out of bed for the past two days. Vitals: BP 110/70, HR 48, RR 16, and SpO2 97% on room air. You place the patient on you cardiac monitor which shows sinus bradycarida, consistent with the patient's pulse. What is the most appropriate treatment for this patient?

Monitor and observe the patient for changes

What is the goal of using the drug adenosine?

Decrease the conduction through the AV node

You are assessing a 68-year-old female patient in a skilled nursing facility who complains of leg pain. Upon assessment, you notice her right leg is unremarkable, but her left leg is swollen, flushed, and feels hot to the touch. The patient complains of increased pain when the foot is flexed. The nurse states that the patient has been bed confined for several days because of exhaustion and has had reduced fluid intake. You suspect?

Deep vein thrombosis

You are dispatched to a 28-year-old female complaining of severe lower left abdominal pain radiating to her flank. She states it was sudden onset, has no medical history, and takes no medications. Her blood pressure is 142/68, pulse is 100, and her respiratory rate is 18. She thinks her last menstrual cycle was over 2 months ago. Her pain is 10/10. What is the patient most likely presenting with?

Ectopic pregnancy

You are dispatched to a woman in labor. Upon arrival the mother is screaming that she is ready to deliver. Your history reveals that she has 3 children and two previous abortions. You could best document this history by which of the following?

G6, P3

Alpha 1 antagonist drugs are primarily used to control which condition?

Hypertension

You are called to a traffic accident, where a patient has no serious bleeding and only one small abrasion on the forehead. You palpate the pulse and it is 120 and thready. This most likely suggests?

Hypovolemic shock

Triage the following patient: A 16-year-old male involved in a motor vehicle crash is complaining of severe chest pain. You note a flail chest segment on the patient's right chest wall. His respiratory rate is 28 breaths per minute. A radial pulse is present and regular. He keeps on asking you what happened to him and does not respond to your questions appropriately.

IMMEDIATE (red)

Your patient is unconscious and does not respond to painful stimuli. You utilize the Glasgow Coma Scale and determine a score of 6. You should?

Immediately intubate the patient.

You and your partner are called to a household where everyone present is experiencing flu-like symptoms. After a few minutes of assessment, you notice you begin to feel light-headed and nauseous. Not long after this, your partner mentions that he is feeling the same way. How do you proceed?

Immediately remove everyone from the scene and call for additional resources

You are called to a car vs. tree motor vehicle collision. You arrive to find an unresponsive 60-year-old male slumped over the steering. The patient has absent lung sounds on the left side and is diminished on the right. Vitals: blood presure 80/p, pulse 118, respirations 28. How will you initially proceed?

Needle decompression for a tension pneumothorax and provide ventilations

You are transporting a patient whose transverse colon has prolapsed into their descending colon. This is called?

Intussusception

You are assessing a 23-year-old male with a knife protruding from his neck. The patient remains conscious and verbal, but has dark red blood oozing from the wound. How should you treat this patient?

Leave the knife in place, apply a bulk dressing to stabilize the object, transport rapidly

You arrive on scene to the report of chest pain and find a 77-year-old male with a history of AMIs. You see a third-degree heart block on the monitor as your patient begins to start slurring his speech. His blood pressure is 88/40. Treatment for this patient includes?

Oxygen, IV, pacing

Which of the following is MOST consistent with a patient who is hypoventilating?

PCO2 of 52 mm Hg

An unresponsive trauma patient has sonorous respirations and blood draining from the corner of his mouth. What should be your FIRST action?

Perform a jaw-thrust maneuver

You are treating a patient with CHF. Medical Control orders you to administer 100 mg of morphine to your patient. You feel the order is detrimental and inappropriate and question the physician but he tells you to carry out the order. You should:

Refuse to carry out the order and document the incident

Which infectious disease is the most common cause of pneumonia in U.S. children under the age of 1?

Respiratory Syncytial Virus

An increased pH, decreased PCO2 level, and low HCO3- levels indicate which of the following acid-base derangements?

Respiratory alkalosis

You have been called to the playground and find a small girl sitting on the curb leaning forward with her arms outstretched to either side of her. Her jaw is open and her chin is thrust forward. Her position is indicative of?

Respiratory distress

Which of the following substances is a nerve agent?

Sarin

Which of the following personality disorders is characterized by detachment from all social relationships?

Schizoid

during your assessment of a 1-year-old female patient, you notice that her heart rate increases when she breathes in and decreases when she breathes out. What is this condition called?

Sinus arrhythmia

Your 9-year-old male patient was involved in an MVC. His GCS is 6 and you determine that he needs endotracheal intubation. What size ET tube would you use for this patient?

Size 6 mm

The white portion of a warning placard will give you information on a hazardous material's?

Specific hazard

Your 18-year-old male patient was struck in the chest with a golf club following an altercation at a local golf course. Upon arrival to the secured scene, you see a teenage male sitting upright near the tee box, appearing extremely anxious and holding his right chest. His vital signs are: BP - 78/p, HR - 100, RR - 34, SaO2 - 84% and falling. Which of the following injuries is the most likely explanation for this patient's presentation?

Tension pneumothorax

You are assessing a 72-year-old female patient who complains of abdominal discomfort. The patient states she feels like she has indigestion, with no relief after taking antacids. Her blood pressure is 148/92, pulse 95, respirations 18, and room air saturations are 96%. She denies increased pain with movement, palpation or respiration. 12 lead reveals ST elevation in leads II, III and aVF. You suspect the patient's MI to be located in?

The inferior wall

In an otherwise healthy individual, breathing is primarily stimulated by:

an increase in arterial CO2.

Which of the following findings is the MOST clinically significant when assessing a patient with a severe headache

an unsteady gait

A 60-year-old woman presents with difficulty breathing. She is conscious and alert, but anxious, and tells you that she was suddenly awakened with the feeling that she was suffocating. She has dried blood on her lips and cyanosis around her mouth. Her heart rate is 120 beats/min and her oxygen saturation is 89%. Your initial action should be to:

apply supplemental oxygen.

You have intubated a 33-year-old woman in cardiac arrest secondary to trauma. While auscultating her lungs, you note that breath sounds are absent over the right hemithorax. This clinical finding is MOST suggestive of:

blood or air in the right hemithorax.

After inserting a King LT supraglottic airway device into a patient and inflating the cuff with 40 mL of air, the paramedic meets resistance when ventilating and cannot see the patient's chest rise. The paramedic should:

slowly pull back on the King airway while observing for chest rise

a 61 year old male presents with cheat pressure that woke him up from his nap 30 min ago. he is diaphoretic, anxious and rates his pain as an 8/10. his past medical history is significant for hypertension, type 2 diabetes, and coronary stent placement 2 month ago. he takes lisinopril, plavix, and glucophage, and is wearing a medical alert bracelet stating "allergic to salicylates". his blood pressure is 160/100mm, pulse is 110 beats/min and respiration are 22 breaths. the 12 lead ecg shows sinus tachycardia with 2-mm ST segment elevation in leads V1-V4. Which of the following treatment modalities is MOST appropriate for this patient

supplemetal oxygen, vascular access, up to three 0.4mg doses of nitroglycerin, and 2-4mg of morphine sulfate if his systolic BP is grater than 90mm and he is still experiencing pain

A 56-year-old woman presents with acute respiratory distress. She is confused, has cyanosis around her mouth, and can only speak in two-word sentences. You should:

ventilate with a bag-valve-mask device.