NREMT (Section 1, Test 1)

Which of the following is the best example of how to communicate with a patient? - "I am here to help and everything will be OK." - "Can you describe the type of pain you are feeling?" - "Can you tell me why you ate that food?" - "I think you have cholecystitis."

"Can you describe the type of pain you are feeling?" "Can you describe the type of pain you are feeling?" is an open-ended question that allows the patient to describe their answer in their own words. That is the best example of therapeutic communication in this question. Providing a false sense of security isn't helpful. Accusing words like "why" a patient did something cuts off communication. And using medical terms like cholecystitis confuses patients and doesn't impress them. Use common words and therapeutic communication.

A 65 year old man complains of chest pain. You should next ask him - "Are you taking any cardiac medication such as nitroglycerin?" - "How many minutes have you been experiencing this pain?" - "What do you think caused this pain?" - "Is this the first time you've had this type of pain?"

"How many minutes have you been experiencing this pain?" Most of these are questions should be asked, but the stem says "next." You'll gain better diagnostic information by asking "how many minutes have you been experiencing this pain?" That's because to reduce loss of cardiac tissue in the face of cardiac ischemia, catheterization needs to occur within the first hours of onset of symptoms. The other options are helpful but are less likely to change patient outcome. A patient history should be conducted using open-ended questions and converge upon evidence that gives you a field diagnosis.

Which of the statements below made by a patient would cause you to think he has acute coronary syndrome? - "I'm having shortness of breath and it began after I did some work in the garden." - "I'm having dull, pressure type pain and my Dad died of a heart attack at age 51." - "I awoke suddenly from sleep unable to breathe and my CPAP isn't working anymore." - "I am feeling dizzy; I was unable to eat and I've had diabetes for 25 years."

"I'm having dull, pressure type pain and my Dad died of a heart attack at age 51." Dull chest pain with a family history of heart disease is often present with myocardial ischemia (heart attack). Becoming short of breath while working is not specific enough and may be respiratory disease. Awaking suddenly unable to breathe causes suspicion of a respiratory complication or heart failure. Dizziness or mentation changes coupled with diabetes leans toward hypoglycemia.

An 18 year old male was hit by a car while walking. He responds to verbal commands with inappropriate words. During your physical examination you noted he had a lower left arm fracture because he withdrew and had facial grimace when you assessed the arm. What should you record as his Glasgow Coma Scale score? - 8 - 14 - 12 - 10

10 10 is the answer. He responds (inappropriately) so record a 3 for eye opening. He uses inappropriate words so that's a 3, and he withdraws from pain which is a 4. GCS questions are difficult to determine the answer. You likely will not memorize the scale and we think you should be using a visible chart when recording a GCS in the field. Have enough familiarity with a GCS to make a good guess on a test. Remember when four numbers are given as choices on any test, it's likely the highest and lowest numbers are wrong choices.

What is the proper rate and depth of chest compressions on an adult patient needing CPR? - 60 compressions per minute; 3 inches in depth. - 120 compressions per minute; 3 inches in depth. - 100 compressions per minute; 2 inches in depth. - 100 compressions per minute; 3 inches in depth

100 compressions per minute; 2 inches in depth. The 2015 standards say 100-120 compressions per minute at 2 - 2.4 inches in depth. Note that three options are 3 inches in depth; a wrong choice. If you don't know an answer, don't think that because an option is used only once, it must be wrong. That can trick you. This is a fact that you either know or you don't. The CPR guidelines are important and are tested on the exam.

During adult CPR, as a second rescuer you should prepare to administer 2 ventilations after - 30 chest compressions. - unlimited chest compressions. - 15 chest compressions. - 5 chest compressions.

30 chest compressions. The answer to this question remains the same in the 2015 guidelines as in the previous guidelines - after 30 chest compressions. The 15 chest compressions apply to children and infants when two rescuers are present. Five to one compressions are from older guidelines. Unlimited isn't a realistic choice.

During CPR the compression to ventilation ratio for two rescuer CPR is - 15:1 - 30:2 - 5:1 - 15:2

30:2 The correct answer is 30:2. All other choices relate to old CPR guidelines, or to no guidelines at all!

pulmonary embolism

A condition in which one or more arteries in the lungs become blocked by a blood clot.

vasovagal syncope

A sudden drop in heart rate and blood pressure leading to fainting, often in reaction to a stressful trigger.

You are off duty eating dinner when someone calls for help. As you approach the victim you see a middle aged man with an ashen face. You see no chest rise. You should - start chest compressions. - activate the EMS system. - give two rescue breaths. - determine if a public access AED is present.

Activate the EMS system Activate the EMS system when you are off-duty (a key word in the stem). This action must be accomplished first to yield the best patient outcome and it can be done rapidly by yelling, "Someone call 9-1-1!" You should, after activating the EMS system, check a pulse, begin chest compressions and have someone search for a nearby AED. CPR does not start by providing two rescue breaths except in near drowning cases.

What is the primary cause of acute coronary syndrome? - Atherosclerosis - Cardiac arrhythmias - Cor pulmonale - Sympathetic stimulation

Atherosclerosis Atherosclerosis is the primary cause of coronary artery blockage (which leads to coronary artery syndrome). Arrhythmias begin when the heart suffers ischemia due to atherosclerosis. The sympathetic system speeds the heart rate (flight or fight mechanism). Cor pulmonale is right heart failure.

Which of the following is the least likely to cause death in a patient who is having an anaphylactic reaction? Airway obstruction Hypoxemia Vasodilation Bronchoconstriction

Bronchoconstriction Vasodilation, airway obstruction and hypoxemia will lead to death more rapidly than bronchoconstriction. Bronchoconstriction is problematic but not as much as the other choices.

A drowsy 19 year old male was stabbed with a knife over the left side of his anterior chest. His skin is cool and clammy and his vitals are B/P 104/82, P 118, R 22 and SpO2 is 94% on room air. What type of shock is he suffering? - Cardiogenic - Metabolic - Hypovolemic - Distributive

Cardiogenic The role of the heart is to pump blood around the body. A stab wound over the heart can lead to pericardial tamponade; an injury where a small amount of bleeding can limit pump action. This person is in cardiogenic shock. This is not a blood volume problem. Certainly the blood is not resting in the vascular system nor are indications present it is full of toxins. "Genic" refers to origin. The origin of this problem is the heart.

A 28 year old male reports he has a very severe headache that began 30 minutes ago. The pain is on one side of his head and you observe excessive tear production on the side of the pain. His vital signs are B/P 130/96, P 84, R 14. What type of headache do you suspect? - Syncopal - Ischemic - Cluster - Hypoglycemic

Cluster A cluster headache is the type of headache that has the above symptoms. Ischemia can cause a headache but most likely presents with a change in level of consciousness. A syncopal headache doesn't exist but can be confused with a syncopal episode (fainting). And hypoglycema, (if blood sugar is low enough) causes altered mental status

Which of the following are three of the five stages of death and dying? - Treatment, remission, exacerbation - Relevant, prodromal, contentment - Denial, anger, acceptance - Prayer, commitment, judgment

Denial, anger, acceptance The five stages of death and dying are: denial, anger, bargaining, depression and acceptance. The other distractors are attractive but wrong.

What phase of cardiac arrest is a patient in immediately after collapsing? - Electrical - Reversible - Circulatory - Metabolic

Electrical The most likely answer is electrical. Perfusion problems begin immediately also but electricity via successful defibrillation can reverse a perfusion problem dramatically. Continued arrest certainly produces metabolic problems. If all cardiac arrests were reversible, heart disease would not be a leading cause of death. Splitting the difference between electrical and circulatory is very close, but keeping in mind electrical helps you understand that use of an AED immediately after collapse is critically important as you attempt resuscitation. An important use of EMT Pass is to learn.

What disease affecting pediatric patients has been dramatically reduced by the administration of a haemophilus influenza type B vaccine? - Epiglottitis - Laryngotracheobronchitis - Meningitis - Otitis media

Epiglottitis The above vaccine reduces the likelihood of acquiring epiglottitis. Laryngotracheobronchitis is the medical term for croup. Meningitis involves swelling of the meninges around the brain or spinal cord, and otitis media is an ear infection that is commonly bacterial. This is a moderately difficult question which may not have been covered in lecture but is likely in your book.

What is the reason an undiagnosed diabetic becomes so hungry? - The elevated blood glucose levels suppress secretions of glucagon. - The elevation of glucose in the blood triggers the hunger zone of the brain. - Obesity has caused the patient to have chronic hunger needs. - Even with an elevated glucose level none is able to enter the cells.

Even with an elevated glucose level none is able to enter the cells. Only one choice makes physiological sense. Insulin helps the cells absorb glucose. Hyperglycemia doesn't trigger hunger, in normal people it prevents hunger. The obesity option is wrong and elevated blood glucose has nothing to do with the actions of normally secreted glucagon.

Which of the following is the single most effective way to prevent the spread of diseases between yourself, your partners and your patients? - Use of germicidal gels - Gloves - Use of bactericidal gels - Hand washing

Hand washing The best answer is hand washing. Although the others may help, research and infectious disease experts point to frequent hand washing as the best method to prevent the spread of disease.

A 52 year old obese female tells you she has diabetes and has been sick for four days. Which of the below symptom groups would make you think she is in diabetic ketoacidosis? - Nausea, vomiting, fever, rapid respirations, dry skin. - Orthostatic hypertension, thirst, tachypnea. - Kussmaul's respirations, left side arm droop, diaphoresis. - Hyperventilation, sweet smelling breath, dry skin.

Hyperventilation, sweet smelling breath, dry skin. In this type of question use the process of elimination to find the answer. You should know hyperventilation is present in hyperglycemia. Thus the options that start with orthostatic hypertension (which is less likely) and the option that includes fever should be eliminated quickly. That leaves only the correct answer and the one that includes Kussmaul respiration left as choices. Hyperglycemia doesn't present with arm droop, so that leaves that option out. The correct answer is hyperventilation, sweet smelling breath and dry skin.

According to the National EMS Scope of Practice Model, which of the following skills are part of the practice of an Advanced EMT? - E.T. tube placement, splinting and defibrillation - IV therapy, administration of NTG, ASA and Beta2 drugs - IV therapy, CO2 monitoring and administration of D50W - E.T. tube placement, morphine administration and SpO2 monitoring

IV therapy, administration of NTG, ASA and Beta2 drugs IV therapy, administration of nitroglycerin, aspirin and beta 2 drugs are recommended minimums of care delivered by AEMTs within the Scope of Practice Model. ET tube placement is recommended for Paramedics. D50W is also a Paramedic intervention and providing morphine was recommended to be limited to Paramedics.

At the scene of a sarin gas attack it will be essential that you carry a - LPRD kit. - gas mask. - Mark 1 kit. - HEPA mask.

Mark 1 kit The use of a Mark 1 kit is to combat the symptoms found in a sarin gas attack. Sarin gas requires a level A protective suit, not just a gas mask. A HEPA mask is a particulate mask used when in contact with patients with respiratory diseases. And there is no such thing as an LPRD kit. Never pick an answer that you have not heard or read about.

What is the best out-of-hospital method to detect the need for cardiac catheterization? - Obtaining a 12 Lead ECG - Evaluating effectiveness of nitroglycerin care - Duration of time since the onset of pain - Nature and type of chest pain

Obtaining a 12 Lead ECG Subjective information provided by a patient is less specific in regards to obtaining confirmation of cardiac ischemia than a patient history. Even a 12-lead is less specific than taking the patient to a cath lab where the interventional cardiologist can see what is occurring within the cardiac circulation.

You and your partner arrive on scene of a patient who is apneic and pulseless. What should you both do? - One secures the airway while the other provides two rescue breaths. - One starts rescue breathing while the other starts chest compressions. - One starts chest compressions while the other prepares the AED. - One sets up the AED while the other orders others to "stand back!"

One starts chest compressions while the other prepares the AED. The team approach to patient care is becoming the educational standard. The correct answer is one starts chest compressions while the other prepares the AED. Rescue breathing and chest compressions leaves off the important step of defibrillation. Using the AED without first doing CPR in out-of-hospital un-witnessed cardiac arrest is not recommended when two rescuers are present. Managing the airway delays compressions.

What is the primary cause of esophageal varices? - Alcoholism - Liver failure - Portal hypertension - Gastric reflux

Portal hypertension The primary cause is portal hypertension. If you don't know what portal hypertension is, the term "portal" frequently refers to a type of circulation around the liver. Liver failure is commonly seen in patients with esophageal varices as a co-morbid disease but it is not the cause. Gastric reflux causes indigestion and a burning sensation. Alcoholism is also co-morbid with esophageal varices but not all alcoholics have the varices. These are like hemorrhoids of the lower esophagus and when they rupture there is massive upper GI bleeding and vomiting of blood.

Which of the following is most likely to result in a patient developing cardiogenic shock? - History of COPD - Prior myocardial infarctions - Pulmonary embolism - Cardiac dysrhythmias

Prior myocardial infarctions Cardiogenic shock is pump failure. Cardiac dysrhythmias can be present without pump failure, such as in atrial fibrillation. A pulmonary embolism produces obstructive shock. COPD produces a ventilation problem.

You are transporting a 46 year old male with chest pain. He say he's "never had this type of pain before." His vitals are B/P 126/82, P 94, R 16 and his SpO2 is 94% on room air. You should - provide supportive care. - determine if he has been prescribed nitroglycerin. - administer oxygen by nasal cannula, 3 Lpm. - administer oxygen by non-rebreather mask.

Provide supportive care. There is no need to provide oxygen as his SpO2 is adequate and it's highly unlikely he has been prescribed nitroglycerin before based on his age and what he says. While you will still ask him if has been prescribed nitro, this is not a "best" choice.

Which of the statements below is true regarding drowning? - Fresh water resuscitations are simplified because water in the lungs is absorbed by the blood. - Salt water resuscitations are more successful because of the pH of the water. - Dirty water resuscitations are the most complicated because of the solubility of the particles in the water. - Resuscitation remains the same regardless of the type of water in which a victim drowns.

Resuscitation remains the same regardless of the type of water in which a victim drowns. This is a multiple true-false type question. So 3 are false. The true answer is resuscitation remains the same regardless of the type of water. The other distractors are just that--distractors. When someone is in cardiac arrest following a near drowning, resuscitate them.

Which two entities establish the Scope of Practice (SOP) and the Standard of Care (SOC)? - State EMS Office establishes the SOP and the EMS department establishes the SOC. - Statewide protocols establish the SOP and the local protocol establishes the SOC. - State legislature establishes the SOP and the local community establishes the SOC. - Local medical director establishes the SOP and the local protocol establishes the SOC.

State legislature establishes the SOP and the local community establishes the SOC. State legislatures determine the scope of practice and in tort cases the local community establishes the standard of care. State EMS Offices administrate the laws of the state and an EMS department might participate in establishing the standard of care if they're involved in EMS protocols. The local medical director likely will be called into a tort case to interpret if you practiced to the standard of care, but in most states does not establish the scope of practice. Statewide protocols must be based upon the scope of practice outlined in state law.

Which of the below should be recorded on a PCR to illustrate a response to painful stimuli? - The patient showed a facial grimace when we splinted his fractured leg. - The patient tried to push my hand away when I applied a trapezius pinch. - The patient grabbed me by the wrist when I applied supraorbital pressure. - When I squeezed the patient's ear lobe he did not make a facial grimace.

The patient tried to push my hand away when I applied a trapezius pinch. earlobe and providing supraorbital pressure are not appropriate stimuli. And reporting facial grimace after splinting a leg fracture is appropriate but might make those who read the report wonder if you know how to asses and treat a suspected fracture.

Which of the below is the best location to find the presence of pitting edema on a patient who has been lying supine? - The suprascapular region of the posterior thorax. - The fingernail beds of the right hand. - The antecubital fossa of the left arm. - The sacral notch in the lower back.

The sacral notch in the lower back. Pitting edema is dependent edema, thus assessing the sacrum of the back is the best place to check on supine patients. Fingernail beds assess microcirculation and are used in kids to check the speed for return of color and for adults the level of "pinkness." Above the scapula (shoulder), assessment is not beneficial. The area where advanced providers likely choose to start IVs (antecubital fossa) can be used to assess for a pulse but not for edema

What sign would cause you the most concern regarding a suspected inhaled poison? - Excessive salivation and sweating - Vertigo and dizziness - Two or more people collapsed - Wheezing and rhonchi

Two or more people collapsed This is a safety first question. Sure you'd be concerned about the symptoms in the choices, but protect yourself first on all calls. So the correct answer is when two or more people collapsed at a scene. If you go into this scene without SCBA, you will likely be the third victim.

pulmonary edema

a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe.

hypoxia

a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level

diabetic ketoacidosis

a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.

A one year old has had a runny nose and nasal congestion over the past 3 days. His Mom called you because he is now coughing, anxious and has skin pallor. He has a hoarse cry. You should suspect - tonsillitis. - a viral upper airway infection. - laryngitis. - a bacterial upper airway infection.

a viral upper airway infection. This child has a viral upper airway infection, most likely croup. The coughing, anxiousness and skin color are the clues. A bacterial infection like epiglottitis (now rarely seen due to vaccines) presents with a sore throat. Laryngitis is not a common childhood disease and causes a loss of voice. Tonsillitis is not seen with skin pallor and anxiousness, more likely a sore throat.

Esophageal varices

abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver

The major complication the body experiences during widespread anaerobic metabolism is the - development of hypoxia. - decrease in blood sugar. - accumulation of acid. - failure to produce ADP.

accumulation of acid. The answer is accumulation of acid. Anaerobic (metabolism with inadequate oxygenation) means cells are not able to release the acid buildup that occurs during metabolism. Blood sugar is not affected. Anaerobic metabolism occurs with hypoxia but hypoperfusion is the most likely cause of anaerobic metabolism in injury and disease. ADP is a precursor to ATP,but ATP is the energy source produced via metabolism within the cells.

You have removed an unconscious 46 year old male from a basement where he collapsed from unknown reasons. He does not appear to have suffered any trauma. His vital signs are B/P 118/82 P 116, R 16 and his SpO2 is 99% on room air. You should first - determine the carbon dioxide levels in the basement. - open his airway and ventilate him with a BVM. - attach an AED and push the analyze button. - administer 100% oxygen by non-rebreather mask.

administer 100% oxygen by non-rebreather mask. This scenario presents so that you should suspect carbon monoxide poisoning. This patient needs 100% O2. The oxygen saturation reading is likely high because of the carbon monoxide binding with the hemoglobin molecules. Cardiac arrest isn't present. Determining carbon dioxide levels requires blood gas analysis (note it is not carbon monoxide). He is breathing so there is no need to ventilate him.

A 46 year old male complains of dull chest pain. You should first - attach the AED. - obtain vital signs. - administer oxygen 100% by non-rebreather mask. - administer aspirin.

administer aspirin. Administer aspirin. Providing oxygen may happen but 100% is not necessary. There is no SpO2 reading in this stem, which should be acquired before a decision is made regarding the delivery of oxygen. Never attach an AED to a conscious patient. Obtaining vital signs should occur but the stem says "first," so the best answer among these choices is to provide the aspirin.

An 8 year old male ate peanuts at school by mistake. The school principal tells you he is allergic and wants you to administer the medication. The child is cool and clammy, having wheezing and a swollen tongue. You should - administer epinephrine. - instruct the principal on how to give the drug. - assess him for hypotension. - contact parents for consent to treat.

administer epinephrine. Although the principal is correct in the need of an Epipen injection he/she is not a professional and you should administer the medication. Contacting the parents is not necessary as the school has "en loco parentis" authority. Assessing for hypotension is nice but the cool, clammy skin should already give you a clue about this. The swollen tongue alone is enough to warrant Epipen injection. Instructing the principal in how to use the Epipen is not necessary when you are present.

A 36 year old diabetic female has a history of schizophrenia. Law enforcement has her handcuffed at the roadside. She has removed her clothes. She tells you President Obama, "wants her." You should - find her clothing to wear. - administer oral glucose. - transport her to an appropriate facility. - restrain her with soft restraints.

administer oral glucose The schizophrenia in the stem can distract you from the real problem. People have co-morbid diseases. So in this case you don't know if her symptoms are due to non-compliance of her schizophrenia medications or if she is diabetic. It might help to ask her. But giving her oral glucose will "do no harm," so administering it here is not wrong. Finding her clothing to wear is outside of your responsibilities when a bed sheet can cover her. Just transporting a nude patient shows no compassion. Restraining her might be necessary but there is nothing in the stem that shows she is a danger to you or a team member.

A 32 year old male has been treated for pneumonia for the past week. His family has urged him to go to the hospital but he has refused. He is now hot to touch. His vital signs are B/P 96/78, P 104, R 24. His SpO2 is 88% on room air. You should - administer oxygen and transport rapidly. - lay him flat, warm him and treat for shock. - assist his ventilations until his SpO2 improves. - administer aspirin for fever and oxygen for hypoxia.

administer oxygen and transport rapidly. Note only one choice includes rapid transport - the correct answer. He's hypotensive (likely septic shock), and doesn't need assisted ventilations. Keeping him warm when he is hot to touch is not good therapy. Using aspirin for fever in this case is improper, not recommended and fails to recognize the severity of his condition.

On arrival a 4 year old with a sore throat is leaning forward with hands on his knees experiencing difficulty breathing. He is hot to touch. When he speaks his voice sounds hoarse. His pulse oximeter reading is 94% on room air. You should - administer oxygen, keep the child calm and transport rapidly. - lay him flat, monitor his ABCs, and transport. - inspect his upper airway, monitor tracheal breath sounds and transport rapidly. - administer high flow oxygen, insert an oral airway and transport.

administer oxygen, keep the child calm and transport rapidly. This child presents with symptoms of epiglottitis. He needs rapid transport, oxygen and to remain calm. Laying a patient flat inhibits inhalation and withholding oxygen when these symptoms are present is not advised. Inserting an oral airway is strictly contraindicated when epiglottitis is a possibility. Even looking in his airway with something like a tongue blade is contraindicated.e

A patient has an allergic reaction, is hypotensive, and self-administers an Epi-pen auto injector. The therapeutic reason for this is its - sympathetic effects. - alpha effects. - beta effects. - adrenergic effects

alpha effects Epinephrine has both alpha and beta effects, but the vasoconstriction of epinephrine raises the blood pressure via its alpha effects. The beta effects will dilate the bronchioles which is also helpful but this question relates to hypotension. Adrenergic effects and sympathetic effects are correct but too broad an answer; the alpha effect is more specific. Know your medication's mechanisms of action.

Hypovolemic shock

an emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

A 62 year old male is having chest pain. He tells you it began one hour ago. You auscultate crackles in his lungs. His vital signs are B/P 142/82, P 94, R 16 and SpO2 is 94%. You administer aspirin and begin transport. En route he begins to sweat and wheeze. His B/P changes to 106/82. You suspect - right sided heart failure. - anaphylactic reaction. - cardiac asthma. - pneumonia.

anaphylactic reaction. This could be a difficult question if you don't notice the onset of hypotension, wheezing and diaphoresis and suspect what caused it. You just administered aspirin which could have caused the allergic condition. So suspecting an allergic reaction to the aspirin is the best choice given his symptoms. Right sided heart failure causes dependent edema (not moist lung sounds). Pneumonia doesn't have a sudden onset. Cardiac asthma is unlikely the cause of the hypotension onset.

An anaphylactic reaction occurs because of a/an antigen-antibody interaction. alpha-beta interaction. sympathetic-parasympathetic interaction. toxin-exotoxin interaction.

antigen-antibody interaction. Anaphylaxis is caused by an antigen-antibody interaction. There is no such thing as an alpha-beta interaction. The sympathetic and parasympathic systems interact but in a supportive way. The toxin-exotoxin interaction is a poor choice. Note some distractors include knowledge beyond that expected of an EMT, so avoid choosing an option that you have never read or heard about in class.

A 24 year old female who has a history of seizures may sense the onset of a seizure by experiencing a/an - flush. - flash. - aura. - headache.

aura You must know the phases of a seizure and many seizure patients have an aura before seizure onset. An aura can be a flash, a feeling of being flushed or a headache but auras are unique to the individual and not all seizure patients have the same sense regarding what will warn them of seizure onset.

A 26 year old male complains of increased breathing difficulty over the past two days. He tells you he has been coughing frequently. His vital signs are B/P 124/88, P 108, R 18. His SpO2 is 91% on room air. You suspect his SpO2 reading is low because he has - many collapsed alveoli in his lungs. - inadequate tidal volume. - lower airway constriction. - bacteria in his lungs.

bacteria in his lungs This patient most likely has bacteria in his lungs causing pneumonia. He has coughing and a gradual onset. Lower airway constriction causes wheezing, which is not present. Inadequate tidal volume is unlikely because he does not have shallow breathing with a change in level of consciousness. Collapse of alveoli is atelectasis; that occurs in pneumothorax and COPD but he's too young and there is no information regarding abnormal breath sounds.

A drug-influenced patient spits in an EMT's face. The EMT is angry and hits the patient in the face. Law enforcement was on the scene and arrests the EMT for - battery. - assault. - negligence. - defamation.

battery. Battery is the answer in most states. An assault legally doesn't imply physical force and could be verbal assault. Defamation relates to tort cases where one person damages the reputation of another. Negligence requires four acts to be proven: duty to act, a breach of that duty, a harmful outcome, and that the outcome was connected to your care. A violation of any one of the components can constitute negligence.

As you approach a 10 month old infant you do not see any chest wall movement. You lay the infant on a hard surface and are unable to find a pulse. You should next - apply an AED. - give two breaths. - begin chest compressions. - insert an oral airway.

begin chest compressions. In order to reduce public confusion regarding CPR in kids compared to adults, the recommendation currently is to follow the same sequence of CAB, thus chest compressions is the best answer. Although giving two breaths in an infant "does no harm" the recommendation (thus the right answer) is chest compressions first. Inserting an airway is not correct because this is a sequence question. The stem's last word is "next" so pick the choice you would first accomplish. Use of an AED is important in a pulseless patient but CPR should not be delayed.

Which of the chronic diseases below leads to increased levels of carbon dioxide in the blood? Cystic Fibrosis Pneumonitis Bronchitis Tuberculosis

bronchitis Bronchitis is one of the three diseases commonly found in patients who have COPD. They cause chronic increases in carbon dioxide. Pneumonitis occurs following aspiration of stomach juices, tuberculosis is a bacterial disease, and cystic fibrosis is a congenital disease found in children.

A 2 year old male was submerged in a backyard swimming pool. When you arrive he is out of the water on the pool deck where bystanders are performing mouth-to-mouth ventilations. You should first - check for a pulse. - perform abdominal thrusts. - begin compressions. - ventilate him.

check for a pulse. This is a near drowning question so the best choice answer is to check for a pulse. No need in ventilating him, it's already being done by the bystanders. But do they know if he's in cardiac arrest? It is best to confirm that. Chest compressions will be necessary if the child has no pulse, but you won't know that without checking that first. Performing abdominal thrusts is a poor choice. Note the stem says "first" so this is a sequence type item.

The level of carbon dioxide in the blood is monitored by the - respiratory rhythm center. - chemoreceptors. - medulla. - lung parenchyma.

chemoreceptors. "Chemo" relates to chemistry and refers to a receptor that monitors chemistry (this is how CO2 is monitored). "Baro" relates to monitoring stretch, mostly in vessels where baroreceptors monitor blood pressure. If you see this question on a CAT test, feel comfortable knowing you are getting higher level questions and likely passing at this point.

An 18 year old male has a gunshot in the right side of his chest. His vitals are B/P 108/82, P 104, R 24. You should suspect - obstructive shock. - pneumonitis. - compensatory shock. - pericarditis.

compensatory shock. Because he has a narrow pulse pressure, he is still compensating for his blood loss. Note hypovolemic shock is not a choice. Pericarditis is due to an infectious process of the pericardial sac. Obstructive shock most often occurs via a large pulmonary embolism. Pneumonitis is inflammation of the lung usually caused by an infection.

Your AED delivered a shock to a pulseless 54 year old man. You should next - re-analyze his rhythm. - check for ROSC. - continue chest compressions. - ventilate him with a BVM.

continue chest compressions. The recommendation in the 2015 guidelines continues to be that following a delivered shock, CPR should be continued for 2 minutes before a recheck of rhythm and pulse.

The primary danger for a patient with abdominal peritonitis, obtained without trauma, is - development of septic shock. - failure to detect the disease. - rupture of an organ. - loss of organ function.

development of septic shock. Peritonitis can be due to abdominal organ inflammation (appendicitis), and/or infections. These create fluid shifts and possible organ rupture leading to septic shock. It is true an organ can rupture but there are other causes of peritonitis so that is too specific to be the best answer. And if an organ ruptures it could result in loss of organ function; another distractor that is too specific. Failure to detect peritonitis is unlikely as it is very painful when fully developed. When choices are specific and a more broad answer is available, pick the more broad answer if you are unsure.

A vasovagal syncope episode mimics a transitory and reversible shock condition most like - cardiogenic shock. - distributive shock. - hypovolemic shock. - metabolic shock.

distributive shock. The blood is not lost (hypovolemic shock) or not moving (cardiogenic shock) nor is it full of metabolic toxins (metabolic shock). The blood is resting in the dilated vascular system in distributive shock. This is often called fainting and resolves itself relatively quickly.

The Mom of a 2 year old male calls you because her son is not able to be aroused during the night. She said yesterday the child's pediatrician said he had an ear infection. You suspect - meningitis. - influenza type symptoms. - anaphylactic reaction. - febrile seizure.

febrile seizure. Ear infections (otitis media) are a leading cause of febrile seizures in children. There is nothing in the stem to suspect an anaphylactic reaction. Meningitis could cause unconsciousness but the child's doctor said he had an ear infection, so meningitis could be correct but not the best choice. This child doesn't have the flu and the flu doesn't often lead to unconsciousness.

Which of the following victims would suffer loss of heat most rapidly? A victim who - had scant clothing on a windy day. - fell into icy water. - got locked in a meat locker. - collapsed drunk outside overnight.

fell into icy water. The body is 70% water and falling into ice water can create rapid hypothermia. Scant clothing on a windy day could be in summer; there is nothing in that distractor that assumes it's winter. Collapsing drunk outside will cause heat loss but not as fast as ice water. Getting locked in a meat locker causes hypothermia but nothing is as fast as immersion in ice water.

A 36 year old male was playing basketball and now complains of a dull pain in the center of his chest. His breath sounds are clear bilaterally. His vital signs are B/P 138/82, P 106 and irregular and R 16. You should - administer oxygen by non-rebreather mask. - monitor his breath sounds for pneumothorax. - frequently monitor his irregular pulse. - ask if he takes nitroglycerin.

frequently monitor his irregular pulse. The correct answer is to monitor his irregular pulse. It isn't likely that a man this young would take nitroglycerin. There is no pulse ox reading in the stem and the patient isn't in distress so administering 100% O2 is not a good choice. It would be OK to monitor his breath sounds, but clearly the best choice is to watch his irregular pulse since it might deteriorate into fibrillation.

A 14 year old male was rescued from a pond by Good Samaritans. When you arrive he is on the shore and no CPR is in progress. As you approach him you see no chest wall movement. You cannot palpate a pulse. You should next remove wet clothing. attach an AED. give two rescue breaths. begin compressions.

give two rescue breaths. This is a special circumstances type question. A CAB approach calls for chest compressions first. But in near drowning, you should ventilate first. Beginning chest compressions should follow. Removing wet clothing doesn't treat cardiac arrest. And attaching an AED may be necessary but should not delay the beginning of resuscitation. Note the stem says "next" so this is a sequence type question

An 18 year old female was in a single car crash at a low rate of speed. When you arrive law enforcement has her in handcuffs for "driving under the influence." As you assess her you should determine if she - drank whisky or another alcohol. - has a history of diabetes. - is susceptible to aspiration. - should go to the hospital or jail.

has a history of diabetes. Diabetics who suffer hypoglycemic episodes can exhibit symptoms that mimic being under the influence. Law enforcement may not know this, so you must assess the patient for a history of diabetes. You will not know by smelling someone's breath what type of alcoholic beverage they drank. It is a law enforcement decision regarding jail or a hospital but you can have major input on their decision if you can affirm the patient has diabetes. Aspiration following vomiting most likely occurs when the patient is unconscious.

When days are long and hot, you become most concerned if you assess someone who - speaks slowly and is confused. - has poor skin turgor and tachycardia. - has dry skin and is unable to sweat. - lost their appetite and has weakness.

has dry skin and is unable to sweat. Hot, dry skin and inability to sweat indicate a high likelihood of heat stroke. Poor skin turgor is not a healthy sign but that option is not as good of a choice as the one that includes dry skin. Speaking slowly and being confused is more likely in heat exhaustion. A loss of appetite and weakness are more likely present with flu-like symptoms.

You approach a victim at a scene who is 15 feet away. You recognize he is likely in hypovolemic shock because he - has blood on his face. - is cyanotic. - has pale skin. - is not looking straight at you.

has pale skin. This is a process of elimination question. A cyanotic patient likely has blood volume, it's just not circulating; thus hypovolemia is not the problem. An unconscious patient won't look at you and unconsciousness should cause you to suspect head trauma or some toxic condition or overdose. This isn't specific for hypovolemia. Having blood on his face is bleeding but not necessarily hypovolemic shock. Pale skin means vessel vasoconstriction or bleeding, thus is the most reliable predictor of shock.

A 25 year old male fell from his motorcycle. When you arrive he is walking around yelling and mad at the driver who forced him off the road. You assess him and find multiple abrasions and contusions but no fractures. His vital signs are B/P 146/82, P 104, R 16 and SpO2 is 97% on room air. As you prepare to transport he refuses care. You should - ask law enforcement to require him to be transported. - call his next of kin with instructions on having him obtain care. - have him sign a refusal form in front of a witness. - encourage him to seek emergency medical care.

have him sign a refusal form in front of a witness. Having him sign a refusal of care form in front of a witness is essential. We'd recommend you advise him to seek medical care but you cannot force someone to do this. It is important that in this stem we are providing evidence this patient is stable. And your run report should show this just in case an occult problem develops later. Law enforcement won't arrest this guy because you ask them to. Calling next of kin is advisable but you are not legally required to do this in order to protect yourself. Any actions you provide can lead to legal complications but having a witness when the patient signs a refusal of care form is important for your protection.

As you approach a patient who is sitting upright in a chair at home you should - begin to gather a history of the current illness. - observe if the patient is alone and ask for others. - have open arms, open hands and relaxed shoulders. -look at surroundings to see medications or any home treatments.

have open arms, open hands and relaxed shoulders. Your nonverbal communications are important when interacting with patients. The best example of using nonverbal therapeutic communication from these examples is to use open arms, open hands and relaxed shoulders. Gathering the history of the current illness happens rapidly on arrival but first try to determine if you are speaking to a reliable historian. Getting some sense of LOC and ability to answer your questions is an important part of your verbal communications, but this item was designed to teach you the importance of nonverbal communication as you approach a patient. Information regarding who is present should be included in your PCR. Looking around a house might be important but not until you've established rapport with the patient, completed a history, performed a physical exam and provided any immediate care.

Failure to allow recoil of the chest during chest compressions results in - increased incidence of rib fractures and subsequent hemothorax. - higher intrathoracic pressure which decreases hemodynamics. - inadequate coronary artery flow which sustains ventricular - fibrillation. - reduced venous return which increases cerebral edema.

higher intrathoracic pressure which decreases hemodynamics. Changes in intrathoracic pressure help blood circulate through the chest and fill the right side of the heart. Failure to allow sufficient recoil reduces the effectiveness of CPR. Rib fractures have nothing to do with recoil. Recoil has no effect on increasing cerebral edema and neither does coronary artery flow during V-fib (it's already inadequate which is why the patient is in V-fib).

A 52 year old obese female has facial droop, arm drift and weak grips of her right hand. These symptoms began 15 minutes ago after she vomited. You should suspect - conversion reaction. - influenza. - hypoglycemia. - electrolyte imbalance.

hypoglycemia Upon first reading the stem you would think "stroke" but that option isn't present. So, which of the answers mimics stoke? The answer is hypoglycemia. The flu, a conversion reaction (a psychological reaction) and an electrolyte imbalance won't mimic a stroke to the degree that hypoglycemia can. If stroke were present the test question would be too easy.

Body temperature is controlled by the brain's - cerebrum. - medulla. - hypothalamus. - cerebellum.

hypothalamus. The answer is hypothalamus (in the brain stem). The medulla is also in the brain stem so that is a really good distractor. The cerebellum is a separate part of the brain and it helps maintain balance when we are standing. The cerebrum is forward or higher up in the brain and it's where we do our thinking.

A 26 year old male is found unconscious in an alley outside a bar. He has pale and clammy skin. His vital signs are B/P 104/82, P 118, R 16 and his SpO2 is 95% on room air. You should suspect - hypovolemic shock. - head trauma. - distributive shock. - intra-thoracic bleeding.

hypovolemic shock. Make sure you pick your answers related to the words in the stem and don't be distracted by thoughts not in the stem (hence reading into the question). The answer to this question is hypovolemic shock. He has cold, clammy skin and a narrow pulse pressure, hence the best (and correct) answer. There is no information in the stem related to chest or head trauma. And distributive shock is a weaker distractor since there are no indications of conditions that cause distributive shock.

A 26 year old was struck by lightning while playing golf. When you arrive he has amnesia, pale, cool clammy skin and an irregular pulse. As you prepare to transport him you should - immobilize him to a long backboard. - ventilate him with 100% oxygen hooked up to a BVM. - elevate the head of the cot for comfort. - apply an AED to monitor him for v-fib.

immobilize him to a long backboard. With today's therapy surrounding clearing C-spines, one might not choose the correct answer to immobilize this patient. Because it is present it could cause you to pick a wrong answer. Never apply an AED to a conscious patient and this stem does not say he is unconscious. Elevation of the head won't help this guy. There is no indication he needs oxygen as there is no SpO2 reading in the stem. Spinal fractures are a possible complication of lightning strikes.

When a patient is in cardiac arrest you can treat him under the doctrine of - involuntary consent. - expressed consent. - nolo contendere. - implied consent.

implied consent It is implied that when a patient is unconscious he/she will want you to provide care. Expressed consent is spoken to you, or expressed when the patient calls 9-1-1 but it can be withdrawn if the patient tells you to not treat him/her. Involuntary consent is not a legal term. Nolo contendere is a plea in a legal case. Implied consent is an important term to remember.

In pediatric patients, excessive ventilations may cause - frequent bag-valve-mask pop-off malfunctions. - increases in intrathoracic pressures. - collapse of immature lung tissues. - reflexive regurgitation of stomach contents.

increases in intrathoracic pressures. Excessive ventilations may cause an increase in intrathoracic pressure in both adults and children. This decreases blood return to the heart and reduces cardiac output. All ventilation may cause regurgitation if done too forcefully but this is not "reflexive." Malfunctions with ventilation devices are rare and collapse of immature lungs is incorrect.

Paramedics have intubated a patient and they ask you to ventilate. You should - say "stop CPR," and administer 2 quick ventilations. - interpose one breath every 6 seconds. - say "stop CPR," and administer 2 slow ventilations. - interpose two breaths after 30 chest compressions.

interpose one breath every 6 seconds. When a patient is intubated, ventilations are interposed between chest compressions. So, an EMT should observe chest compressions and when the chest is compressed a ventilation should be delivered during the recoil period of the chest before the next compression is delivered. This should occur every 6 seconds. The team should not "stop" CPR except to defibrillate. Interposing after 30 compressions would result in too few ventilations.

A 72 year old female with a history of mental illness complains of a headache. Within 5 minutes she becomes unconscious. Her vitals are B/P 128/90, P 90, R 16. You should suspect - conversion reaction. - vasovagal syncope. - drug overdose. - intracerebral bleeding.

intracerebral bleeding. Intracerebal bleeding is the best choice. Vasovagal syncope (a simple faint), is present with hypotension. Conversion reaction is a psychological reaction and typically does not present with unconsciousness. A drug overdose is unlikely to present with a headache. Patients who complain of severe head pain who lose consciousness should be suspected of most likely suffering a stroke.

A 75 year old male is hot to touch and only able to mumble when you speak to him. His wife says he's been experiencing diverticulitis for the past week. His vitals are B/P 96/78, P 126, R 16 and his SpO2 is 90% on room air. You should - place him in the recovery position, provide oxygen and transport. - elevate his head, titrate his oxygen, and transport. - elevate his head, provide 100% oxygen and rapidly transport. - lay him flat, provide 100% oxygen, and rapidly transport.

lay him flat, provide 100% oxygen, and rapidly transport. The correct answer is to treat for shock. Elevation of the head is not recommended for patients in shock. Patients in shock that demonstrate the type of evidence found in this scenario (decreased BP, narrowing pulse pressure, altered mental status and low SpO2) need rapid transport.

You are eating lunch in a cafe when the person sitting next to you says, "I am feeling faint." You should - prepare for emesis. - get the ambulance cot. - lay the person flat. - assess his pulse rate.

lay the person flat. When someone reports being "faint," lay them flat. Going to get the ambulance cot takes time and fainting will likely happen before you return. Assessing pulse rate won't prevent the syncope from occurring. It is unlikely this person will vomit.

A 19 year old is threatening to "kill you," if you approach him. He's already told his mother that he wants to die. You should first - determine his lethality. - leave the scene. - determine if he is serious. - ask him his plan.

leave the scene. There is no lethal weapon in the stem, so this is a judgment call. The safest answer is to leave the scene; this is a law enforcement matter. Determining his lethality sounds good and you may do it, but it could result in your personal injury. Having a conversation with this young man may be OK, but it's best to wait until law enforcement tells you the scene is safe. His mother knows him best so determining if he is serious is also a judgment call that should wait until law enforcement says the scene is safe. Regardless, patients who express homicide or suicide need transport either by you or law enforcement.

Your team is performing CPR on an obese man who was found on the 2nd floor of his home. During your resuscitation attempts and transportation, outcome will most likely improve if you - use a mechanical CPR device. - limit interruptions of chest compressions. - switch CPR partners frequently. - ventilate at a rate of 10 bpm.

limit interruptions of chest compressions. Limiting interruptions of chest compressions is always recommended. In this scenario you should understand the CPR treatment dilemma. Ventilating at a rate of 10 bpm is OK, but if your team only pays attention to the ventilation rate during resuscitation and transportation, you'll be missing the biggest patient outcome opportunity of continuous CPR. Mechanical CPR devices have not been proven to provide better patient outcomes. They can be used, but scientifically they do not supersede good CPR without interruptions. Switching CPR partners is fine, but that too should be accomplished with limited interruptions.

The major complication for a patient with Type I diabetes is the - requirement to take insulin. - cessation of pancreatic function. - long term implications. - risk of death from hyperglycemia.

long term implications. It is important to know the difference between type I and type II diabetes. Type I used to be called juvenile onset, so the long term implications of the disease can be severe. Taking insulin is complicated but therapeutic. Patients with hyperglycemia know it is likely present and seek care. The loss of vision or an extremity infection are long term implications of diabetes but are not the only ones, thus a weaker choice.

A 53 year old female with a history of depression took 20 pills about 1 hour ago. She answers your questions but her speaking is slow. When you speak to her you should - hold her hand to make a physical connection. - tell her that suicide is not the answer. - ask questions slowly to be understood. - maintain good eye contact.

maintain good eye contact. Maintaining good eye contact shows compassion on your behalf. Asking questions slowly to a patient who speaks slowly is uncalled for. She is awake and discussing suicide with her is not called for; you can assume that based upon her history. She'll need transportation and the hospital will question her about suicide. Holding hands may make a patient comfortable but touch is not always accepted well.

A 52 year old lives in a home without air conditioning. It has been hot for the past 6 days. She is hot to touch and babbles when she speaks. Prior to transporting her you should - have her drink electrolyte containing sports drinks. - fan her and transport with your air conditioning on full strength. - cover her head and face with ice soaked towels. - make every effort to rapidly cool her temperature.

make every effort to rapidly cool her temperature. This patient is exhibiting signs and symptoms of heat stroke. She needs rapid cooling. A sports drink helps for heat cramps. Ice soaked towels over her face helps but this does not fulfill all of the requirements of rapid cooling and may cause airway issues. Fanning and lowering ambient temperature helps but again is an incomplete answer.

A 22 year old male vomited while running a 10K race and dropped out after 5 miles. He says to you, "I shouldn't have run today because I had the flu yesterday." His vitals are B/P 108/78, P 118, R 20 and his SpO2 is 92% on room air. You suspect - obstructive shock. - hypovolemic shock. - metabolic shock. - distributive shock.

metabolic shock. The judgment regarding the correct answer is between metabolic shock and hypovolemic shock. Distributive shock and obstructive shock are poor choices. This patient "thinks" he had the flu but there is no evidence in the stem of a medical diagnosis. Vomiting and sweating could lead to hypovolemia but he's only run 5 miles, so it's unlikely hypovolemia is from an acute cause. He was/is sick, he's produced much cellular waste from running and he could have bacteria in his blood. So the possibility of him having toxins in his blood is high. Metabolic shock is the correct answer, but choosing hypovolemic shock as your answer may not be completely wrong. Choose the best or most correct answer on a test. The most correct answer on an NREMT exam is confirmed by at least two panels of experts and via the outcome of pilot testing that was not used in construction of this item. This is a judgment answer type question not a hospital diagnosis

The best sign or symptom that differentiates angina from myocardial infarction is - not available within EMS practice. - the intensity of the pain the patient experiences. - the presence of fluid in the lungs. - location of the patient's chest pain.

not available within EMS practice. The best way to differentiate angina from an MI is to obtain serial cardiac enzymes after hospital admission. Chest pain is present in both MI and angina. Fluids in the lungs, most commonly due to cardiac disease, are present due to congestive heart failure. Pain intensity varies with all patients so angina and MI pain intensity is not specific enough. At times you will have to "eliminate" all choices and choose the one left because you know three of the four choices are wrong or less appealing choices.

You are called to a school by the nurse. On arrival she tells you a 12 year old girl with a history of diabetes is acting up. When you see her she is sweating and angry. You should - offer her some oral glucose. - call law enforcement for help. - obtain help to restrain her. - administer oxygen by nasal cannula.

offer her some oral glucose. This patient needs glucose. The other options are either ineffective in solving the problem (restrain her or call the cops) and giving her O2 won't reverse her hypoglycemia. Don't let false scene safety concerns lead you away from the best answer.

When using the Los Angeles Prehospital Stroke Screen a patient should be suspected of having a stroke if he has a deviation in - hemisphere assessments. - pupil reaction to light. - two or more assessment findings. - one assessment finding.

one assessment finding The most important thing regarding these stroke scales (either the Cincinnati or Los Angeles) is that one assessment finding that is abnormal is enough to conclude a possible stroke. Hemispheric assessment is part of both scales (arm drift or weakness) but not the entire scale as other assessments are included. Pupil reaction to light is not part of any scale.

You are speaking to online medical direction over the phone and providing the doctor the patient's medications. He interrupts your speaking and tells you to immediately give one of the drugs "PO." You should administer the drug - orally. - as a topical ointment. - as an eye drop. - sublingually.

orally. PO is a medical abbreviation meaning "administer orally." Eye drops can be administered OS (left eye) and OD (right eye). Topical ointments are not administered orally. Sublingual is an incorrect choice.

When completing a mental status examination a 28 year old male tells you, "I am afraid the CIA is going to arrest me for being an alien from outer space." You should suspect - catatonic schizophrenia. - paranoid schizophrenia. - delusions of grandeur. - delusional conflicts.

paranoid schizophrenia This patient has paranoid schizophrenia. This is not a delusion such as a delusion of grandeur. And two answers use the word delusion so most likely they are both bad choices. Catatonia is complete loss of affect in a patient with schizophrenia.

You are off duty swimming at a lake when someone rescues a swimmer who was submerged. When the rescuer brings the swimmer to shore you determine he is pulseless and apneic. You should first - assess for a cervical stepdown. - activate the EMS system. - perform a finger sweep of his airway. - perform five cycles of CPR.

perform five cycles of CPR. Perform five cycles of CPR. Activating the EMS system is a good choice but ventilations and CPR can change the outcome rapidly in this type of emergency. Note it says five cycles. If breathing doesn't return spontaneously you will need help, so activate the EMS system. Performing a finger sweep is incorrect. Assessing for a spinal injury should not be your first choice.

When a patient suffers a pulmonary embolism the clot will have its greatest influence on - perfusion pressure. - hydrostatic pressure. - oncotic pressure. - ventilation pressure.

perfusion pressure A large blood clot stops blood flow, thus decreasing perfusion pressure. Ventilation pressure comes from breathing, hydrostatic pressure is water pressure in the blood stream and oncotic pressure is the pulling pressure caused by actions of proteins in the blood stream. Both hydrostatic and oncotic pressure are not taught in an EMT course as frequently as they should be and should not be chosen as an option (they're wrong too).

cyanotic

pertaining to a blue or purple discoloration due to deoxygenated blood

A 24 year old female is having a grand mal seizure. After seizing for 5 minutes she stops. You should immediately suction her airway to remove secretions. place her in the recovery position. attach a pulse oximeter to determine hypoxia. protect her airway with an oropharyngeal airway.

place her in the recovery position. Vomiting may follow a seizure so protecting the airway is vital. The recovery position does that and helps drainage of secretions. An oropharyngeal airway opens the airway and only protects it from collapse of the tongue in an unconscious patient. Determining blood oxygenation is nice but aspiration of stomach contents can be lethal. Suctioning is also nice but if her stomach is full prior to the seizure moving her to a lateral position helps eliminate the stomach contents if she vomits and then you should suction any remaining contents. Note the stem says "immediately."

A 16 year old was stabbed in his LUQ. He is comfortable but upset about the incident. His vitals are B/P 128/82, P 94, R 14 and SpO2 is 96% on room air. You should - provide support and transport. - cover the wound with a non-porous dressing. - place him in the recovery position. - administer oxygen by non-rebreather mask.

provide support and transport. Provide supportive care. This patient needs monitoring but currently is not sick. There is no evidence in the stem that he needs O2, to be placed in the recovery position or that he needs a non-porous dressing over his abdominal wound.

A 46 year old male complains of severe epigastric pain 20 minutes after eating dinner with his wife. He is diaphoretic and pale. His vitals are B/P 138/82, P 94, R 16 and SpO2 is 96% on room air. You should - provide supportive care. - administer aspirin 81 mg. - attach an AED. - administer oxygen by nasal cannula 3 Lpm.

provide supportive care. This patient is most likely suffering a gallbladder attack and there is nothing you can do but provide supportive care. Supportive care means to support body systems. He is conscious so attaching the AED is contraindicated. He doesn't need oxygen with an SpO2 of 96%. While the epigastric pain may be cardiac related, the proximity to eating makes it less likely and makes aspirin a lesser choice.

Rapid ascent to high altitude without proper acclimatization will produce - pericarditis. - thrombophlebitis. - anaerobic metabolism. - pulmonary edema.

pulmonary edema. The only realistic choice is pulmonary edema. Anaerobic metabolism happens most often when healthy people exercise beyond their aerobic range and it is present in low perfusion states. Pericarditis is wrong as it's an inflammation of the heart. Thrombophlebitis happens when venous blood is not moving or there is damage to the lining of a vein. Acclimatization means getting "used to" a rise in elevation over time.

A 52 year old male complains of sudden onset of shortness of breath. He has some right sided chest pain. His vitals are B/P 102/84, P 108, R 18 and SpO2 is 86% on room air. He tells you he thinks he has some odd type of flu because 2 days ago he flew home from Asia. You suspect - pulmonary embolism. - Asian encephalitis. - cor pulmonale. - pneumonia.

pulmonary embolism. Lack of movement is a leading cause of pulmonary embolism and this patient just completed a long airline flight from Asia. Encephalitis (brain swelling) causes headache, not chest pain. Pneumonia could be possible but it's less likely because he is not coughing, doesn't complain of fever and he has a stated report of long distance travel which likely led to venous obstruction. Cor pulmonale is right-sided heart failure and these vital signs and his history don't fit with that disease.

When moving objects it is always best to - push rather than pull. - pull rather than push. - complete a lift within 30 seconds. - complete a lift within 10 seconds.

push rather than pull. Pushing objects leads to less injuries than pulling objects. There is no time limit on lifting or moving objects or patients.

A victim who has a low body temperature must be - re-warmed before defibrillation. - ventilated with super heated air. - re-warmed from the center outward. - placed in a hyperbaric chamber.

re-warmed from the center outward. The general answer of rewarmed from the center outward is the correct answer. Not all hypothermic patients are in fibrillation and some can be shocked depending upon how low the body temperature is. Ventilation with warm moist air is a technique for rewarming from the core outward but not with super-heated air such as that seen during a fire where flames are inhaled. A hyperbaric chamber is used to decompress patients with the bends who surface too fast when SCUBA diving as well as for other therapies.

When a person goes into cardiac arrest the oxygen level in the non-circulating arterial blood decreases dramatically. becomes diffused into tissues. remains the same. decreases slightly.

remains the same Deoxygenation of blood takes time. Right when someone goes into cardiac arrest the blood oxygen remains the same. After 1 minute without breathing it decreases and the longer apnea is present the more it decreases. Note the stem says, "goes into cardiac arrest." Read each question carefully and its lettered answers. Oxygen diffuses into cells but that is not as strong an answer as it remains the same. Because blood oxygen remains the same initially, the AHA guidelines continue to recommend not delaying chest compressions while the AED is being prepared in cases of non-witnessed cardiac arrest.

You are transporting a 3 year old who "fell down the stairs." He is unconscious and you notice many ecchymotic areas on him during your examination. You should - report child abuse to children's services. - report this to hospital personnel. - ask the parents questions regarding the fall. - record your observations on the PCR.

report this to hospital personnel. In most states you must legally (and certainly ethically) report signs of possible child abuse to hospital personnel. This is the best answer. Children's services will be part of the investigation but "reporting" your suspicions to the hospital receiving staff is minimally essential. Asking the parents about the fall is part of your history and their answers will help you determine what you should report. You should also record your observations on your PCR as you would with any patient.

A 60 year old homeless man is found leaning beside a sign talking to no visible person. He says he's interviewing for a job. You should suspect he has - delusions. - illusions. - bipolar disease. - schizophrenia.

schizophrenia. The correct answer is schizophrenia; a common problem in homeless persons. A delusion is when someone thinks something false is true despite convincing evidence the delusion is false. An illusion is when you falsely interpret something acquired by the senses, such as by sight. Persons with bipolar disease may have periods where false beliefs are present but it's most typically a mood disorder of hyperactivity followed by periods of depression.

A 16 year old female has an altered mental status and is verbally threatening her mother. When you arrive she screams, "Go away!" As you are talking to her, her level of consciousness decreases. You approach her and she takes a swing at you with her fist. You should - leave the scene. - call for law enforcement. - offer her some oral glucose. - set up a plan to restrain her.

set up a plan to restrain her. This is a judgment call. The description of the situation doesn't involve a weapon and she has a decreasing level of consciousness. So, in this case you better be prepared to restrain her following setting up a plan. Leaving the scene won't tell you why she has an altered mental status. You should assess her. Calling law enforcement might be necessary but you will still need to assess her and calling the cops might not be necessary. Offering her oral glucose would be a better choice if there was some indication of a diabetic history.

You are called to an unkempt home of a 32 year old female, whose father called because she had an acute onset of shortness of breath. During your assessment she says she is afraid to go outside and to the hospital. Her vital signs are B/P 128/84, P 90, R 16 and her SpO2 is 90%. You hear diffuse wheezing throughout her lung fields. You suspect - drug interaction. - hyperventilation syndrome. - hypoglycemia. - she has a phobia.

she has a phobia. Except for the wheezing, this person is doing pretty well. Being afraid to go outdoors to the hospital would represent a phobia called agorophobia. Respiratory rates of 16 are unlikely to yield hyperventilation unless the inspiratory volume is very high. She's not diabetic so hypoglycemia is unlikely. There is no mention of her taking prescription drugs so a drug interaction is unlikely. Drug interactions occur with prescription and over-the-counter drugs. Don't confuse drug interaction with a drug overdose.

Most ingested poisons are absorbed in the - colon. - large bowel. - stomach. - small bowel.

small bowel Toxins are absorbed in the small bowel. The stomach starts the digestive process but doesn't absorb many products. The large bowel continues the digestive process and the colon absorbs water and stores fecal matter.

A 25 year old male complains of shortness of breath over the past four hours after playing soccer. His chest expansion is normal and he has no chest wall pain. You hear diminished breath sounds over his right upper thorax. Vital signs are B/P 126/84, P 106, R 18. His SpO2 is 92% on room air. You should suspect - pleuritis. - pulmonary embolism. - spontaneous pneumothorax. - costochondritis.

spontaneous pneumothorax. This man most likely suffered a spontaneous pneumothorax. Exertion during exercise of a young man, (likely thin in body structure), that causes diminished breath sounds on one side are the clues. A pulmonary embolism is unlikely in a young person who was exercising. Costrochondritis presents with chest wall pain. Pleuritis presents with chest pain that dissipates when the patient holds their breath

A 6 month old boy is cyanotic and has a pulse rate of 46 bpm. You should - attach an AED that is capable of adjusting the shock delivered in joules. - start chest compressions using the two finger chest compression technique. - start chest compressions using the two thumb encircling hand technique. - attach an AED that possesses a pediatric attenuator device.

start chest compressions using the two thumb encircling hand technique. This infant is hypoperfusing and needs to improve circulation. Start chest compressions first. It is recommended to perform the two thumb encircling hand technique on a 6 month old rather than the two finger chest compression technique. Attaching an AED is incorrect as most infants who have hypoperfusion without trauma develop arrest due to a lack of oxygen. The patient has a pulse.

A 58 year old female is unconscious and in respiratory failure. As you begin managing her she vomits. You should first - ventilate her twice and then clear her airway. - rapidly turn her to clear her airway then turn her supine to ventilate. - suction her for 15 seconds then ventilate her. - suction her airway for a minute then ventilate her.

suction her for 15 seconds then ventilate her. Suction quickly and efficiently for as long as it takes to clear the airway. 15 seconds isn't a definite rule, but is the best answer here. Suctioning is part of opening an airway, which precedes any ventilations. If you ventilate gastric juices into the lung you can help cause a lethal aspiration pneumonitis. Suctioning is more effective than moving the patient onto their side. Suction first, then ventilate.

anaphylactic reaction (anaphylaxis)

sudden, widespread, potentially severe and life-threatening allergic reactions. Anaphylactic reactions often begin with a feeling of uneasiness, followed by tingling sensations and dizziness.

A 42 year old Type II diabetic has an altered level of consciousness. You should provide - coffee. - soda. - sugar drink. - oxygen.

sugar drink This is an easy question. Provide a sugar drink before the patient becomes unconscious. The oxygen won't help the hypoglycemia. Coffee has no sugar unless added and a soda won't react as fast as a sugar drink.

Inhalation of a toxic gas can lead to hypoxia when the substance in the gas produces - damage to the epithelial cells of the airway. - swelling which narrows the bore of the airway. - irritation of the larynx and esophagus causing spasm. - breakdown of cilia in the airway causing pain.

swelling which narrows the bore of the airway. Swelling in airways causes airway obstruction (in upper airways, lower airways or both). A breakdown of the cilia lining in the lower airways occurs due to cigarette smoking or chronic exposure to toxins. Irritation of the larynx is a poor choice. A toxic gas will damage the epithelial cells of the airway after they swell up and close the airway causing additional long term complications from the inhalation.

A 72 year old female suddenly collapsed in church. When you arrive she is awake but "feels funny." Witnesses say she did not have a pulse and after 2-3 minutes she woke up. Her vitals are B/P 100/70, P 64, R 14. You should suspect - hypoglycemia. - syncope. - transient ischemic attack. - heart attack.

syncope This patient fainted in church and woke up relatively quickly, thus syncope is the correct answer. A heart attack is unlikely, as one would assume a heart attack that causes unconsciousness is most likely fibrillation and the patient will not wake up. A TIA could be possible but the hypotension doesn't fit well in that scenario. And once someone is hypoglycemic enough to collapse, it is unlikely they will wake up unless provided glucose intravenously.

A 13 year old with a history of asthma self administered her metered dose inhaler prior to your arrival. She remains short of breath and has wheezes throughout her lung fields. After administration of oxygen you should - tell her to self administer a second dose of medication. - titrate her oxygen delivery to pulse oximeter reading. - transport her routinely to the hospital. - ask her to demonstrate how she used the inhaler.

tell her to self administer a second dose of medication. Telling this person to repeat the dose of her inhaler will inform you if she is oriented enough to understand your instructions and if she can self-administer the medication properly. Another dose won't cause any harm as there is no toxic dose for beta2 inhalation drugs. Titrating her O2 to pulse oximeter readings is not recommended. It could be OK to transport routinely but in light of the other choices, this would not be optimal care or the best answer (this answer assumes you are not going to provide any care). Having her demonstrate how she used the inhaler doesn't mean she is receiving a second dose.

syncope

temporary loss of consciousness caused by a fall in blood pressure.

acute coronary syndrome

term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.

Heat stroke patients have hot dry skin because - they were unable to ingest adequate fluids. - during transition from exhaustion to stroke they did not absorb water. - their ability to sweat becomes disrupted. - during the prodromal phase all their fluids are shifted

their ability to sweat becomes disrupted. This is a process of elimination question because all but the right answer are definitely wrong. Hot dry skin is a key sign in heat stroke, which affects the thermoregulating system in the brain. A prodromal phase relates to infectious diseases. Fluid input helps prevent heat stroke but once it's present, it's too late to drink fluids. Not absorbing water is a very weak distractor.

An elementary school nurse calls you to transport a child she says had a petit mal seizure. During transport you should monitor the child - for signs of impending brain attack. - to assure an open airway. - to provide support and comfort. - for periods of apnea.

to provide support and comfort. A petit mal seizure is a simple seizure and this child will likely become fully conscious without any care. Petit mal seizures don't cause apnea. The child will have an open airway. And a stoke (or brain attack) is very unlikely in this child.

A 64 year old male complains of chest pain over the past two hours. He says he feels tightness and is otherwise comfortable. He tells you his father died of a heart attack, "at a young age." His vitals are B/P 118/78, P 94, R 16 and SpO2 is 95% on room air. You should - administer oxygen by nasal cannula. - administer oxygen by non-rebreather mask. - transport and monitor him. - transport and apply an AED.

transport and monitor him. Transport and monitor this patient. His oxygen saturation is adequate so he doesn't need oxygen via any delivery device and applying an AED on a conscious patient is contraindicated.

An 81 year old female has increasing shortness of breath. She tells you she smoked cigarettes "all my life and I loved them!" She has swollen lower extremities. Her vitals are B/P 112/86, P 86, R 16 and her SpO2 is 93% on 3 Lpm. You should - increase her oxygen to 6 Lpm by nasal cannula. - administer oxygen by non-rebreather mask. - transport her on 3 Lpm by nasal cannula. - ask her if she is being treated for emphysema.

transport her on 3 Lpm by nasal cannula. Transport her and maintain her O2 flow rate. Her assessment findings indicate she is oxygenating well for someone with COPD. She doesn't need ventilation. Increasing her oxygen flow rate is not necessary at this point—and 6 liters is a lot, which makes this choice less valid. Another dose of medication may help but is not necessary. She needs transport more than any other choice listed.

A 72 year old male is vomiting large amounts of dark foul smelling liquids. He has diffuse colicky abdominal pain. His skin is cool and clammy. His vital signs are B/P 108/86, P 106, R 16 and SpO2 is 93% on room air. You should - give sips of sports drinks. - treat for shock. - provide supportive care. - administer 100% oxygen.

treat for shock. Treat this patient for shock. He has a narrow pulse pressure (a vital sign you must pay attention to) with cool, clammy skin and he's oxygenated. He likely has a bowel obstruction so don't give patients oral fluids with abdominal pain. Supportive care is not enough; he's in the early stages of shock.

The cause of epilepsy is - unknown. - abnormal delivery. - non-compliance of drugs. - poor nutrition.

unknown. The cause is unknown. Poor nutrition and abnormal delivery (childbirth) are poor choices. Non-compliance of medications for those who have epilepsy may make seizures more frequent but it is not the pathophysiological cause.

The cause of schizophrenia is - malnutrition. - unknown. - poor child development. - genetic.

unknown. This is one that you either know or don't know. The cause of schizophrenia is unknown. Your studies would have mentioned if it was a genetic disease, or due to poor child development or malnutrition. So, if you didn't read or hear the best answer to a test item in class or from the book, and unknown is an option, pick that option.

A 60 year old male is pale and short of breath on your arrival. He asks to go to the hospital because he is "sick and weak." His vitals are B/P 104/82, P 96, R 14. He tells you his stools have been dark colored for the past week. You should suspect - lower gastrointestinal bleeding. - diverticulitis. - upper gastrointestinal bleeding. - the onset of colon cancer.

upper gastrointestinal bleeding. The best assessment would most likely be an upper GI bleed. An upper GI bleed leads to "digested" blood being dark in color compared to a lower GI bleed where the blood is more red in color. The diverticula appear in the lower bowel and cause pain, and perhaps bleeding. Since the colon is also in the lower bowel an understanding of anatomy helps lead to the answer.

When speaking to a child under the age of 4 it is best to - hold their hands to reduce fears. - use a calm voice and smile at them. - change your voice to a higher tone. - let them hold a toy or blanket.

use a calm voice and smile at them. Using a calm voice and smiling are effective with a child of this age. Giving them a toy or blanket might be helpful but younger children will likely benefit more than this age child. Changing your voice doesn't help. Since the child doesn't know you, touch or holding the hand might cause anxiety.

The mechanism that causes migraine headaches is - vasoconstriction followed by vasospasm. - nerve cell inflammation followed by vasoconstriction. - vasospasm followed by vasodilation. - vasodilation followed by nerve cell inflammation.

vasospasm followed by vasodilation. This one is a moderate to difficult question for an aspiring EMT. Vasospasm of cerebral arteries leading to vasodilation of those arteries causes migraine headaches. Vasoconstriction is not part of the mechanism. Nerve cell inflammation (encephalitis) is likely from a cerebral infection.

A 14 year old female collapsed at a drug store after receiving a flu shot. When you arrive she is conscious and alert. Her vital signs are B/P 108/78, P 64, R 12. Her SpO2 is 97% on room air. You suspect - allergic reaction. - psychosomatic symptoms. - vasovagal syncope. - anaphylactoid reaction.

vasovagal syncope. She fainted. Vasovagal syncope is the cause. There are no other signs of an anaphylactoid reaction or an allergic reaction. Psychosomatic symptoms is not the answer, but for a teenager getting a shot can cause psychological stress.

A 14 year old female collapsed at a drug store after receiving a flu shot. When you arrive she is conscious and alert. Her vital signs are B/P 108/78, P 64, R 12. Her SpO2 is 97% on room air. You suspect - vasovagal syncope. - psychosomatic symptoms. - anaphylactoid reaction. - allergic reaction.

vasovagal syncope. She fainted. Vasovagal syncope is the cause. There are no other signs of an anaphylactoid reaction or an allergic reaction. Psychosomatic symptoms is not the answer, but for a teenager getting a shot can cause psychological stress.

The primary origin of an irregular pulse is located in the - atrium. - left mainstem artery. - SA node. - ventricles.

ventricles A heart beat is detected peripherally by amplitude of the stroke output detected along an artery that passes over a bony area, such as the radial pulse. When it is irregular, the primary cause is a premature ventricular beat that disrupts stroke volume (thus a loss of pulse amplitude). The SA node can misfire but it will cause a loss of atrial kick. While affecting stroke volume, it is less likely to cause a loss of pulse. The mainstem artery and atrium are poor anatomic choices.