Paramedic final part 1.

Ace your homework & exams now with Quizwiz!

Which of the following classifications of medication may potentiate atenolol? A) Alpha-adrenergic agonist B) Calcium channel blocker C) Selective beta-2 agonist D) Beta-1 receptor agonist

) Calcium channel blocker

Premature ventricular complexes: A) are ectopic complexes that originate from a different pacemaker site. B) are extra systolic beats that break the regularity of the underlying rhythm. C) are in themselves considered arrhythmias, but are generally insignificant. D) occur later than the next expected complex, causing an irregular rhythm.

Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is: A) a vasopressor. B) calcium chloride. C) an inotrope. D) an antidysrhythmic.

Repolarization begins when: A) the sodium and calcium channels close. B) calcium ions slowly enter the cardiac cell. C) potassium ions rapidly escape from the cell. D) the inside of the cell returns to a positive charge.

Sinus arrest is characterized by: A) a dropped PQRST complex. B) an irregularly irregular rhythm. C) PR intervals greater than 0.12 seconds. D) irregularity during the inspiratory phase.

The 6-second method for calculating the rate of a cardiac rhythm: A) involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10. B) is an accurate method for calculating the heart rate if the cardiac rhythm is grossly irregular and very fast. C) will yield an estimated heart rate that is typically within 2 to 3 beats per minute of the actual heart rate. D) takes longer than other methods of calculating the rate and is thus impractical to use with critical patients.

The MOST common cause of right-sided heart failure is: A) left-sided heart failure. B) pulmonary hypotension. C) acute pulmonary embolism. D) long-standing emphysema.

The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration. A) 0.12, 0.20 B) 0.14, 0.30 C) 0.16, 0.40 D) 0.18, 2.0

The S1 heart sound represents: A) closure of the mitral and tricuspid valves. B) the end of ventricular contraction. C) closure of the aortic and pulmonic valves. D) the beginning of atrial contraction.

The __________ represents the end of ventricular depolarization and the beginning of repolarization. A) J point B) T wave C) ST segment D) T-P interval

The ability of the heart to vary the degree of its contraction without stretching is called: A) contractility. B) chronotropy. C) automaticity. D) the Frank-Starling mechanism.

The atrioventricular valves of the heart include the: A) tricuspid and mitral. B) mitral and aortic. C) bicuspid and aortic. D) tricuspid and pulmonic.

The brain and spinal cord are connected through a large opening at the base of the skull called the: A) foramen magnum. B) lamboid suture. C) vertebral foramen. D) mastoid process.

The catecholamine epinephrine (adrenaline) has an affinity for: A) alpha and beta receptors. B) alpha-1 receptors only. C) beta-1 receptors only. D) alpha-1 and beta-2 receptors.

The cell membrane is selectively permeable, which means that it: A) allows only certain substances to pass through it. B) will allow any substance to readily pass through it. C) only allows potassium and calcium to pass through it. D) only allows sodium and chloride to pass through it.

The epiglottis can be BEST described as: A) a valve that covers the trachea during swallowing. B) cartilage that closes the esophagus during breathing. C) a ligament that attaches the vocal cords to the glottic opening. D) cartilage that is inferior to the glottis and keeps the esophagus open.

The farther removed the conduction tissue is from the SA node: A) the slower its intrinsic rate of firing. B) the longer the PR interval will be. C) the faster its intrinsic rate of firing. D) the narrower the QRS complex will be.

The femoral artery gives rise to all of the following arteries, EXCEPT the: A) iliac arteries. B) popliteal arteries. C) dorsalis pedis arteries. D) posterior tibial arteries.

The first artery to branch from the aortic arch is the: A) brachiocephalic artery. B) internal carotid artery. C) external carotid artery. D) common iliac artery.

The first portion of the small intestine that receives food from the stomach is the: A) duodenum. B) jejunum. C) ilium. D) ileum.

The heart's anatomic location is MOST accurately described as being: A) retrosternal. B) hemithoracic. C) submediastinal. D) supradiaphragmatic.

The hypoxic drive, a backup system to control breathing, is stimulated when: A) arterial PaO2 levels decrease. B) arterial PaCO2 levels increase. C) arterial PaO2 levels increase. D) arterial PaCO2 levels decrease.

The inferior wall of the left ventricle is supplied by the: A) right coronary artery. B) left coronary artery. C) circumflex artery. D) left anterior descending artery.

The layers of the wall of the heart, beginning with the outermost layer, are the: A) epicardium, myocardium, and endocardium. B) endocardium, epicardium, and myocardium. C) myocardium, epicardium, and endocardium. D) epicardium, endocardium, and myocardium.

The mitral valve: A) is located on the higher-pressure side of the heart. B) separates the right atrium from the right ventricle. C) prevents blood regurgitation into the left ventricle. D) is a tricuspid valve located on the right side of the heart.

The myocardium is the only muscle that can generate its own electrical impulses. This process is called: A) automaticity. B) excitability. C) conductivity. D) dromotropy. 70. Dysfunction of

The normal P wave duration is less than ___ milliseconds and the amplitude is less than ___ millimeters tall. A) 110; 2.5 B) 120; 3.0 C) 130; 3.5 D) 140; 4.0

The outer adrenal cortex produces which of the following substances? A) Aldosterone B) Epinephrine C) Norepinephrine D) Dopamine

The point where the first cervical vertebra (C1) articulates with the base of the skull is called the: A) atlanto-occipital joint. B) odontoid process. C) vertebral foramen. D) vertebra prominens.

The process of aortic dissection begins when: A) the intimal layer of the aortic wall is torn. B) hypertension causes acute rupture of the aorta. C) the aorta is weakened due to excessive pressure. D) blood accumulates between the layers of the aorta.

The projection of the neurons that receives electrical impulses from other neurons is called a(n): A) dendrite. B) axon. C) neuroglia. D) motor fiber.

The respiratory center of the brain is located in the: A) medulla. B) cerebrum. C) cerebellum. D) hypothalamus.

The thick fibrous membrane that surrounds the heart is called the: A) pericardium. B) myocardium. C) epicardium. D) endocardium.

Tiny particles that compose elements and vary in size and weight are called: A) atoms. B) electrons. C) isotopes. D) molecules.

To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that: A) stimulates beta-1 and beta-2 receptors. B) stimulates beta-2 and alpha receptors. C) blocks beta-1 and beta-2 receptors. D) blocks beta receptors and stimulates alpha receptors.

Ventricular muscle contraction and the pumping of blood throughout the body occur during: A) systole. B) diastole. C) asystole. D) the cardiac cycle.

What are the three layers of the blood vessel, starting with the outer layer? A) Tunica adventitia, tunica media, tunica intima B) Tunica intima, tunica adventitia, tunica media C) Tunica media, tunica intima, tunica adventitia D) Tunica media, tunica adventitia, tunica intima

What is the MOST appropriate sequence of treatment for a patient with a suspected acute myocardial infarction? A) Oxygen, aspirin, nitroglycerin, morphine B) Oxygen, nitroglycerin, aspirin, morphine C) Aspirin, nitroglycerin, oxygen, morphine D) Morphine, oxygen, aspirin, nitroglycerin

What is the R-on-T phenomenon? A) A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized B) When the R wave occurs at the J point of the next cardiac cycle C) A unifocal PVC that occurs during the upslope of any given T wave D) A PVC that occurs during a time when the ventricles are depolarizing

What is the action of adrenocorticotropic hormone (ACTH)? A) Controls hormone secretion from the adrenal cortex B) Increases the size and division rate of body cells C) Develops egg-containing follicles in females D) Controls conservation of water in the kidneys

What is the approximate maximum dose of lidocaine for a 200-pound patient? A) 275 mg B) 300 mg C) 325 mg D) 350 mg

What is the function of a baroreceptor? A) Monitoring changes in arterial pressure B) Sensing changes in arterial oxygen levels C) Monitoring the pH of cerebrospinal fluid D) Sensing the arterial level of carbon dioxide

What physiologic response occurs when a person loses blood? A) Vessels constrict and myocardial contractility increases. B) The heart rate increases and cardiac afterload decreases. C) The sympathetic nervous system decreases SA node discharge. D) Blood vessels dilate in order to increase arterial blood pressure.

What portion of the brain is a relay center that filters important signals from routine signals? A) Thalamus B) Prefrontal area C) Hypothalamus D) Temporal lobe

What type of tissue fills body spaces, stores fat, and produces blood cells? A) Connective B) Muscle C) Nerve D) Epithelial

When activated, fibrinogen is converted to: A) fibrin. B) plasmin. C) thrombin. D) thromboplastin.

When applying the precordial leads, lead V1 should be placed in the: A) fourth intercostal space at the right sternal border. B) fourth intercostal space at the left sternal border. C) fifth intercostal space at the left midclavicular line. D) fourth intercostal space at the left midclavicular border.

When reviewing a cardiac patient's medication list, you note that she is taking bisoprolol. You recognize that this drug is also called _____________ and is classified as a(n) _____________. A) Zebeta, beta blocker B) Betapace, antiarrhythmic C) Ticlid, antiplatelet agent D) Norvasc, calcium channel blocker

Which of the following ECG abnormalities is MOST consistent with hyperkalemia? A) Tall, peaked T waves B) Prominent U waves C) Prolonged QT interval D) The presence of a J wave

Which of the following describes the shock position? A) The head and torso are supine and the legs are elevated 6" to 12". B) The head is elevated at a 45° angle and the legs are elevated 8". C) The body is supine with the head down and the legs elevated. D) The body is laterally recumbent and the head is lowered.

Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia? A) Aberrant conduction B) Absence of P waves C) Retrograde conduction D) The rate of the rhythm

Which of the following is NOT part of the pelvis? A) Trochanter B) Iliac crest C) Pubic symphysis D) Sacroiliac joint

Which of the following lists, in the correct order, the return of blood from the systemic circulation to the heart? A) Capillaries, venules, veins, vena cava B) Venules, capillaries, veins, vena cava C) Capillaries, arterioles, arteries, aorta D) Arterioles, capillaries, arteries, aorta

Which of the following statements regarding an idioventricular rhythm is correct? A) Most patients with an idioventricular rhythm are hemodynamically unstable. B) Treatment for an idioventricular rhythm focuses on increasing blood pressure. C) Idioventricular rhythms are typically accompanied by nonconducted P waves. D) The most common cause of an idioventricular rhythm is failure of the SA node.

Which of the following statements regarding interstitial fluid is correct? A) It is located in the extracellular space and between the cells. B) It accounts for approximately 30% of total body weight. C) It is located within the blood vessels in the form of plasma. D) It is equal to approximately 15% to 20% of the total body weight.

Which of the following statements regarding sinus bradycardia is correct? A) Treatment focuses on the patient's tolerance to the bradycardia. B) Symptomatic bradycardia is often caused by a decreased atrial rate. C) Sinus bradycardia often requires multiple doses of atropine to correct it. D) Sinus bradycardia is caused by decreased vagal tone in most patients.

Which of the following statements regarding the SA node is correct? A) The SA node is the dominant cardiac pacemaker in healthy patients. B) SA nodal ischemia occurs when the left coronary artery is occluded. C) The SA node is located in the superior aspect of the right ventricle. D) Impulses generated by the SA node travel through the right atrium only.

Which of the following statements regarding the thyroid cartilage is correct? A) It is the anterior part of the larynx. B) It is inferior to the cricoid cartilage. C) It is not easily seen in most people. D) It lies directly posterior to the larynx.

Which of the following represents a correct adult dose of diphenhydramine? A) 25 to 50 mg IM B) 1 to 2 mg/kg IV C) 12.5 to 25 mg SC D) 50 to 100 mg IV

A) 25 to 50 mg IM

The standard adult dose for ondansetron (Zofran) is: A) 4 mg. B) 12.5 mg. C) 10 to 15 mg. D) 0.1 mg/kg.

A) 4 mg.

After administering rocuronium bromide (Zemuron), you can expect its effects to last for at least: A) 45 minutes. B) 60 minutes. C) 90 minutes. D) 120 minutes.

A) 45 minutes.

Indications for lidocaine hydrochloride (Xylocaine) include all of the following, EXCEPT: A) AV heart block in the absence of an artificial pacemaker. B) ventricular fibrillation that is refractory to defibrillation. C) wide-complex tachycardia with a normal baseline QT interval. D) stable ventricular tachycardia with preserved ventricular function.

A) AV heart block in the absence of an artificial pacemaker.

Which of the following is an example of secondary injury prevention? A) Administering oxygen to a patient with a closed head injury B) Inspecting a child safety seat to ensure that it is installed properly C) Transporting a patient from home to a physical therapy appointment D) Conducting a seminar regarding the appropriate use of bicycle helmets

A) Administering oxygen to a patient with a closed head injury

Which of the following medications converts hemoglobin to methemoglobin, which chemically binds with cyanide and prevents its toxic effect? A) Amyl nitrite B) Romazicon C) Calcium gluconate D) Hydroxocobalamin

A) Amyl nitrite

What is the mechanism of action of amiodarone? A) Blocks sodium channels and myocardial potassium channels B) Acts directly on the sinus node and slows impulse formation C) Blocks calcium channels and decreases cardiac contractility D) Antagonizes beta-1 receptors and decreases the heart rate

A) Blocks sodium channels and myocardial potassium channels

Which of the following medications should NOT be given through an IV line of D5W? A) Dilantin B) Solu-Medrol C) Verapamil D) Amiodarone

A) Dilantin

65. IO infusion rates are comparable to IV infusion rates: A) when a pressure bag or mechanical infusion device is used. B) only when the extremity with the IO needle inserted is elevated. C) if the patient's systolic blood pressure is at least 100 mm Hg. D) only if the IO needle is inserted in the proximal tibia.

Ans: A Page: 439

67. Which of the following statements regarding the IM route of medication administration is correct? A) Medications have a bioavailability of 75% to 100% following IM administration. B) Any medication given by the IV route can be given by the IM route. C) IM-administered medications are subject to first-pass metabolism in the liver. D) Muscle perfusion has minimal effect on the absorption of IM-administered drugs.

Ans: A Page: 439

72. In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? A) Seizure termination B) Acute renal failure C) Respiratory failure D) Anaphylactic shock

Ans: A Page: 440

77. Most medication biotransformation occurs in the: A) liver. B) kidneys. C) lungs. D) GI tract.

Ans: A Page: 442

79. Patients with _________________ are at significant risk for toxic effects of medications or metabolic waste products in the body. A) renal failure B) diabetes mellitus C) stomach cancer D) heart failure

Ans: A Page: 442

85. All of the following medications are used to reduce a patient's heart rate and blood pressure, EXCEPT: A) lorazepam. B) diltiazem. C) metoprolol. D) Tenormin.

Ans: A Page: 446

86. Which of the following medications possesses positive inotropic effects, allows the cellular uptake of glucose, and is used in the treatment of hyperkalemia? A) Insulin B) Osmitrol C) Glucophage D) Clopidogrel

Ans: A Page: 446-447

91. Unlike a nondepolarizing paralytic, a competitive depolarizing paralytic: A) causes muscle fasciculations. B) does not induce full paralysis. C) causes profound sedation. D) lowers serum potassium.

Ans: A Page: 448

96. Ipratropium bromide (Atrovent) causes bronchodilation by: A) antagonizing muscarinic receptors. B) agonizing nicotinic receptors. C) agonizing beta-2 receptors. D) antagonizing beta-2 receptors.

Ans: A Page: 449-450

97. Which of the following occurs during phase 1 of the cardiac cellular action potential? A) Sodium influx decreases while potassium slowly exits the cell B) Rapid influx of sodium ions through channels in the cardiac cell C) Calcium enters the cell while potassium continues to leave the cell D) Calcium movement ceases with continued outflow of potassium

Ans: A Page: 450-451

103. Calcium chloride or calcium gluconate may mitigate hypotension or bradycardia following an overdose of: A) diltiazem. B) adenosine. C) Cordarone. D) metoprolol.

Ans: A Page: 451

107. Patients who take alpha-blocking medications at home are frequently prone to: A) postural hypotension. B) hypertensive crisis. C) narrow-angle glaucoma. D) vagal-induced bradycardia.

Ans: A Page: 452

112. The vagus nerve releases _________________, which acts on _________________ receptors. A) acetylcholine, muscarinic-2 B) norepinephrine, alpha-1 C) epinephrine, beta-2 D) acetylcholinesterase, nicotinic

Ans: A Page: 453

118. Catecholamines and sympathomimetic medications should be administered with caution because they: A) can increase cardiac workload and myocardial oxygen demand. B) have an average duration of action of between 24 and 48 hours. C) are associated with paradoxical bradycardia in younger patients. D) have a tendency to cause a significant decrease in cardiac output.

Ans: A Page: 453

4. Which of the following is NOT a critical point addressed by the "White Paper" written in 1966 that was entitled "Accidental Death and Disability: The Neglected Disease of Modern Society"? A) Ensuring that paramedics responded to every call B) Participating in community-based prevention efforts C) Allocating adequate resources for medical direction D) Developing and pursuing a national EMS research agenda

A) Ensuring that paramedics responded to every call

100. A loss of normal sympathetic nervous system tone causes: A) neurogenic shock. B) obstructive shock. C) profound vasoconstriction. D) a reduced absolute blood volume.

105. The chief white blood cell of the immune response is the: A) lymphocyte. B) neutrophil. C) monocyte. D) eosinophil.

107. After T lymphocytes leave the bone marrow, they mature in the: A) thymus gland. B) lymph nodes. C) hypothalamus. D) liver and spleen.

108. _____________ are the MOST abundant white blood cells, are largely responsible for protecting the body against infection, and are key components of the first response to foreign body invasion. A) Neutrophils B) Eosinophils C) B lymphocytes D) Basophils

112. The induction phase of the immune response begins when: A) part of the immune system recognizes an antigen. B) the body is initially exposed to a foreign substance. C) an antibody binds to a specific antigen and destroys it. D) biologic mediators release histamine and other chemicals.

118. During the acute inflammatory response: A) transient arteriolar constriction is followed by arteriolar dilation, which allows an influx of blood under increased pressure. B) active hyperemia causes the blood vessels to constrict, which diverts blood flow away from the affected site. C) increased vessel wall permeability forces fluid out of the interstitial spaces, resulting in cell shrinkage and eventual death. D) chemical mediators, which are primarily produced by monocytes, cause localized constriction of the vessels adjacent to the affected site.

120. Aspirin and NSAIDs reduce inflammation and pain by: A) inhibiting prostaglandin synthesis. B) decreasing circulating pyrogen levels. C) thinning the blood and reducing platelets. D) promoting mast cell synthesis of prostaglandins.

127. Which of the following disease processes would MOST likely cause delayed or dysfunctional wound healing? A) Diabetes B) Hypothyroidism C) Heart disease D) Hypertension

128. Angiogenesis is defined as: A) the growth of new blood vessels. B) the destruction of blood vessels. C) rerouting of intact blood vessels. D) regrowth of damaged blood vessels.

134. If the cause of a disease is unknown, it is said to be: A) idiopathic. B) organic. C) functional. D) pathologic.

135. Type O blood contains: A) neither A nor B antigens but contains both A and B plasma antibodies. B) erythrocytes with type A antigens and plasma with type B antibodies. C) A and B surface antigens, but the plasma contains no ABO antibodies. D) both A and B surface antigens and both A and B plasma antibodies.

14. What structure conducts electrical impulses away from the cell body? A) Axon B) Synapse C) Dendrite D) Synaptic gap

15. Homeostasis is MOST accurately defined as: A) a constant effort to preserve a degree of stability or equilibrium. B) cellular oxygen delivery and carbon dioxide removal from the body. C) the balance of water or hydration in the cells and body of an organism. D) the inability of the body to maintain a constant internal environment.

2. The paramedic is in the BEST position to formulate an appropriate treatment plan for an ill patient if the paramedic: A) is able to identify the etiology of the patient's illness. B) obtains a complete list of all the patient's medications. C) performs a head-to-toe exam to detect all abnormalities. D) gathers a reliable medical history from the patient's family.

20. All of the following are endocrine hormones, EXCEPT: A) histamine. B) insulin. C) adrenaline. D) thyroxine.

24. Cerebrospinal fluid and synovial fluid are MOST appropriately classified as ____________ fluids. A) interstitial B) intravascular C) intracellular D) extracellular

27. The movement of water and a dissolved substance from an area of high pressure to an area of low pressure is called: A) filtration. B) active transport. C) facilitated diffusion. D) passive transport diffusion.

3. Groups of cells form: A) tissues. B) organs. C) an organism. D) organ systems.

33. Ascites is defined as: A) an abnormal accumulation of fluid in the peritoneal cavity. B) lower extremity edema caused by lymphatic obstruction. C) fluid buildup in the lungs due to decreased cardiac function. D) fluid backup in the periphery due to right atrial dysfunction.

34. The cardinal sign of overhydration is: A) edema. B) dyspnea. C) hypertension. D) tachycardia.

39. The MOST prevalent cation of the extracellular fluid is: A) sodium. B) chloride. C) potassium. D) bicarbonate.

40. Renin is a protein that is released into the bloodstream by the _________ in response to changes in __________. A) kidneys, blood pressure B) liver, acid-base balance C) pancreas, insulin levels D) hypothalamus, body temperature

45. Orthostatic hypotension and oliguria are common manifestations of: A) dehydration. B) fluid overload. C) hypernatremia D) left-sided heart failure.

51. Muscle cramps and paresthesias in a malnourished patient with alcoholism are MOST likely the result of: A) hypocalcemia. B) hypernatremia. C) hyperkalemia. D) hypermagnesemia.

52. Half of the body's magnesium is stored in the: A) bones. B) kidneys. C) skeletal muscle. D) extracellular fluid.

57. Acidosis is characterized by a(n): A) increase in hydrogen ions and a decrease in pH. B) decrease in hydrogen ions and an increase in pH. C) increase in hydrogen ions and an increase in pH. D) decrease in hydrogen ions and a decrease in pH.

60. A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience: A) increased CO2 retention. B) acute metabolic acidosis. C) excess CO2 elimination. D) a pH well above 7.45.

62. When cells are hypoxic for more than a few seconds: A) they produce substances that may damage other local or distant body systems. B) the respiratory system rapidly decompensates and breathing becomes slow. C) an increase in cytochrome production occurs and the body makes more energy. D) lysosomes quickly release enzymes that attempt to rebuild the structure of the cell.

66. In the presence of infection, white blood cells release endogenous chemicals called _________, which produce fever. A) pyrogens B) histamines C) leukotrienes D) catecholamines

7. The ____________ of the cell contains RNA. A) nucleus B) cytoplasm C) Golgi complex D) mitochondria

77. Early signs or symptoms of breast cancer include: A) a small, painless lump in the breast. B) swollen lymph glands in the axilla. C) significant weight loss and vomiting. D) nipple discharge and breast tenderness.

78. Patients with type 1 diabetes mellitus: A) need exogenous insulin to survive. B) are less likely to develop ketoacidosis. C) experience excessive cellular uptake of glucose. D) control their disease with dietary modification

83. Hypertrophic cardiomyopathy is characterized by: A) enlargement or thickening of the heart muscle. B) progressive shrinking of the right side of the heart. C) a significant reduction of blood return to the atria. D) generalized thinning of the left and right ventricles.

88. What disease is characterized by erosions in the mucous membrane lining of the gastrointestinal tract, specifically the stomach? A) Peptic ulcer disease B) Crohn's disease C) Cholethiasis D) Cholecystitis

94. When oxygen does not reach the cell, the cell reverts to: A) anaerobic metabolism and produces lactic acid. B) aerobic metabolism and produces carbon dioxide. C) fat metabolism and begins producing ketoacids. D) anaerobic metabolism and produces bicarbonate.

A 17-year-old man complains of palpitations and lightheadedness that began suddenly about 20 minutes ago. His blood pressure is 118/74 mm Hg, heart rate is rapid and regular, and respirations are 18 breaths/min. The cardiac monitor reveals a narrow QRS complex tachycardia at 180 beats/min. As you are applying supplemental oxygen, the cardiac rhythm spontaneously converts to a sinus rhythm. Closer evaluation of his rhythm reveals a rapid upslope to the R wave immediately after the end of the P wave. Which of the following statements regarding this scenario is correct? A) This patient likely has Wolff-Parkinson-White syndrome. B) The patient's ECG abnormality is called an Osborn wave. C) The ECG abnormality is caused by failure of the AV node. D) In this patient, there is a delay in ventricular depolarization.

A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect? A) Positive end-expiratory pressure ventilation B) IV or IO access and 20 to 40 mg of furosemide C) 0.4 mg sublingual nitroglycerin, up to three doses D) Supplemental oxygen via nonrebreathing mask

A bedridden patient with right-sided heart failure would be LEAST likely to present with: A) edema to the feet. B) presacral edema. C) hepatomegaly. D) jugular venous distention.

A beta adrenergic blocker would counteract all of the following medications, EXCEPT: A) atropine. B) epinephrine. C) isoproterenol. D) norepinephrine.

A demand pacemaker: A) generates pacing impulses only when it senses that the heart's natural pacemaker has fallen below a preset rate. B) sends out single electrical impulses when the patient's inherent pacemaker rate exceeds 150 beats/min. C) is easily identified on a cardiac rhythm strip by noting the presence of pacer spikes before all of the QRS complexes. D) attaches to the atria and the ventricles and only generates an impulse if it senses that the patient is in ventricular fibrillation.

A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads. A) elevation, 1, two B) depression, 2, one C) elevation, 2, one D) depression, 1, two

A fracture of the orbital bone is commonly referred to as a: A) blowout fracture. B) midface fracture. C) LeFort fracture. D) basilar fracture.

A major complication associated with atrial fibrillation is: A) clot formation in the fibrillating atria. B) a significant reduction in atrial filling. C) pulmonary congestion and hypoxemia. D) a profound increase in the atrial kick.

A patient is considered a potential candidate for fibrinolytic therapy if he or she has experienced chest discomfort for: A) less than 12 hours. B) more than 5 minutes. C) less than 15 minutes D) more than 24 hours.

A person with type A + blood could receive which of the following blood types? A) A+ B) B- C) AB- D) O+

A physiologic effect of sympathetic nervous stimulation includes: A) dilation of the bronchioles. B) decreased conduction velocity. C) a negative dromotropic effect. D) dilation of the blood vessels.

A pure alpha agent: A) causes marked vasoconstriction. B) has a direct effect on the heart rate. C) causes moderate bronchoconstriction. D) decreases the blood pressure by dilating the vessels.

A trauma patient complains of pain to the costovertebral angle (CVA) during palpation. The organ MOST likely injured is the: A) kidney. B) liver. C) spleen. D) bladder.

After delivering a shock to a patient in pulseless ventricular tachycardia, you should: A) resume CPR. B) check for a pulse. C) reassess the cardiac rhythm. D) deliver two effective ventilations.

All of the following are formed components of the blood, EXCEPT: A) plasma. B) platelets. C) red blood cells. D) white blood cells.

All of the following medications are angiotensin II receptor blockers, EXCEPT: A) Niaspan. B) Diovan. C) Avapro. D) Atacand.

An electrical wave moving in the direction of a positive electrode will: A) cause a positive deflection on the ECG. B) produce a significant amount of artifact. C) cause a negative deflection on the ECG. D) manifest with narrow QRS complexes.

An increase in peripheral vascular resistance causes: A) an increase in afterload. B) a decrease in blood pressure. C) an increase in cardiac output. D) a decrease in cardiac workload.

Any cell that ingests microorganisms or other cells is called a(n): A) phagocyte. B) endocyte. C) exocyte. D) pinocyte.

Any electrical impulse that originates in the ventricles will produce: A) wide QRS complexes and a rate between 20 and 40 beats/min. B) a rapid rhythm with wide QRS complexes and no pulse. C) low-amplitude QRS complexes and dissociated P waves. D) bizarre-looking QRS complexes and a rate less than 60 beats/min.

Any vertical plane that is parallel to the median plane and divides the body into unequal left and right parts is called the: A) sagittal plane. B) median plane. C) caudal plane. D) transverse plane.

Approximately two thirds of the heart muscle lies within a space in the thoracic cavity called the: A) mediastinum. B) hemithorax. C) pericardium. D) endocardium.

As an electrical impulse travels down the electrical conduction system, it transiently slows at the: A) AV node. B) bundle of His. C) sinoatrial node. D) interatrial septum.

Cardiac arrhythmias following an acute myocardial infarction: A) tend to originate from ischemic areas around the infarction. B) typically manifest as atrial fibrillation or atrial tachycardia. C) generally originate from the center of the infarcted tissues. D) are uncommon within the first 24 hours after the infarction.

Depolarization, the process by which muscle fibers are stimulated to contract, occurs when: A) cell wall permeability changes and sodium rushes into the cell. B) calcium ions rapidly enter the cell, facilitating contraction. C) potassium ions escape from the cell through specialized channels. D) cardiac muscle relaxes in response to a cellular influx of calcium.

Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of a(n): A) ischemic stroke. B) pericardial tamponade. C) hemorrhagic stroke. D) myocardial infarction.

Disruption of blood flow through the innominate artery due to dissection is likely to produce: A) pulse or blood pressure deficits. B) a rapid, irregular pulse. C) collapsed jugular veins. D) a widened pulse pressure.

Freshly oxygenated blood is returned to the left atrium through the: A) pulmonary veins. B) pulmonary arteries. C) superior vena cava. D) inferior vena cava.

Hypertensive disease is characterized by: A) persistent elevation of the diastolic pressure. B) a diastolic blood pressure above 90 mm Hg. C) constant fluctuation in the systolic blood pressure. D) a systolic blood pressure greater than 140 mm Hg.

Hypomagnesemia would MOST likely result in: A) decreased cardiac conduction. B) decreased myocardial irritability. C) a decrease in cardiac contractility. D) decreased myocardial automaticity.

If a particular interval on the ECG graph paper is 1.5 small boxes in width, the interval would be measured as: A) 0.06 seconds. B) 2 millimeters. C) 45 milliseconds. D) 600 milliseconds.

If a patient remains comatose following return of spontaneous circulation, you should: A) provide mild hyperventilation. B) begin hypothermia treatment. C) immediately obtain a 12-lead. D) begin an infusion of dopamine.

If a patient's ECG rhythm shows any artifact, you should: A) ensure the electrodes are applied firmly to the skin. B) reverse the limb leads to obtain a clearer ECG tracing. C) place the ground lead in a different anatomic location. D) remove the negative lead and reassess the cardiac rhythm.

If an increased amount of blood is returned to the heart: A) the cardiac muscle must stretch to accommodate the larger volume. B) stroke volume decreases accordingly because of the larger volume. C) an increase in stroke volume occurs because the heart rate increases. D) cardiac workload is decreased, resulting in a decreased cardiac output.

If the R-R interval spans ___ large boxes or less, the heart rate is greater than 100/min. A) 3 B) 4 C) 5 D) 6

If the body is sliced so the result is a top and bottom portion, this is referred to as the: A) transverse plane. B) cross section. C) midsagittal plane. D) body's midline.

If you are unsure whether a conscious cardiac patient requires immediate transport versus continued assessment at the scene, you should: A) continue with the secondary assessment to obtain more information. B) take the patient's vital signs and then make your transport decision. C) begin immediate transport and perform a focused assessment en route. D) contact medical control and inform him or her of the patient's condition.

In contrast to coarse ventricular fibrillation, fine ventricular fibrillation indicates that: A) energy reserves of the cardiac cells have been expended. B) the arrhythmia is more likely to respond to defibrillation. C) a perfusing rhythm is not possible following defibrillation. D) the cardiac cells temporarily have adequate energy stores.

In contrast to the right side of the heart, the left side of the heart: A) drives blood out of the heart against the relatively high resistance of the systemic circulation. B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs. C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta. D) drives blood out of the heart against the relatively low resistance of the pulmonary

In order to call a cardiac rhythm "paroxysmal" supraventricular tachycardia, you would have to: A) witness its onset and/or spontaneous termination. B) confirm the pacemaker origin with a 12-lead ECG. C) observe a consistent heart rate greater than 150 beats/min. D) ask the patient when he or she began feeling palpitations.

In response to shock or stress, sympathetic nervous system stimulation causes: A) vasoconstriction. B) slowing of the heart rate. C) increased gastrointestinal function. D) shunting of blood to the body's periphery.

In the bloodstream, _____________ reacts with the plasma protein angiotensinogen to form angiotensin I. A) renin B) sodium C) aldosterone D) testosterone

In the pregnant patient, the secretion of oxytocin causes: A) uterine smooth muscle contraction. B) uterine smooth muscle relaxation. C) decreased milk production in the breasts. D) thickening of the uterine wall for implantation.

Ischemia to the anterior wall of the myocardium would present with: A) T-wave inversion in leads V3 and V4. B) ST-segment depression in leads I and aVL. C) T-wave inversion in leads II, III, and aVF. D) ST-segment elevation in leads V3 and V4.

Lead I views the ________ wall of the heart, while lead aVF views the _________ wall of the heart. A) lateral, inferior B) septal, anterior C) posterior, septal D) anterior, inferior

Lowering of a significantly elevated blood pressure: A) is best accomplished in a hospital setting. B) is contraindicated in the prehospital setting. C) should be initiated in the field with labetalol. D) is routinely accomplished with nitroglycerin.

Most patients with an ST-elevation myocardial infarction: A) will develop Q waves. B) heal without treatment. C) experience cardiac arrest. D) present without chest pain.

Myocardial ischemia occurs when the heart muscle: A) is deprived of oxygen because of a blocked coronary artery. B) undergoes necrosis because of prolonged oxygen deprivation. C) suffers oxygen deprivation secondary to coronary vasodilation. D) experiences a decreased oxygen demand and an increased supply.

Normally, the ST segment should be: A) at the level of the isoelectric line. B) elevated by no more than 1 mm. C) depressed by no more than 2 mm. D) invisible on a normal ECG tracing.

Ordinarily, approximately _____% of the cardiac output passes through the liver each minute. A) 25 B) 40 C) 55 D) 65

Osmosis is the movement of a: A) solvent from an area of low solute concentration to one of high concentration. B) solvent from an area of high solute concentration to one of low concentration. C) solute from an area of high solvent concentration to one of low concentration. D) solute from an area of low solvent concentration to one of high concentration.

Oxygen and carbon dioxide pass across the alveolar capillary membrane through a process called: A) diffusion. B) osmosis. C) perfusion. D) metabolism.

Patients experiencing a right ventricular infarction: A) may present with hypotension. B) should not be given baby aspirin. C) often require higher doses of morphine. D) usually have anterior myocardial damage.

Patients with a heart rate greater than 150 beats/min usually become unstable because of: A) reduced ventricular filling. B) an increase in the atrial kick. C) increased right atrial preload. D) a significantly reduced afterload.

Which of the following statements regarding hetastarch (Hespan) is correct? A) Hetastarch can expand circulating volume for up to 36 hours. B) Hetastarch is an isotonic crystalloid used primarily for blood loss. C) Patients who are allergic to peanuts may be allergic to hetastarch. D) Hetastarch has been shown to antagonize anticoagulant medications.

A) Hetastarch can expand circulating volume for up to 36 hours.

In which of the following situations is morphine sulfate associated with the greatest risk of bradycardia or AV heart block? A) Inferior wall MI B) Anterior wall MI C) Unstable angina D) Lateral wall MI

A) Inferior wall MI

What is the mechanism of action of aspirin when given to patients experiencing an acute myocardial infarction? A) Prevents platelets from aggregating and forming emboli B) Converts plasminogen to plasmin, which destroys fibrin C) Dilates the coronary arteries and improves blood flow D) Prevents conversion of fibrinogen to fibrin and lyses clots

A) Prevents platelets from aggregating and forming emboli

45. Which of the following statements regarding protocols is correct? A) Protocols are usually developed in conjunction with national standards. B) A well-written protocol should address every possible patient condition. C) Most protocols reflect the personal opinion of the EMS medical director. D) Protocols are orders, and the responder cannot deviate from them under any circumstances.

A) Protocols are usually developed in conjunction with national standards.

According to the Haddon matrix, which of the following is an example of a pre-event strategy used to prevent injury of a child who is riding in a motor vehicle? A) Reducing driving during high-risk times B) Training bystanders in basic pediatric first aid C) A driver maintaining control of his or her vehicle D) Outfitting ambulances with pediatric-sized equipment

A) Reducing driving during high-risk times

A drug that is contraindicated for pregnant women is assigned an FDA pregnancy category: A) X. B) D. C) C. D) B.

A) X.

For anaphylactic shock, epinephrine should be given via the _____________ route. A) intravenous B) endotracheal C) intramuscular D) subcutaneous

A) intravenous

Nitroglycerin is indicated for patients with __________ chest pain. A) ischemic B) traumatic C) pleuritic D) somatic

A) ischemic

The onset of action of etomidate (Amidate) is: A) less than 1 minute. B) 1 to 3 minutes. C) 3 to 5 minutes. D) 5 to 7 minutes.

A) less than 1 minute.

The onset of action of naloxone (Narcan) is: A) less than 2 minutes. B) 2 to 5 minutes C) 5 to 8 minutes. D) greater than 10 minutes.

A) less than 2 minutes.

Prior to administering vecuronium bromide (Norcuron), or any other neuromuscular blocker, it is important for the paramedic to remember that: A) neuromuscular blockers have no effect on a patient's level of consciousness. B) chemical paralysis should be achieved prior to administering a sedative drug. C) the airway should be secured with an ET tube or other advanced airway device. D) neuromuscular blockers are potent analgesics and may cause severe hypotension.

A) neuromuscular blockers have no effect on a patient's level of consciousness.

When given via the IM route, lorazepam (Ativan) is: A) not diluted. B) given rapidly. C) diluted with sterile saline. D) not an effective anxiolytic.

A) not diluted.

EMS providers can be MOST effective in helping reduce the incidence of suicide, domestic violence, and child abuse by: A) noting risk factors at the scene and reporting data. B) continuing their education regarding such incidents. C) conducting seminars that target high-risk populations. D) working with law enforcement to identify risk factors.

A) noting risk factors at the scene and reporting data.

50. Possible stress points in the day-to-day operations of the EMS system that would likely be identified by a comprehensive CQI program include all of the following, EXCEPT: A) personal finance issues. B) receiving facility issues. C) medical direction issues. D) education and training issues.

A) personal finance issues.

In addition to rapidly increasing serum glucose levels, dextrose: A) provides a short-term diuretic effect. B) causes a decrease in intracranial pressure. C) has potent anticonvulsant properties. D) stimulates the liver to produce glycogen.

A) provides a short-term diuretic effect.

Diltiazem is commonly used for patients with: A) rapid atrial fibrillation. B) ventricular tachycardia. C) high-grade AV heart block. D) heart failure and hypotension.

A) rapid atrial fibrillation.

Pralidoxime (2-PAM) reverses the effects of organophosphate poisoning by: A) reactivating cholinesterase. B) blocking the vagus nerve. C) increasing vagal tone. D) deactivating cholinesterase.

A) reactivating cholinesterase.

38. When educating citizens who live in an area where EMS response times will be lengthy, the MOST important skill to teach them is: A) rescue breathing and chest compressions. B) maintenance of a patient's body temperature. C) initial management of a patient with a seizure. D) manually stabilizing an injured person's neck.

A) rescue breathing and chest compressions.

The antihypertensive properties of labetalol (Normodyne) are due to its: A) selective alpha and nonselective beta-adrenergic blocking effects. B) nonselective alpha and selective beta-1 adrenergic blocking effects. C) selective alpha and selective beta-adrenergic blocking effects. D) nonselective dopaminergic and selective alpha-adrenergic blocking effects.

A) selective alpha and nonselective beta-adrenergic blocking effects.

44. Specific functions that the paramedic should perform prior to contacting medical control are called: A) standing orders. B) online protocols. C) physician directives. D) predefined standards.

A) standing orders.

Glucagon increases the blood glucose level by: A) stimulating glycogenesis. B) inhibiting gluconeogenesis. C) agonizing the effects of insulin. D) facilitating glucose entry into the cell.

A) stimulating glycogenesis.

The BEST example the paramedic can set with regard to injury prevention is: A) taking care of himself or herself and serving as a role model for others. B) remaining physically fit for the rigors of the prehospital environment. C) always wearing seat belts while on duty, even on non-emergency calls. D) regularly reviewing the use of personal protective equipment and practices.

A) taking care of himself or herself and serving as a role model for others.

58. When research participants are advised of all the aspects of the project, the research project is said to be: A) unblinded. B) retrospective. C) cross-sectional. D) double-blinded.

A) unblinded.

36. When you transfer care of your patient to the hospital staff, it is MOST important to: A) use discretion and protect the patient's privacy. B) give a brief report and quickly return to service. C) only give your hand-off report to a staff physician. D) always obtain a signature from the receiving nurse.

A) use discretion and protect the patient's privacy.

If, when responding to a call for a patient in cardiac arrest, you run every stop sign and drive with unnecessary speed: A) you are not a credible advocate for injury prevention. B) law enforcement will generally allow you to do this. C) the chances of a successful resuscitation are greater. D) you are more likely to arrive at the scene much sooner.

A) you are not a credible advocate for injury prevention.

Which of the following questions would be appropriate to ask a patient who has no medical training? A: "Do you have any breathing or heart problems?" B: "Have you ever experienced a syncopal episode?" C: "Do you have any endocrine-related illnesses?" D: "Have you ever had an acute myocardial infarction?"

A: "Do you have any breathing or heart problems?"

Proximate cause is MOST accurately defined as: A: A link between the paramedic's improper action and the patient's injury B: An action on the part of the paramedic that improved the patient's condition C: A direct relationship between the mechanism of injury and the patient's injury D: An act of ordinary or gross negligence that resulted in further harm to the patient

A: A link between the paramedic's improper action and the patient's injury

If a patient has a potentially life-threatening illness or injury and there is any doubt as to his or her decision-making capacity, the paramedic should: A: Treat and transport, even if it is against the patient's will B: Obtain a court order and then begin emergency treatment C: Have the patient arrested and placed in protective custody D: Obtain consent from a family member to treat the patient

A: Treat and transport, even if it is against the patient's will

Eye-to-eye contact with a patient reinforces: A: Trust and honesty B: Passing listening C: Sympathy D: Professional courtesy

A: Trust and honesty

Using the NATO phonetic alphabet, how should you spell Dr. "Wilson"? A: WHISKEY-INDIA-LIMA-SIERRA-OSCAR-NOVEMBER B: WHISKEY-IDA-LIMA-SAM-OSCAR-NANCY C: WILLIAM-INDIA-LINCOLN-SIERRA-OCEAN-NOVEMBER D: WILLIAM-IDA-LINCOLN-SAM-OCEAN-NANCY

A: WHISKEY-INDIA-LIMA-SIERRA-OSCAR-NOVEMBER

Implied consent is based on the premise that a patient: A: Would consent to care because of the seriousness of his or her injury B: Will die unless emergency medical treatment is provided immediately C: Is of legal age and is able to make rational decisions regarding his or her care D: Would refuse any emergency medical care if he or she were unconscious

A: Would consent to care because of the seriousness of his or her injury

An advance directive is MOST accurately defined as a: A: Written document that expresses the wants, needs, and desires of the patient in reference to his or her future medical care B: Legal document that describes which life-sustaining procedures are to be performed in the patient's condition acutely deteriorates C: Notarized document that is executed by a terminally ill patient's family when the patient develops cardiopulmonary arrest D: General guideline provided to the paramedic by the medical director that stipulates the level of care provided to terminally ill patients

A: Written document that expresses that wants, needs, and desires of the patient in reference to his or her future medical care

A DNR order is MOST accurately defined as a: A: Written order designed to tell health care providers when resuscitation is or is not appropriate B: Legal document that is executed by the patient while he or she still has decision-making capacity C: Written or oral directive that stipulates the care that a patient should receive at the end of his or her life D: Legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients

A: Written order designed to tell health care providers when resuscitation is or is not appropriate

Which of the following words would be the MOST difficult to hear over the radio? A: Yes B: Negative C: Affirmative D: Received

A: Yes

If a patient is unable to tell you who he or she is, where he or she is, and what day of the week it is: A: You should suspect decreased blood flow to the brain B: He or she is most likely scared and unable to remember C: He or she likely has an intracerebral hemorrhage or lesion D: You should ask him of her questions that require more thought

A: You should suspect decreased blood flow to the brain

Percutaneous coronary interventions involve: A) recanalizing a blocked coronary artery by passing a balloon or stent through a catheter via a peripheral artery. B) passing a 2-mm catheter through the femoral artery and administering a fibrinolytic agent through the catheter. C) using a large vein from one of the lower extremities to reroute blood flow past an occluded coronary artery. D) passing a guide wire through one of the external jugular veins to directly visualize an occluded coronary artery.

120. At 5 to 10 μg/kg/min, dopamine: A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility. B) activates dopaminergic receptor sites, causing renal and mesenteric artery vasodilation. C) no longer activates dopaminergic receptor sites and predominately activates alpha-1 receptor sites. D) has a negative chronotropic effect on the heart, but an increased inotropic effect.

Ans: A Page: 454

125. Which of the following statements regarding vasopressin is correct? A) Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion. B) In cardiac arrest, current guidelines recommend 20 to 40 units of vasopressin every 5 minutes. C) Vasopressin reduces cardiac afterload, which may cause clinically significant hypotension. D) Vasopressin is a useful medication for patients with right heart failure and peripheral edema.

Ans: A Page: 454

129. For which of the following conditions may a patient be prescribed furosemide? A) Kidney dysfunction B) Chronic dehydration C) Low serum potassium D) Reactive airway disease

Ans: A Page: 455

132. The preferred IV fluid for Y-site tubing administration during a blood product transfusion is: A) normal saline. B) 5% dextrose in water. C) lactated Ringer's. D) 0.45% sodium chloride.

Ans: A Page: 456

137. The paramedic may be called upon to administer platelets to patients with: A) thrombocytopenia. B) hemolytic anemia. C) a low hematocrit. D) hypercoagulopathy.

Ans: A Page: 457

140. Which of the following is NOT an oral antiplatelet medication? A) ReoPro B) Plavix C) Ticlid D) Aspirin

Ans: A Page: 457-458

145. In up to one third of all patients, morphine sulfate causes: A) nausea and vomiting. B) severe hypotension. C) complete heart block. D) a reflex tachycardia.

Ans: A Page: 458

150. The paramedic should administer promethazine (Phenergan) by: A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes. B) rapid IV push undiluted, as this will minimize the risk of vascular injury. C) mixing it with 25 mg of diphenhydramine in order to prevent dystonia. D) diluting it in 50 to 100 mL of normal saline and giving it over 30 minutes.

Ans: A Page: 459

155. Which of the following medications is used to provide cardiac cell membrane stabilization following tricyclic antidepressant overdose? A) Sodium bicarbonate B) Magnesium sulfate C) Diphenhydramine D) Calcium chloride

Ans: A Page: 462

130. Prior to administering a medication to any patient, the paramedic should: A) inquire about drug allergies. B) repeat the initial assessment. C) always contact medical control. D) perform a detailed physical exam.

Ans: A Page: 469-471

136. In contrast to an antiseptic, a disinfectant is: A) toxic to living tissues and should never be used on a patient. B) capable of destroying pathogens but is not toxic to living tissues. C) not intended to be used on nondisposable patient care equipment. D) used to cleanse an area before performing an invasive procedure.

Ans: A Page: 472

12. Sodium is a ________ cation and can react completely with _______. A) monovalent, 1 mEq of a singly charged anion B) bivalent, 2 mEq of a doubly charged cation C) monovalent, 2 mEq of a singly charged anion D) bivalent, 1 mEq of a doubly charged cation

Ans: A Page: 473

4. In a 175-lb man, intravascular fluid accounts for approximately ____ lb. A) 8 B) 9 C) 10 D) 12

Ans: A Page: 473

10. Which of the following electrolytes is NOT a cation? A) Chloride B) Calcium C) Potassium D) Magnesium

Ans: A Page: 473-474

13. Which of the following statements regarding calcium is correct? A) Calcium is needed for bone growth and proper blood clotting. B) Patients with ataxia should be suspected of being hypocalcemic. C) Calcium can react completely with 1 mEq of a singly charged anion. D) Abdominal cramps are a sign of an increased level of serum calcium.

Ans: A Page: 474

17. The primary buffer used in all circulating body fluids is: A) bicarbonate. B) phosphorus. C) potassium. D) magnesium.

Ans: A Page: 474

22. Pumping sodium out of the cell and potassium into the cell has the added benefit of: A) moving glucose into the cell at the same time. B) transiently decreasing serum levels of calcium. C) facilitating water reabsorption in the renal tubules. D) expending minimal levels of adenosine triphosphate.

Ans: A Page: 475

170. A 71-year-old woman presents with tachypnea, flushed skin, and postural hypotension. Which of the following chief complaints is MOST consistent with these clinical findings? A) Diarrhea B) Renal failure C) Acute weight gain D) Shortness of breath

Ans: A Page: 476

28. Which of the following statements regarding dehydration is correct? A) It is often a chronic condition in elderly patients and may take days to manifest. B) During early dehydration, a profound loss of interstitial fluid occurs in the body. C) In younger patients, dehydration is typically caused by an acute loss of more than 50 mL of blood. D) During dehydration, fluid shifts from the extracellular compartment to the intracellular compartment.

Ans: A Page: 476

29. Signs and symptoms of dehydration include all of the following, EXCEPT: A) bradypnea. B) flushed, dry skin. C) postural hypotension. D) dry mucous membranes.

Ans: A Page: 476

32. Signs and symptoms of overhydration include: A) edema. B) oliguria. C) weight loss. D) wheezing.

Ans: A Page: 476

125. A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer? A) 0.1 mg B) 0.15 mg C) 0.01 mg D) 0.2 mg

Ans: A Page: 506

141. In which of the following cases would the paramedic MOST likely instill medication down a gastric tube? A) Toxic ingestion in patients with a depressed swallowing mechanism B) In the absence of vascular access in a patient who is clinically unstable C) Acute overdose to lavage the stomach and prevent digestion of the drug D) To instill nutritional substances in patients who cannot swallow effectively

Ans: A Page: 509

143. When injecting a medication via the rectal route, you should: A) instruct the patient not to bear down. B) use a large uncuffed endotracheal tube. C) ensure that the patient is fully conscious. D) recall that the rectal mucosae are relatively avascular.

Ans: A Page: 511

149. The main benefit of using a prefilled medication syringe is that: A) it does not require you to draw up each individual medication dose. B) it is made of plastic and is less likely to break or get damaged. C) there is no need to expel air from the syringe prior to giving the drug. D) all of the contents of a prefilled syringe are administered at one time.

Ans: A Page: 514

150. What medication route is typically used during allergy testing or when performing a skin test for tuberculosis? A) Intradermal B) Subcutaneous C) Intramuscular D) Percutaneous

Ans: A Page: 516

158. Which of the following is NOT always considered a mandatory action after administering a medication via the enteral or parenteral route? A) Contacting on-line medical control B) Monitoring the patient's condition C) Immediately disposing of any sharps D) Documenting the time of administration

Ans: A Page: 518-519

185. Immediately after administering intramuscular epinephrine to a patient with an allergic reaction, you should: A) dispose of the needle and syringe in a sharps container. B) monitor the patient and obtain another set of vital signs. C) reassess the patient for signs of clinical improvement. D) document the medication name and time of administration.

Ans: A Page: 519

155. Neither subcutaneous nor intramuscular injections should be given to patients: A) with inadequate peripheral perfusion. B) who are morbidly obese or very thin. C) who require less than 5 mL of a drug. D) with a systolic BP greater than 140 mm Hg.

Ans: A Page: 520

164. When administering sublingual nitroglycerin to a patient, you should do all of the following, EXCEPT: A) instruct the patient to chew and swallow the tablet. B) perform a focused history and physical examination. C) ensure that the patient's mucous membranes are moist. D) thoroughly assess the patient for any transdermal patches.

Ans: A Page: 526-527

169. Medication routes, from slowest to fastest rates of absorption, are: A) subcutaneous, intramuscular, sublingual, inhalation, intravenous. B) intramuscular, sublingual, subcutaneous, intravenous, inhalation. C) intravenous, inhalation, sublingual, subcutaneous, intramuscular. D) subcutaneous, sublingual, inhalation, intramuscular, intravenous.

Ans: A Page: 535-536

1. Your entire assessment of a patient should: A) appear to be a seamless process. B) yield a definitive field diagnosis. C) only focus on his or her complaint. D) not deviate at all from a strict format.

Ans: A Page: 589

4. In prehospital care, the priorities of evaluation and treatment are based on: A) the degree of threat to the patient's life. B) your overall experience as a paramedic. C) the receiving physician's online orders. D) standard treatment guidelines and algorithms.

Ans: A Page: 589

6. When determining whether a patient is sick, your MOST effective tool is often: A) a quick visual assessment. B) the patient's chief complaint. C) past medical history findings. D) the patient's baseline vital signs.

Ans: A Page: 589

29. When asking a patient if he or she uses illegal drugs, you will MOST likely get accurate information if you: A) remain professional and nonjudgmental. B) reassure the patient that you can be trusted and will not tell anyone. C) question the patient in the presence of a trusted family member. D) tell the patient that withholding such information from you is illegal.

Ans: A Page: 617

38. If you suspect that a patient has been abused, it is MOST important that you: A) request law enforcement personnel if necessary. B) discreetly ask the patient if he or she was abused. C) contact medical control to make him or her aware. D) ask a family member about the possibility of abuse.

Ans: A Page: 617-618

43. When dealing with a patient who has multiple symptoms, the MOST effective way to develop an appropriate care plan is to: A) prioritize the patient's complaints. B) perform a complete head-to-toe exam. C) address all complaints simultaneously. D) assume that all complaints are linked.

Ans: A Page: 619

113. The optic nerve is a _______ nerve, and controls _______. A) sensory, light perception and vision B) sensory, hearing and balance perception C) motor, eye movements and pupil dilation D) motor, pupil constriction and eye movement

Ans: A Page: 672

119. The brachioradialis tendon is located: A) proximal to the wrist. B) in the antecubital fossa. C) on the distal humerus. D) directly over the elbow.

Ans: A Page: 676

120. In contrast to dementia, delirium is: A) an acute change in mental status. B) characteristic of Alzheimer's disease. C) more common in the elderly population. D) a gradual deterioration in cognitive function.

Ans: A Page: 677

183. You are transporting a conscious middle-aged woman who fell from a second-story balcony while watering her plants. Full spinal motion restriction precautions have been implemented, supplemental oxygen is being administered, and an IV line of normal saline is in place. With a 15-minute estimated time of arrival at the hospital, the patient's mental status markedly decreases and her respirations become shallow and are making a gurgling sound. Your FIRST action should be to: A) immediately suction her oropharynx. B) perform immediate endotracheal intubation. C) insert a nasal airway and assist ventilations. D) contact the receiving facility to update them.

Ans: A Page: 685

3. The care plan that you implement based on your working field diagnosis of a patient is almost always defined by: A) your EMS system's patient care protocols or standing orders. B) your previous experience with patients who had a similar condition. C) direct orders from the physician at the receiving medical facility. D) a combination of your and your partner's knowledge and experience.

Ans: A Page: 696

8. Which of the following scenarios is the BEST example of independent decision making? A) Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital B) Selecting the appropriate patient care algorithm from your protocol book when treating a middle-aged male patient with symptomatic bradycardia C) Definitively diagnosing a patient with cholecystitis who has right upper quadrant abdominal pain and nausea that began shortly after eating a meal D) Contacting medical control and requesting permission to administer adenosine to a patient with a heart rate of 190 beats/min and a stable blood pressure

Ans: A Page: 697

13. Knowledge of anatomy, physiology, and pathophysiology is MOST important during the ________________ stage of critical thinking. A) data interpretation B) concept formation C) reflection in action D) application of principle

Ans: A Page: 699

14. Comments such as "I can't believe you called EMS for this!": A) show a lack of compassion and interest in providing the best possible care. B) demonstrate an illegal act for which the paramedic will be held accountable. C) are commonly made by paramedics with less than 5 years of field experience. D) are typically ignored by the patient because he or she is frightened at the time

Ans: A Page: 699

20. Uncertainty regarding the specific cause of a patient's problem is called: A) medical ambiguity. B) a working diagnosis. C) the general impression. D) the differential diagnosis.

Ans: A Page: 701

25. Which of the following is NOT a typical element to evaluate when reading the scene of a motor vehicle crash? A) The person at fault B) Access and exit routes C) Environmental conditions D) Overall safety of the situation

Ans: A Page: 702

269. After inserting an oropharyngeal airway in an unresponsive woman, the patient begins to gag. You should: A) remove the airway and have suction ready. B) suction her oropharynx for up to 15 seconds. C) spray an anesthetic medication into her mouth. D) turn the patient on her side in case she vomits.

Ans: A Page: 744

80. The MOST significant complication associated with the use of an oropharyngeal airway is: A) soft-tissue trauma with oral bleeding. B) mild bradycardia in pediatric patients. C) significant bruising of the hard palate. D) a tachycardic response in adult patients.

Ans: A Page: 744

270. A construction worker fell approximately 15 ft and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should: A) administer oxygen via nonrebreathing mask and continue your assessment. B) insert a nasopharyngeal airway and assist ventilations with a bag-mask device. C) suction his nasopharynx for up to 30 seconds and apply oxygen via nasal cannula. D) insert a nasopharyngeal airway and administer oxygen via nonrebreathing mask.

Ans: A Page: 746

71. An airway obstruction secondary to a severe allergic reaction: A) requires specific and aggressive treatment. B) often responds well to humidified oxygen. C) is usually the result of pulmonary aspiration. D) is treated effectively with abdominal thrusts.,

Ans: A Page: 748

85. A Bourdon-gauge oxygen flowmeter: A) reduces the high pressure in the oxygen cylinder to a safe pressure. B) allows you to administer oxygen to a patient under high pressures. C) is used for transferring oxygen from a larger tank to a smaller tank. D) must be placed in an upright position because it is affected by gravity.

Ans: A Page: 752

91. In contrast to negative-pressure ventilation, positive-pressure ventilation: A) may impair blood return to the heart. B) moves air into the esophagus and trachea. C) causes decreased intrathoracic pressure. D) is the act of normal, unassisted breathing.

Ans: A Page: 756-757

92. Compared to mouth-to-mouth ventilation, mouth-to-mask ventilation is more advantageous in that it: A) can be used in conjunction with supplemental oxygen. B) carries a lower risk of gastric distention and vomiting. C) is less likely to result in hyperventilation of the rescuer. D) allows greater tidal volume to be delivered to the patient.

Ans: A Page: 758

98. The flow-restricted, oxygen-powered ventilation device: A) has a demand valve that is triggered by the negative pressure generated during inhalation. B) is the preferred initial device for ventilating an apneic or inadequately breathing patient. C) delivers 100% oxygen to apneic patients at a fixed flow rate of 50 to 60 L/min. D) should be used in patients with thoracic trauma because it is less likely to cause barotrauma.

Ans: A Page: 761

102. A length-based resuscitation tape measure can be used to determine the most appropriate size of bag-mask device for pediatric patients who weigh up to: A) 34 kg. B) 38 kg. C) 42 kg. D) 46 kg.

Ans: A Page: 763

106. Which of the following patients may benefit from CPAP? A) Alert patient with respiratory distress following submersion in water B) Comatose patient with shallow breathing after overdosing on heroin C) Trauma patient with labored breathing and extensive chest wall bruising D) Patient with pulmonary edema who is unable to follow verbal commands

Ans: A Page: 763-764

112. When determining the correct-sized nasogastric tube for a patient, you should measure the tube: A) from the nose to the ear and to the xiphoid process. B) from the nose to the chin and to the epigastric region. C) from the mouth to the chin and to the xiphoid process. D) from the nose, around the ear, and to the xiphoid process.

Ans: A Page: 766-767

111. In contrast to the nasogastric tube, the orogastric tube: A) is safer to use in patients with severe facial trauma. B) should only be used in patients who are conscious. C) can be used in patients who require gastric lavage. D) is not necessary in patients who have been intubated.

Ans: A Page: 768

247. When suctioning a patient's stoma, you should: A) insert the catheter until resistance is felt. B) ask the patient to inhale as you are suctioning. C) insert the catheter no more than 15 cm. D) provide suction for no longer than 20 seconds.

Ans: A Page: 770-771

252. Removal of a dental appliance after intubating a patient is: A) dangerous and may cause dislodgement of the tube. B) generally preferred but should be performed carefully. C) mandatory in the event the patient will require surgery. D) acceptable only if the device is an upper or lower bridge.

Ans: A Page: 773

253. Which of the following interventions is NOT appropriate when treating an unresponsive patient whose airway is obstructed by a dental appliance? A) Abdominal thrusts B) Chest compressions C) Direct laryngoscopy D) Use of Magill forceps

Ans: A Page: 773

256. A mouth-opening width of less than cm indicates a potentially difficult airway. A) 3 В) 4 C) 5 D) 6

Ans: A Page: 775

120. Regardless of the internal diameter, all ET tubes have: A) a 15/22-mm proximal adaptor. B) an inflatable cuff at the distal tip. C) a pilot balloon on the proximal end. D) black millimeter markings on the side.

Ans: A Page: 777

123. When inserting a stylet into an ET tube, you must ensure that: A) the stylet rests at least 1/2in back from the end of the tube. B) you use a petroleum-based gel to facilitate easy removal. C) the stylet is rigid and does not allow the ET tube to bend. D) the tube is bent in the form of a U to facilitate placement.

Ans: A Page: 778

129. After properly positioning the patient's head for intubation, you should open his or her mouth and insert the blade: A) into the right side of the mouth and sweep the tongue to the left. B) in the midline of the mouth and gently lift upward on the tongue. C) into the left side of the mouth and move the blade to the midline. D) in the midline of the mouth and gently sweep the tongue to the left.

Ans: A Page: 781

131. You will know that you have achieved the proper laryngoscopic view of the vocal cords when you see: A) two white fibrous bands that lie vertically within the glottic opening. B) the tip of the straight blade touching the posterior wall of the pharynx. C) the thyroid cartilage bulge anteriorly as you lift up on the laryngoscope. D) the epiglottis lift when the tip of the curved blade is resting underneath it.

Ans: A Page: 782

135. When using a straight blade, a major mistake of new paramedics is to: A) try to pass the ET tube down the barrel of the blade. B) insert the blade directly between the vocal cords. C) use traction while lifting up on the patient's mandible. D) insert the blade into the left side of the patient's mouth.

Ans: A Page: 783

275. You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should: A) inflate the distal cuff with 5 to 10 mL of air. B) attach an ETCO, detector to the tube. C) secure the ET tube with a commercial device. D) begin ventilations and auscultate breath sounds.

Ans: A Page: 783-784, 788

147. Following ET intubation, the ideal time to attach the capnography T-piece is: A) when the bag is attached to the ET tube. B) after 6 to 8 positive pressure breaths. C) immediately after removing the stylet. D) after auscultating the lungs and epigastrium.

Ans: A Page: 784

150. The average depth of ET tube insertion for adult patients is: A) 21 to 25 cm. B) 22 to 26 cm. C) 23 to 27 cm. D) 24 to 28 cm.

Ans: A Page: 785

152. Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because: A) it must be performed on spontaneously breathing patients. B) the procedure should be performed in less than 10 seconds. C) it does not involve direct visualization of the vocal cords. D) patients requiring nasotracheal intubation are usually stable.

Ans: A Page: 786

155. The MOST common complication associated with nasotracheal intubation is: A) bleeding. B) aspiration. C) hypoxemia. D) regurgitation.

Ans: A Page: 789

156. The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will: A) reduce the likelihood and severity of nasal bleeding. B) sedate the patient and facilitate his or her compliance. C) dilate the nasal vasculature and facilitate tube insertion. D) anesthetize the nasopharynx and reduce patient discomfort.

Ans: A Page: 789

163. Digital intubation can be performed on trauma patients because: A) the head does not have to be placed in a sniffing position. B) most trauma patients have distortion of the airway anatomy. C) orotracheal intubation is unsafe to perform on trauma patients. D) the technique is easier to perform than other forms of intubation.

Ans: A Page: 792

164. Digital intubation should be performed only on a patient who has a bite block inserted in his or her mouth and who is _________ and _________ A) unconscious, apneic B) stuporous, bradypneic C) comatose, breathing inadequately D) semiconscious, tachypneic

Ans: A Page: 792-793

165. The MOST significant complication associated with digital intubation is: A) hypoxia. B) dental trauma. C) airway swelling. D) vocal cord damage.

Ans: A Page: 793

167. When determining whether transillumination-guided intubation should be attempted, you should: A) consider the amount of soft tissue that is overlying the trachea. B) avoid the procedure if the patient is thin or is greater than 6 ft tallI. C) ensure the airway is clear of secretions by suctioning for 30 seconds. D) recall that patients with short necks are often easy to transilluminate.

Ans: A Page: 796

279. Several attempts to orotracheally intubate an unresponsive, apneic young man have failed. You resume bag-mask ventilations and begin transport to a hospital located 25 miles away. En route, you begin having difficulty maintaining an adequate mask-to-face seal with the bag-mask device. Assuming that you have the proper equipment, which of the following techniques to secure a patent airway would be MOST appropriate? A) Transillumination intubation B) Blind nasotracheal intubation C) An open or needle cricothyrotomy D) Further attempts at orotracheal intubation

Ans: A Page: 796

175. Which of the following statements regarding field extubation is correct? A) It is generally better to sedate the patient rather than extubate. B) The patient should be extubated if spontaneous breathing occurs. C) The risk of laryngospasm following extubation is relatively low. D) Extubation should be performed with the patient in a supine position.

Ans: A Page: 803

281. An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should: A) administer a sedative medication. B) suction his airway and carefully extubate. C) chemically paralyze him with vecuronium. D) physically restrain his head to the stretcher.

Ans: A Page: 803

173. Appropriate insertion of a soft-tip (whistle-tip) suction catheter down the ET tube involves: A) gently inserting the catheter until resistance is felt. B) inserting the catheter until secretions are observed. C) inserting the catheter no farther than 6 to 8 in. D) applying suction while gently inserting the catheter.

Ans: A Page: 803-804

180. When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade.

Ans: A Page: 805

15. Which of the following statements regarding the EMT is correct? A) Manual defibrillation is a skill that all EMTs are required to learn and perform. B) In some states, EMTs are trained in advanced airway management and IV therapy. C) There are far more certified paramedics in the United States than there are EMTs. D) EMTs are licensed and can provide basic life support without medical direction.

Ans: B Page: 11-12 Type: General Knowledge

17. Compared to an EMT, an AEMT: A) can administer a variety of emergency medications. B) has a more advanced knowledge of pathophysiology. C) is trained and authorized to perform manual defibrillation. D) can legally transfer patient care to a provider of lesser training.

Ans: B Page: 11-12 Type: General Knowledge

24. A paramedic is considered a health care professional, and as such should: A) demand respect from others who are in the EMS profession. B) meet societal expectations whether he or she is on or off duty. C) obtain more than the required amount of continuing education. D) maintain higher standards than other health care professionals.

Ans: B Page: 15 Type: General Knowledge

28. If a paramedic is self-motivated, he or she should NOT: A) continuously educate himself or herself. B) require maximum supervision at work. C) possess an internal drive for excellence. D) be able to accept constructive feedback.

Ans: B Page: 16 Type: General Knowledge

1. The use of the lights and siren on an ambulance: A) gives you the legal right of way. B) is a request for the right of way. C) enables you to exceed the speed limit. D) is statistically the safest mode of transport.

Ans: B Page: 2173

6. Which of the following entities created the first standardized list of equipment to be carried on an ambulance? A) U.S. Department of Transportation B) American College of Surgeons C) American Academy of Orthopaedic Surgeons D) National Registry of Emergency Medical Technicians

Ans: B Page: 2173

5. Which of the following pieces of equipment requires regular calibration? A) Pulse oximeter B) Cardiac monitor C) Non-invasive blood pressure cuff D) Electronic thermometer

Ans: B Page: 2174

11. An ambulance should be removed from service immediately if you feel or hear: A) belt noise. B) brake fade. C) tire squeal. D) a slight drift.

Ans: B Page: 2175

16. The goal of system status management is to: A) allow paramedics ample time to rest before going on another call. B) minimize response times by deploying EMS resources strategically. C) ensure that every ambulance is staffed with at least one paramedic. D) post at least three ambulances in an area where most EMS calls occur.

Ans: B Page: 2177

17. Upon arriving at a motor-vehicle crash, the paramedic should look for safety hazards and then: A) direct traffic away from the crash scene. B) evaluate the need for additional resources. C) begin treating the most critically injured. D) establish a centralized treatment location.

Ans: B Page: 2178

37. The killing of pathogenic agents by directly applying a chemical made for that purpose is called: A) cleaning. B) disinfection. C) sterilization. D) high-level disinfection.

Ans: B Page: 2179

28. When transporting a small child on the stretcher, you should: A) place the child on a backboard, even in the absence of trauma. B) use a pediatric transport securing device whenever possible. C) place the child on a parent's lap and secure them both with straps. D) secure the child as usual, using the adult straps on the stretcher.

Ans: B Page: 2181

22. When parking the ambulance off the side of the highway in dry weather: A) the entire ambulance should be positioned off of the gravel. B) the heat from underneath the vehicle could start a grass fire. C) you should place safety cones at all four points of the vehicle. D) it is generally considered safe to turn off your warning lights.

Ans: B Page: 2183

23. Safe practices when parking your emergency vehicle on a roadway at night include all of the following, EXCEPT: A) using your emergency flashers. B) leaving the headlights on. C) wearing a reflective vest. D) turning off the strobe lights.

Ans: B Page: 2183-2184

53. Which of the following factors would have the LEAST influence on the duration and effectiveness of a medication? A) Dose administered B) Patient's dietary habits C) Route of administration D) Patient's clinical status

Ans: B Page: 436

54. The peak of a medication's effect depends on _____________, whereas the duration of effect depends on ______________. A) distribution, absorption B) absorption, metabolism C) elimination, absorption D) metabolism, distribution

Ans: B Page: 436

59. Physiologic drug antagonism occurs when: A) the action of one medication increases or decreases the ability of another medication to be absorbed by the body. B) two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes. C) the effect of one medication is enhanced by the presence of another medication, which does not have the ability to produce the same effect. D) two medications, each producing identical effects, are present simultaneously, resulting in an enhanced physiologic response.

Ans: B Page: 437

64. When the paramedic administers a medication via the IV route: A) bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation. B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. C) it is important for him or her to remember that the medication's onset of action is relatively slow. D) first-pass metabolism significantly alters the medication's effects, thereby requiring frequent dosing.

Ans: B Page: 438

66. All of the following are common sites for emergency IO cannulation, EXCEPT the: A) proximal humerus. B) iliac crest. C) proximal tibia. D) manubrium.

Ans: B Page: 439

70. Medications commonly administered via a nebulizer include all of the following, EXCEPT: A) albuterol. B) lidocaine. C) Xopenex. D) Racemic epinephrine.

Ans: B Page: 440

73. Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption? A) Liver B) Urinary tract C) Bone marrow D) Vascular system

Ans: B Page: 441

144. Patients who receive opioid substances on a long-term basis: A) are less likely to develop cross-tolerance than a non-opioid user. B) often need higher doses of an opioid medication for pain relief. C) are less likely to experience severe nervous system depression. D) typically respond to lower doses of an opioid medication.

Ans: B Page: 458

146. Fentanyl (Sublimaze) is the preferred opioid analgesic for patients in critical or unstable condition because: A) its effects last much longer than any other opioid. B) it is not as prone to causing hypotension as morphine. C) it only requires one small dose to achieve analgesia. D) it hyperstimulates mu (μ) opioid receptor sites.

Ans: B Page: 458

152. IV calcium is routinely used to treat: A) cardiopulmonary arrest. B) magnesium sulfate toxicity. C) sulfuric acid exposure. D) beta-blocker overdose.

Ans: B Page: 460

153. Glucagon is used in the treatment of beta-blocker overdose because it: A) causes vasoconstriction and increases blood pressure. B) produces positive inotropic and chronotropic effects. C) activates beta-1 receptors and increases the heart rate. D) blocks alpha-2 receptors and increases blood pressure.

Ans: B Page: 461

129. When administering a medication, the paramedic: A) cannot be held legally accountable if a physician gives an inappropriate drug order and the paramedic follows the order. B) is just as responsible for the administration of the drug and its possible consequences as the physician giving the order. C) does not need the patient's consent to administer the medication, but must obtain consent for the dose that is ordered. D) should obtain a full set of vital signs within 15 minutes of administering the medication, regardless of the type of medication.

Ans: B Page: 469-471

128. If you receive a medication order from on-line medical control that seems inappropriate to you, you should: A) refuse to administer the medication. B) ask the physician to repeat the order. C) look up the correct dose in your field guide. D) administer the drug as ordered and document it.

Ans: B Page: 470

184. While consulting with the attending physician at the receiving facility about a patient with symptomatic bradycardia, the physician orders you to administer 0.5 mg/kg of atropine to the patient. After recognizing that this is an inappropriate dose of atropine, you should: A) contact your medical director at once. B) ask the physician to repeat the order. C) refuse to administer the ordered dose. D) confirm the correct dose in your field guide.

Ans: B Page: 470

134. Medical asepsis is MOST accurately defined as: A) ensuring that all patient care supplies remain sterile. B) the practice of preventing contamination of the patient. C) the destruction of all living organisms using heat or gas. D) preventing infection of the patient by using clean supplies.

Ans: B Page: 471

3. Cerebrospinal fluid and intraocular fluid are types of: A) plasma. B) interstitial fluid. C) intracellular fluid. D) intravascular fluid.

Ans: B Page: 473

7. Which of the following statements regarding electrolytes is correct? A) Electrolytes are nonreactive and relatively harmless if they are left to circulate in the body. B) Electrolytes are also called ions and dissociate into charged components when placed in water. C) Electrolytes help to regulate muscular contraction, but have no effect on cardiac function. D) Electrolyte charges are stabilized by blood so that they can aid in the body's metabolic functions.

Ans: B Page: 473

8. Cations are electrolytes that have an overall __________ charge, and anions are electrolytes that have an overall ___________ charge. A) negative, neutral B) positive, negative C) neutral, positive D) negative, positive

Ans: B Page: 473

14. The principal extracellular cation that regulates the distribution of water throughout the body is: A) calcium. B) sodium. C) chloride. D) phosphorus.

Ans: B Page: 473-474

19. Which of the following electrolytes plays the MOST active role in metabolism? A) Potassium B) Magnesium C) Bicarbonate D) Phosphorus

Ans: B Page: 474

20. The movement of compounds or charges across a cell membrane to an area of lower concentration is called: A) osmosis. B) diffusion. C) filtration. D) selective permeability.

Ans: B Page: 474

24. The net effect of osmosis is to: A) balance the concentration of water on both sides of the cell wall. B) equalize solute concentrations on both sides of the cell membrane. C) utilize ATP to actively move solutes across the cell membrane. D) maintain a higher concentration of solutes outside of the cell.

Ans: B Page: 475

26. The internal environment's resistance to change is called: A) hemostasis. B) homeostasis. C) hypertonicity. D) hypotonicity.

Ans: B Page: 476

31. A common cause of overhydration is: A) hypertension. B) kidney failure. C) gastrointestinal drainage. D) prolonged hyperventilation.

Ans: B Page: 476

42. Which of the following statements regarding isotonic crystalloid solutions is correct? A) You should infuse 1 mL of isotonic crystalloid solution for every 3 mL of estimated blood loss. B) Approximately two thirds of infused isotonic crystalloid solution will leave the vascular space within 1 hour. C) Isotonic crystalloids, such as normal saline, have the ability to carry and deliver oxygen to the body's cells. D) The ability of isotonic crystalloids to cross membranes and alter fluid levels makes them dangerous to use for fluid replacement.

Ans: B Page: 477

36. It is MOST important to exercise caution when administering isotonic solutions to patients with: A) hypotension and severe hypovolemia. B) hypertension and congestive heart failure. C) dehydration secondary to excessive diarrhea. D) a history of insulin-dependent diabetes mellitus.

Ans: B Page: 478

94. A lavender-topped blood tube: A) contains a preservative to help determine blood-clotting factors. B) is used to determine a patient's hematocrit and hemoglobin levels. C) contains no additives and is intended to clot if blood typing is needed. D) is filled with heparin and is used to evaluate electrolyte and glucose levels.

Ans: B Page: 496

97. The IO space collectively comprises the ________ bone of the ________ and the medullary cavity of the ________. A) tibial, upper leg, diaphysis B) cancellous, epiphysis, diaphysis C) diaphyseal, epiphysis, proximal tibia D) epiphyseal, diaphysis, cancellous bone

Ans: B Page: 497

102. When infusing crystalloid solutions through an IO catheter in an unconscious adult, you should: A) give 200 mL at a time. B) use a pressure infuser device. C) deliver the solution via syringe. D) inject lidocaine prior to the infusion.

Ans: B Page: 499

103. If the posterior aspect of the leg rapidly becomes edematous during IO infusion, you should: A) elevate the lower extremity. B) suspect extravasation of fluid. C) assume that the leg is fractured. D) carefully reposition the IO needle.

Ans: B Page: 500

111. Which of the following represents the appropriate metric units of weight from largest to smallest? A) g, kg, µg, mg B) kg, g, mg, µg C) mg, g, µg, kg D) kg, mg, g, µg

Ans: B Page: 502

110. 0.2 mg equals: A) 0.02 g. B) 200 µg. C) 0.02 µg. D) 2,000 µg.

Ans: B Page: 504

117. On the Fahrenheit scale, water freezes at: A) 0°. B) 32°. C) 40°. D) 45°.

Ans: B Page: 504

116. A patient with a core body temperature of 35° on the Celsius scale has a core body temperature of ____ on the Fahrenheit scale. A) 94° B) 95° C) 96° D) 97°

Ans: B Page: 504-505

119. To administer a drug, you must know the weight of the drug that is present in: A) 1 L. B) 1 mL. C) 100 mL. D) 0.1 mL.

Ans: B Page: 505

123. Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A) 0.5 mL B) 5 mL C) 0.25 mL D) 10 mL

Ans: B Page: 505-506

124. A hypoglycemic patient requires IV dextrose. Medical control orders you to administer 25 mL. You have a prefilled syringe of 50% dextrose that contains 25 g/50 mL. How much dextrose will you give? A) 500 mg B) 12.5 g C) 5,000 mg D) 50 g

Ans: B Page: 505-506

182. During the attempted resuscitation of a man in V-Fib cardiac arrest, your protocols call for the administration of 1.5 mg/kg of lidocaine. You have prefilled syringes of lidocaine in a concentration of 100 mg/5 mL. The patient weighs 180 lb. How many milliliters will you administer? A) 5.5 B) 6.2 C) 6.5 D) 6.8

Ans: B Page: 505-506

139. The ________ route of medication administration refers to any route in which medication is absorbed through some portion of the gastrointestinal tract. A) oral B) enteral C) rectal D) gastric tube

Ans: B Page: 508

140. If you give a medication via the oral route in the prehospital setting, you should give it early because: A) toxic levels are reached easily. B) absorption via this route is slow. C) its onset of action is unpredictable. D) the patient may aspirate the medication.

Ans: B Page: 509

145. The ___________ route is the MOST commonly used medication route in the prehospital setting. A) IO B) IV C) percutaneous D) intramuscular

Ans: B Page: 511

147. When using a vial of medication, you must FIRST determine: A) the needle gauge that you will need and the appropriate size syringe. B) how much of the drug is needed and how many doses are in the vial. C) if the medication has completely settled to the base of the container. D) the appropriate amount of air that you will need to inject into the vial.

Ans: B Page: 512-513

152. When administering a medication via the intramuscular route, you should: A) pinch the skin over the injection site and insert the needle at a 45° angle. B) stretch the skin over the injection site and insert the needle at a 90° angle. C) use a 24- to 26-gauge ½ to 1 needle to inject medication into the muscle. D) use a 21-gauge needle to inject medication into the fatty tissue of the arm.

Ans: B Page: 519-520

154. The IV route is the fastest route of medication administration because: A) veins do not collapse during hypoperfusion. B) it bypasses most barriers to drug absorption. C) medications immediately enter the right atrium. D) blood pressure expedites absorption of the drug.

Ans: B Page: 521

160. Electromechanical infusion pumps are MOST beneficial when administering a medication maintenance infusion because: A) an alarm sounds if there is any air in the tubing. B) these devices allow for precise medication dosing. C) these devices totally eliminate the risk of infiltration of a vein. D) these devices will accommodate a needleless syringe.

Ans: B Page: 523

161. Which of the following steps is usually necessary when administering a drug via the IO route, but not necessary when administering a drug via the IV bolus route? A) Rapid administration of any drug that you give B) Placing a pressure infuser device around the IV bag C) Flushing with 20 mL of saline after the drug is given D) Clamping off the tubing proximal to the injection port

Ans: B Page: 524

188. A 60-year-old woman with acute chest discomfort requires 0.4 mg of sublingual nitroglycerin. Prior to administering the medication, you should: A) assess her mucous membranes to ensure they are dry. B) ask her if she wears a transdermal nitroglycerin patch. C) ensure that her systolic BP is greater than 120 mm Hg. D) determine to which hospital she wishes to be transported.

Ans: B Page: 526

166. The MOST common inhaled medication is: A) Alupent. B) oxygen. C) Ventolin. D) Bronkosol.

Ans: B Page: 528

3. A key part of making your practice of prehospital care successful is for you to: A) let the patient guide the questions that you ask in order to build a cohesive rapport on which you can build. B) develop and cultivate your own style of assessment and an overall strategy for evaluating and providing care. C) approach every patient in the same fashion with the realization that patient assessment in the field is a static process. D) strictly adhere to your department's standard operating procedures so that they become a rote series of actions.

Ans: B Page: 589

8. You will MOST likely develop your field impression of a patient based on the: A) medications the patient is taking. B) chief complaint and patient history. C) results of your secondary assessment. D) patient's perception of his or her problem.

Ans: B Page: 589

127. Which of the following actions would you likely NOT perform at the scene of a fall before engaging in the care of a conscious patient? A) Gathering dispatch information B) Speaking with immediate family C) Assessing the scene for safety D) Noting the mechanism of injury

Ans: B Page: 592-594

126. The general type of illness a patient is experiencing is called the: A) chief complaint. B) nature of illness. C) general impression. D) differential diagnosis.

Ans: B Page: 594

174. You are about to assess a patient who complains of fever, chills, and coughing up blood. In addition to donning gloves and eye protection, you should: A) place a tight-fitting mask on the patient. B) wear a properly fitted HEPA or N-95 mask. C) immediately notify the health department. D) ask the patient if he or she is HIV-positive.

Ans: B Page: 595

136. If manual positioning of a patient's head is required to keep his or her airway open, you should: A) intubate the trachea. B) insert an airway adjunct. C) suction the oropharynx. D) ventilate with a bag-mask device.

Ans: B Page: 598

138. A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is: A) irregular. B) bounding. C) thready. D) rapid.

Ans: B Page: 598

179. During your primary assessment of a 20-year-old man with blunt chest trauma, you note that he is semiconscious with rapid, shallow breathing. You do not see any obvious bleeding and note that his pulse is rapid and irregular, and his skin is cool and moist. An appropriate action would be to: A) quickly log roll the patient and assess his back. B) apply a cardiac monitor to assess for dysrhythmias. C) perform a secondary assessment while at the scene. D) insert an oral airway and apply supplemental oxygen.

Ans: B Page: 598

161. Which of the following is the MOST practical method of assessing for gross neurologic deficits during your assessment of a patient? A) Check deep tendon reflexes with a reflex hammer or similar object. B) Ask the patient if he or she can feel and move his or her fingers and toes. C) Assess capillary refill time at the forehead and the fingernails and toenails. D) Ask the patient to lift both legs and hold them up for 20 to 30 seconds.

Ans: B Page: 600

143. A patient in shock due to internal bleeding will benefit MOST from: A) oxygen and thermal management. B) limited scene time and rapid transport. C) a comprehensive physical examination. D) two large-bore IV lines of normal saline.

Ans: B Page: 601, 603

180. A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. Upon noting this, it is MOST important to: A) contact online medical control. B) prepare for immediate transport. C) position the patient on her side. D) start an IV line of normal saline.

Ans: B Page: 603

13. Asking the patient about the date, time, location, and events surrounding the current situation will enable you to: A) rapidly formulate a working diagnosis and prepare a care plan. B) determine if the patient is alert to person, place, time, and event. C) quickly rule out a life-threatening cause of the patient's problem. D) determine if the patient's problem is medical or trauma in nature.

Ans: B Page: 605

20. The paramedic should address a patient: A) by using the patient's formal name. B) as the patient wishes to be addressed. C) by the patient's first name whenever possible. D) in a manner that the paramedic deems most professional.

Ans: B Page: 606

22. EMS providers who read off a list of questions to the patient to fill in all the blanks on the run report: A) usually provide the most competent patient care. B) tend to make little or no eye contact with the patient. C) are in the best position to establish good patient rapport. D) are reassuring the patient that he or she is not being ignored.

Ans: B Page: 606

15. The history of present illness is defined as: A) the reason why the patient called EMS in the first place. B) a chronologic account of the patient's signs and symptoms. C) your perception of the severity of the patient's condition. D) a past medical problem that is causing the chief complaint.

Ans: B Page: 607

157. A deformed steering wheel in conjunction with a deployed air bag indicates that the: A) driver wore a lap belt only. B) driver was not wearing a seat belt. C) driver has intrathoracic hemorrhage. D) driver's legs struck the steering wheel.

Ans: B Page: 610

28. An empathetic attitude: A) is often offensive to the patient. B) puts you in your patient's shoes. C) will put your patient at ease quickly. D) allows you to feel sorry for the patient.

Ans: B Page: 614-615

25. Making your patient aware that you perceive something inconsistent with his or her behavior is called: A) clarification. B) confrontation. C) facilitation. D) interpretation.

Ans: B Page: 616

32. Which of the following is an example of a leading question? A) "On a scale of 1 to 10, what number would you assign your pain?" B) "Do you think that you are experiencing a cardiac emergency?" C) "Has anything like this ever happened to you before today?" D) "Does the pain stay in your chest or does it move anywhere else?"

Ans: B Page: 616

35. It would MOST likely be necessary to ask a patient a direct question if: A) he or she is elderly and has more than one medical complaint. B) he or she is not giving you usable facts about himself or herself. C) he or she is having chest pain and a heart attack must be ruled out. D) there are numerous family members and friends present at the scene.

Ans: B Page: 617

39. Which of the following findings is LEAST indicative of abuse or domestic violence? A) Multiple injuries that are in various stages of healing B) A patient who refuses to allow a family member to speak for him or her C) Injuries that are inconsistent with the history that you are given D) A husband who towers over his wife and answers your questions for her

Ans: B Page: 618

40. When asking questions pertaining to a patient's sexual history, it is important to remember that: A) you should inquire about the patient's HIV status. B) obtaining the history in a private setting is essential. C) a physical examination should be performed as well. D) the patient's sexual preference is especially relevant.

Ans: B Page: 618

45. The MOST negative immediate consequence of providing inappropriate reassurance to your patient in the prehospital setting is: A) a lawsuit lodged against you by the patient or his or her family. B) the patient's choice not to share as much information with you. C) causing the patient's family members severe emotional distress. D) emotional distress when the physician tells the patient otherwise.

Ans: B Page: 620

The oropharynx: A) contains the adenoids on its posterior wall. B) forms the posterior portion of the oral cavity. C) is bordered superiorly by the hard palate only. D) consists of the anterior portion of the oral cavity.

Ans: B Page: 714

During forceful inhalation, the vocal cords: A) are partially open to allow for turbulent air flow. B) open widely to provide minimum resistance to air flow. C) abruptly spasm in order to protect the lower airway. D) bulge anteriorly to facilitate air flow into the trachea.

Ans: B Page: 715

Which of the following statements regarding the tonsils is correct? A) The tonsils are located on the posterior nasopharyngeal wall. B) The tonsils rarely become swollen enough to obstruct the airway. C) The tonsils are comprised of lymphatic tissue and help to trap bacteria. D) The tonsils are located in the anterior pharynx and filter bacteria.

Ans: C Page: 714-715

Surfactant is: A) produced by the mucous cells of the left and right mainstem bronchi. B) quickly destroyed in patients who have a severe upper airway obstruction. C) a phospholipid compound that decreases surface tension on the alveolar walls. D) a lubricating substance that increases alveolar surface tension during breathing.

Ans: C Page: 716

The ____________ are pyramid-like structures that form the posterior attachment of the vocal cords. A) palatine tonsils B) pyriform fossae C) arytenoid cartilages D) hypoepiglottic ligaments

Ans: C Page: 716

The process of moving air into and out of the lungs is called: A) respiration. B) inhalation. C) ventilation. D) exhalation.

Ans: C Page: 717

Approximately ____ mL of air remains in the anatomic dead space of an adult with a tidal volume of 500 mL. A) 100 B) 125 C) 150 D) 175

Ans: C Page: 719-720

The normal alveolar volume in a healthy adult is: A) 250 mL. B) 300 mL. C) 350 mL. D) 400 mL.

Ans: C Page: 719-720

During sleep, the metabolic rate is ___________ and the number of respirations ___________: A) low, increases B) high, decreases C) low, decreases D) high, increases

Ans: C Page: 722

The fraction of inspired oxygen (FIO,) increases with: A) increased tidal volume. B) forceful inhalation. C) supplemental oxygen. D) an increase in respirations.

Ans: C Page: 722

A patient with respiratory splinting: A) is often tachypneic with deep breathing. B) is holding his or her arm against the chest. C) is breathing shallowly to alleviate chest pain. D) has an increased tidal volume due to a chest injury.

Ans: C Page: 727

49. An adult patient with an abnormal respiratory rate should: A) be given oxygen at 4 L/min with a nasal cannula. B) be assessed immediately for heart rate abnormalities. C) be evaluated for other signs of inadequate ventilation. D) receive ventilatory assistance with a bag-mask device.

Ans: C Page: 729

262. Which of the following findings is MOST clinically significant in a 30-year-old woman with difficulty breathing and a history of asthma? A) Oral temperature of 97.9°F B) Expiratory wheezing on exam C) Prior ICU admission for her asthma D) 3 mm Hg drop in systolic BP during inhalation

Ans: C Page: 730

57. Which of the following findings is MOST significant in a patient with acute respiratory distress? A) A regular heart rate of 110 beats/min B) A family history of pulmonary embolism C) Prior ICU admission for the same problem D) Low-grade fever and flu-like symptoms

Ans: C Page: 730

60. Which of the following abnormal respiratory patterns generally do NOT suggest brain injury or cerebral anoxia? A) Biot respirations B) Agonal respirations C) Kussmaul respirations D) Cheyne-Stokes respirations

Ans: C Page: 731

64. An increasing peak expiratory flow reading in a patient with respiratory distress suggests that the patient is: A) experiencing worsened hypoxemia. B) no longer experiencing bronchospasm. C) responding to bronchodilator therapy. D) in need of further bronchodilator therapy.

Ans: C Page: 734

140. If the ET tube is placed in the trachea properly, the colorimetric paper inside the ETCO, detector should: A) not change colors. B) turn yellow during inhalation. C) turn yellow during exhalation. D) remain purple during ventilations.

Ans: C Page: 736

141. The use of capnography in patients with prolonged cardiac arrest may be limited because: A) of an excess buildup of nitrogen in the blood. B) the paramedic often ventilates the patient too slowly. C) of acidosis and minimal carbon dioxide elimination. D) metabolic alkalosis damages the colorimetric paper.

Ans: C Page: 736

145. On a capnographic waveform, point _________ is the maximal ETCO, and is the best reflection of the alveolar CO, level. A) B В) С C) D D) E

Ans: C Page: 736

68. If you suspect that an unconscious patient has experienced a spinal injury, you should open his or her airway by: A) applying firm pressure to the patient's forehead and tilting the head back. B) placing your fingers behind the angle of the jaw and lifting the jaw forward. C) carefully grasping the tongue and jaw and slowly lifting the jaw forward. D) lifting up on the jaw while placing the head in a slightly extended position.

Ans: B Page: 738

79. If an unresponsive patient does not have a gag reflex, an oropharyngeal airway: A) should only be inserted if the patient is not breathing. B) should be inserted whether the patient is breathing or not. C) will effectively prevent aspiration if the patient vomits. D) must be inserted by depressing the tongue with a tongue blade.

Ans: B Page: 744

82. It would be appropriate to insert a nasopharyngeal airway in patients who: A) are unresponsive with multiple facial bone fractures. B) have an altered mental status with an intact gag reflex. C) are semiconscious with active vomiting and cyanosis. D) have CSF leakage from the nose and are semiconscious.

Ans: B Page: 746

177. After confirming that an intubated patient remains responsive enough to maintain his or her own airway, you should first: A) fully deflate the distal cuff on the ET tube. B) have the patient sit up or lean slightly forward. C) suction the oropharynx to remove any secretions. D) insert an orogastric tube to ensure the stomach is empty.

Ans: B Page: 803-804

179. In which of the following situations would ET intubation of a pediatric patient be LEAST necessary? A) Traumatic brain injury with unconsciousness B) Administration of certain resuscitative medications C) Cardiopulmonary arrest due to respiratory failure D) Difficulty effectively ventilating with a bag-mask

Ans: B Page: 805

187. Which of the following is NOT an appropriate method for confirming proper ET tube placement in a 15-kg child? A) Waveform capnography B) Esophageal bulb or syringe C) Bilateral auscultation of breath sounds D) Assessment of skin color and oxygen saturation

Ans: B Page: 807

189. Which of the following clinical findings is LEAST suggestive of a pneumothorax in an intubated child? A) Decreased ventilation compliance B) Stronger breath sounds on the right side C) Persistent cyanosis despite ventilations D) Stronger breath sounds on the left side

Ans: B Page: 807

264. You respond to a residence for a possible overdose. The patient, a young man, is unresponsive with slow, snoring respirations. There are obvious needle track marks on his arms. Your FIRST action should be to: A) insert an oral airway. B) suction his oropharynx. C) manually open his airway. D) begin ventilation assistance.

Ans: C Page: 737-738

76. A whistle-tip suction catheter is MOST often used to: A) suction large debris from the oropharynx. B) rapidly remove large volumes of vomitus. C) remove secretions from an ET tube. D) suction an adult's mouth for 15 to 30 seconds.

Ans: C Page: 740-742

70. A foreign-body airway obstruction should be suspected in a child who presents with: A) diffuse wheezing and nasal flaring.. B) a productive cough and flushed skin. C) acute respiratory distress without fever. D) progressive respiratory distress and hoarseness,

Ans: C Page: 746

81. Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may: A) result in ventricular dysrhythmias secondary to intracranial pressure. B) cause acute herniation of the brainstem through the foramen magnum. C) cause the device to enter the brain through a hole caused by a fracture. D) result in acute hypertension and decreased cerebral perfusion pressure.

Ans: C Page: 746

19. The 2009 National EMS Education Standards: A) clearly state that all paramedic training programs must be at least 1,200 hours in length. B) require inclusion of a college-level pathophysiology course within the paramedic program. C) mandate that the paramedic designation must be achieved through an associate degree program. D) outline the minimum knowledge base that the paramedic must possess in order to function in the field.

Ans: D Page: 12 Type: General Knowledge

134. You should insert the ET tube between the vocal cords until the: A) centimeter marking reads 15 cm at the patient's teeth. B) distal end of the cuff is 1 to 2 cm past the vocal cords. C) proximal end of the cuff is 1 to 2 cm past the vocal cords. D) tube meets resistance as it makes contact with the carina.

Ans: C Page: 783

274. Approximately 10 seconds into an intubation attempt, you catch a glimpse of the patient's vocal cords, but quickly lose sight of them. You should: A) sweep the patient's tongue to the right side of the mouth and revisualize. B) abort the intubation attempt and ventilate the patient with a bag-mask device. C) ask your partner to apply backward, upward, rightward pressure to the thyroid. D) gently pry back on the laryngoscope to improve your view of the upper airway.

Ans: C Page: 783

146. According to the most current guidelines for emergency cardiac care, the MOST reliable method for monitoring correct ET tube placement is: A) pulse oximetry. B) the esophageal detector device. C) waveform capnography. D) colorimetric capnography.

Ans: C Page: 784

160. If you see a soft-tissue bulge on either side of the airway when performing nasotracheal intubation: A) inadvertent esophageal intubation has likely occurred. B) you should completely remove the tube and reoxygenate. C) you have probably inserted the tube into the pyriform fossa. D) the tube is positioned correctly just above the glottic opening.

Ans: C Page: 790

161. Which of the following is NOT a step that is performed during nasotracheal intubation? A) Advancing the ET tube as the patient inhales B) Preoxygenating with bag-mask as necessary C) Ensuring that the patient's head is hyperflexed D) Placing the patient's head in a neutral position

Ans: C Page: 790-791

168. Transillumination-guided intubation can be difficult or impossible to perform: A) in any patient with dentures. B) if the patient has oral secretions. C) in a brightly lit environment. D) in patients over 70 years of age.

Ans: C Page: 796

170. Which of the following indicates that the lighted stylet has entered the trachea? A) Dim, diffuse light at the anterior part of the neck B) Bulging of the soft tissue above the thyroid cartilage C) Tightly circumscribed light below the thyroid cartilage D) Absent illumination at the midline of the patient's neck

Ans: C Page: 798-799

172. During tracheobronchial suctioning, it is MOST important to: A) apply suction for no longer than 5 seconds in the adult. B) avoid rotating the catheter as you are suctioning the trachea. C) monitor the patient's cardiac rhythm and oxygen saturation. D) inject 10 mL of saline down the ET tube to loosen secretions.

Ans: C Page: 803

154. The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because: A) the ET tube cannot be secured effectively when it is in the nose. B) most patients who are intubated nasally are extremely combative. C) he or she did not visualize the tube passing between the vocal cords. D) most nasotracheal intubation attempts result in esophageal placement.

Ans: C Page: 789

20. The main purpose of continuing education is to: A) facilitate networking of EMS personnel. B) recall material that was learned previously. C) allow EMS personnel to function at a higher level. D) remain current with the latest treatment guidelines.

Ans: D Page: 12-13 Type: General Knowledge

25. In order to provide the best possible patient care, the paramedic must: A) disregard negative judgments made by the patient. B) project a sympathetic demeanor toward all patients. C) appear competent, even if he or she feels incompetent. D) establish and maintain credibility and instill confidence.

Ans: D Page: 15-16 Type: General Knowledge

30. All of the following are examples of injury prevention, EXCEPT: A) demonstrating the proper use of a bicycle helmet. B) instructing a person on how to wear a seat belt properly. C) informing a patient of a loose rug at the top of the stairs. D) teaching rescue breathing and CPR to a group of citizens.

Ans: D Page: 16 Type: General Knowledge

3. What entity is responsible for making recommendations regarding infection control practices that include all areas of personal protective equipment, sharps containers, and disinfecting equipment that is carried on an ambulance? A) Centers for Disease Control and Prevention B) United States Department of Transportation C) National Highway Traffic Safety Administration D) Occupational Safety and Health Administration

Ans: D Page: 2173

8. Unless the fluid level is low, you should NOT uncap the brake fluid reservoir because: A) air will be drawn into the hydraulic brake lines. B) the reservoir is pressurized and may cause burns. C) doing so releases pressure within the brake lines. D) brake fluid absorbs moisture from the atmosphere.

Ans: D Page: 2176

13. When determining productivity of an EMS system, the EMS provider: A) calculates the ratio of EMS calls to the number of operating ambulances. B) determines the number of paramedics on duty versus the number of EMS calls. C) calculates the number of critical patients per month and how many survived. D) measures how many patient transports per hour each ambulance accomplishes.

Ans: D Page: 2177

21. When you are dispatched to an emergency, it is MOST important to: A) take a route that will ensure a fast response time. B) use GPS to ensure accurate navigation to the scene. C) use your lights and siren to warn other motorists. D) determine which route will be used to arrive safely.

Ans: D Page: 2180

27. General principles for backing up an ambulance include: A) using one spotter for each side of the ambulance. B) keeping the window up to avoid any distractions. C) not using audible warning devices so you can hear. D) stopping the vehicle if you lose sight of your spotter.

Ans: D Page: 2182

18. With respect to emergency driving, due regard means that: A) an ambulance must never exceed the posted speed limit, even if it is responding to a call for a critical patient. B) the emergency vehicle operator can legally exceed the posted speed limit by 20 miles per hour, but only if it is safe to do so. C) an ambulance must use its lights and siren and remain at least 100 feet behind a vehicle that is failing to yield. D) the use of lights and siren does not exempt you from operating the ambulance with concern for the safety of others.

Ans: D Page: 2185

41. While responding to a call for a pediatric cardiac arrest, you approach a school bus with its red warning lights on. You should: A) turn your emergency lights and siren off and carefully proceed past the bus at a slow speed. B) use your PA system to advise the students to remain on the bus as you carefully pass it on the left. C) carefully pass the bus on the right, if possible, so the children exiting the bus will be able to see you. D) wait for the bus driver to turn off the red warning lights and close the door before carefully passing.

Ans: D Page: 2186

31. Air ambulances are advantageous for all of the following reasons, EXCEPT: A) the ability to access remote areas. B) faster transport to definitive care. C) the availability of specialized equipment. D) more experience of the flight paramedics.

Ans: D Page: 2187-2188

36. After a helicopter lands and continues to keep its rotor blades active, you should: A) post a firefighter near the tail rotor to keep bystanders away. B) approach the aircraft from the front and keep the pilot in view at all times. C) slowly approach the left side of the aircraft while keeping your head down. D) not approach the aircraft until the pilot or a crew member signals you to do so.

Ans: D Page: 2189-2190

45. A helicopter has just landed to transport your critically injured patient to the hospital. The helicopter is configured so that the patient must be loaded from the rear of the aircraft. Unless otherwise directed by the flight crew, you should approach the aircraft from the: A) left. B) rear. C) right. D) front.

Ans: D Page: 2189-2190

12. Common actions performed by the dispatcher after receiving an emergency call include all of the following, EXCEPT: A) receiving and entering all data regarding the call. B) relaying information to the appropriate resources. C) interpreting the information provided by the caller. D) determining if an ambulance should be dispatched.

Ans: D Page: 11 Type: General Knowledge

283. While transporting an intubated 8-year-old boy, he suddenly jerks his head and becomes cyanotic shortly thereafter. His oxygen saturation and capnometry readings are both falling, and he is becoming bradycardic. You attempt to auscultate breath sounds, but are unable to hear because of the drone of the engine. What has MOST likely happened? A) Tension pneumothorax B) Inadvertent extubation C) Obstruction of the tube D) Right mainstem intubation

Ans: B Page: 807

57. Medication X is given to increase the effects of medication Y, which provides more relief than if medication Y were given alone. This is an example of: A) synergism. B) summation. C) potentiation. D) antagonism.

Ans: C Page: 437

61. First-pass metabolism of a medication occurs when: A) a medication's effects are greatly enhanced by digestive enzymes in the stomach. B) a medication's bioavailability is immediately reduced when it enters the bloodstream. C) the bioavailability of a medication is reduced before it reaches the systemic circulation. D) the liver increases a medication's effects before it reaches the systemic circulation.

Ans: C Page: 438

68. Transdermal medication patches: A) deliver a fluctuating dose of a medication over a relatively short period of time. B) should never be removed by the paramedic, even if he or she is administering a drug of the same type. C) may alter a patient's clinical presentation or interfere with medications administered by the paramedic. D) are a reliable medication delivery route because they are unaffected by the patient's perfusion status.

Ans: C Page: 439

74. The process that the cells of large medication molecules use to ingest intracellular fluids and their contents is called: A) osmosis. B) filtration. C) pinocytosis. D) phagocytosis.

Ans: C Page: 441

78. The paramedic should suspect altered medication metabolism in a patient with: A) hypertension. B) acute pancreatitis. C) chronic alcoholism. D) chronic renal failure.

Ans: C Page: 442

81. A patient takes 500 mg of a medication that has a half-life of 2 hours. How much medication will be in the patient's body after 6 hours? A) 250 mg B) 125 mg C) 62.5 mg D) 31.25 mg

Ans: C Page: 443

87. Which of the following statements regarding benzodiazepine medications is NOT correct? A) Benzodiazepines have potent anxiolytic, antiseizure, and sedative properties. B) A benzodiazepine may be used as the primary sedative for advanced airway care. C) High doses of a benzodiazepine may be needed to maintain a patient's blood pressure. D) Benzodiazepines are commonly used in the prehospital setting to terminate seizures.

Ans: C Page: 448

92. Which of the following statements regarding succinylcholine is correct? A) It has a rapid onset of action and long duration of action. B) It causes tachycardia, especially in small children. C) It has a rapid onset of action and short duration of action. D) It may induce or exacerbate existing hypokalemia.

Ans: C Page: 448

93. Compared to succinylcholine, rocuronium: A) has a rapid (30 to 60 seconds) onset of action and a relatively brief (3 to 8 minutes) duration of action. B) binds with nicotinic receptors on muscles and causes a brief activation known as fasciculation. C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects. D) does not bind with nicotinic receptor sites on muscle cells and does not antagonize acetylcholine.

Ans: C Page: 448

98. Repolarization and myocardial contraction are occurring through phases: A) 0 and 1. B) 1 and 2. C) 2 and 3. D) 3 and 4.

Ans: C Page: 450-451

99. What phases of the cardiac cellular action potential comprise the absolute refractory period? A) 1 and 2 only B) 2 and 3 only C) 0 through 3 D) 0 through 4

Ans: C Page: 450-451

105. Which of the following statements regarding adenosine is correct? A) Adenosine has a half-life of between 20 and 30 seconds and should be given slowly. B) Adenosine increases conduction velocity and shortens the effective refractory period. C) Adenosine is used to assess for P waves when slowing a supraventricular tachycardia. D) Ventricular tachycardia is often terminated following the administration of adenosine.

Ans: C Page: 451-452

111. Patients taking ACE inhibitor medications commonly have: A) immunosuppression. B) thin and fragile skin. C) a chronic, dry cough. D) a reduced platelet count.

Ans: C Page: 452

113. Acetylcholinesterase is an enzyme that: A) decreases the heart rate. B) slows cardiac conduction. C) breaks down acetylcholine. D) promotes acetylcholine secretion.

Ans: C Page: 453

119. In contrast to epinephrine, norepinephrine: A) specifically targets beta-1 receptors. B) has minimal effect on blood pressure. C) primarily stimulates alpha receptors. D) stimulates beta-1 and beta-2 receptors.

Ans: C Page: 453

124. Hypotension may occur following initiation of a dobutamine infusion because it: A) is a direct vasodilator. B) blocks alpha-1 receptors. C) reduces cardiac afterload. D) has negative inotropic effects.

Ans: C Page: 454

130. In critical care settings, mannitol is used to: A) manage hypothermia. B) lower the blood pressure. C) reduce cerebral edema. D) treat anaphylaxis.

Ans: C Page: 456

131. If unmatched blood is administered in the prehospital setting, it will almost always be: A) O, Rh-positive. B) AB, Rh-negative. C) O, Rh-negative. D) AB, Rh-positive.

Ans: C Page: 456

136. Which of the following statements regarding fresh frozen plasma (FFP) is correct? A) FFP is the ideal volume expander for critically injured patients whose blood type is not known. B) FFP is contraindicated in patients with warfarin (Coumadin) toxicity due to the risk of hemolysis. C) FFP must be compatible with the recipient's blood type, but does not have to be Rh compatible. D) FFP should not be administered to patients who require large volumes of other blood products.

Ans: C Page: 457

141. Which of the following is an influencing factor regarding the administration of a fibrinolytic drug to a patient experiencing an acute myocardial infarction? A) Quality of the chest pain B) History of unstable angina C) Time of symptom onset D) Concurrent use of aspirin

Ans: C Page: 458

143. Narcotic analgesics relieve pain by: A) blocking opioid receptors. B) suppressing adrenergic function. C) stimulating opioid receptors. D) blocking neuromuscular activity.

Ans: C Page: 458

148. What type of medication is used to decrease gastric acid secretion? A) Histamine-1 receptor antagonist B) Alpha-2 receptor antagonist C) Histamine-2 receptor antagonist D) Phosphodiesterase-5 inhibitor

Ans: C Page: 459

151. All of the following medications possess antiemetic properties, EXCEPT: A) ondansetron. B) dolasetron. C) famotidine. D) prochlorperazine.

Ans: C Page: 459-460

131. If you receive orders to administer more than one drug to the same patient, it is MOST important to: A) start a second IV line. B) give a 100-mL saline bolus between drugs. C) make sure the drugs are compatible. D) wait 10 minutes before giving the second drug.

Ans: C Page: 471

135. The site on a patient's forearm that has been cleaned with iodine and alcohol before starting an IV is said to be: A) sterile. B) autoclaved. C) medically clean. D) disinfected.

Ans: C Page: 471

137. When performing an invasive procedure, such as starting an IV, minimum standard precautions include: A) gloves only. B) gloves and a mask. C) gloves and protective eyewear. D) gloves, gown, and full facial protection.

Ans: C Page: 472

1. Approximately ___% of an adult male's weight is constituted by water. A) 40 B) 50 C) 60 D) 70

Ans: C Page: 473

11. The milliequivalent (mEq) represents the chemical combining power of the ion and is based on the: A) percentage of sodium in a given electrolyte solution. B) ability to unite with an electrolyte with the same charge. C) number of available ionic charges in an electrolyte solution. D) ratio of positively and negatively charged ions.

Ans: C Page: 473

2. Intracellular fluid: A) is the fluid that bathes the cells. B) transports red and white blood cells. C) is the water contained inside the cells. D) accounts for about 15% of body weight.

Ans: C Page: 473

5. A composition of dissolved elements and water is called a(n): A) solute. B) solvent. C) solution. D) electrolyte.

Ans: C Page: 473

18. The chemical sign for sodium bicarbonate is: A) NaCl. B) H2CO3. C) NaHCO3. D) KCl.

Ans: C Page: 473-474

16. Hyperkalemia would MOST likely result in: A) abnormal gastrointestinal function. B) decreased skeletal muscle function. C) hyperstimulation of neural cell transmission. D) severe bradycardia due to increased vagal tone.

Ans: C Page: 474

23. Osmosis occurs when: A) water moves from an area of higher solute concentration to an area of lower solute concentration. B) solutes move from an area of lower water concentration to an area of higher water concentration. C) water moves from an area of lower solute concentration to an area of higher solute concentration. D) solutes move from an area of higher water concentration to an area of lower water concentration.

Ans: C Page: 475

27. A healthy person loses approximately ___ to ___ liters of fluid daily through urine output, through exhalation, and through the skin. A) 0.5, 1 B) 1, 1.5 C) 2, 2.5 D) 3, 4

Ans: C Page: 476

44. How much isotonic crystalloid solution should you administer to a patient who weighs 65 kg and who has signs and symptoms of internal bleeding? A) Boluses of up to 1,625 mL each B) 10 to 20 mL/kg every 5 to 10 minutes C) An amount adequate to maintain perfusion D) Enough to increase blood pressure to a normal level

Ans: C Page: 477

33. IV fluids introduced into the circulatory system: A) are only effective if the patient is experiencing renal insufficiency. B) will always cause a fluid shift out of the intracellular compartment. C) can affect the tonicity of the extracellular fluid and can be harmful. D) usually do not cause a fluid shift into or out of the intracellular space.

Ans: C Page: 478

38. Lactated Ringer's (LR) solution may be beneficial to patients who have lost large amounts of blood because: A) it takes less LR to effectively expand the intravascular compartment than any other isotonic solution. B) LR has the ability to carry oxygen and can maintain cellular perfusion until the patient receives definitive care. C) the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis. D) the likelihood of causing acute circulatory overload is minimal relative to other hypertonic solutions.

Ans: C Page: 478

40. Hypotonic solutions: A) include normal saline and lactated Ringer's solution. B) draw fluid from the cells and into the vascular space. C) hydrate the cells while depleting the vascular compartment. D) are the preferred solutions to use in patients with head trauma.

Ans: C Page: 478-479

50. The MOST important point to remember about IV therapy is to: A) locate the largest vein. B) wear two pairs of gloves. C) keep the IV equipment sterile. D) prepare all supplies ahead of time.

Ans: C Page: 479

51. Which of the following questions does the paramedic generally NOT ask himself or herself when determining the most appropriate IV solution to use on a patient? A) Is the patient's condition critical? B) Will the patient need medications? C) Has the patient had IV therapy before? D) Will the patient need fluid replacement?

Ans: C Page: 479

56. When a patient needs rapid fluid replacement, you should: A) use a microdrip administration set because you can deliver more precise volumes of IV fluid. B) choose an administration set that delivers the least amount of volume per the most number of drops. C) select an administration set that contains a large opening between the piercing spike and drip chamber. D) use a microdrip administration set in order to avoid inadvertently overloading the patient with fluid.

Ans: C Page: 480

144. Compared with enterally administered medications, parenterally administered medications: A) require the presence of a peripheral IV line. B) must pass through the gastrointestinal tract to be effective. C) are absorbed into the central circulation at a more predictable rate. D) achieve their therapeutic effects much more slowly and are less predictable.

Ans: C Page: 511

146. When drawing medication from an ampule, you should: A) cleanse the rubber stopper with an alcohol prep. B) always use a 14- or 16-gauge hypodermic needle. C) gently tap the ampule if medication is stuck in the neck. D) inject air into the ampule before withdrawing the medication.

Ans: C Page: 512-513

151. Which of the following statements regarding subcutaneous medication administration is correct? A) A subcutaneous injection involves using a 20- or 21-gauge needle. B) The needle is inserted at a 90° angle during a subcutaneous injection. C) Volumes of a drug given subcutaneously are typically 1 mL or less. D) The rectus femoris muscle is a common site for subcutaneous injections.

Ans: C Page: 517

186. You reassess your patient after administering a medication via the IV bolus route and note that his clinical condition is unchanged. What is the LEAST likely cause of the patient's unchanged condition? A) The patient may require another dose of the same drug. B) The dose was too low for the patient's clinical condition. C) The IV tubing was occluded proximal to the injection port. D) You diluted the bolus by following it with a 20-mL saline flush.

Ans: C Page: 521-523

157. Failure to pinch the tubing proximal to the injection port when administering a drug via the IV bolus route will: A) cause the medication to enter the patient's central circulation rapidly. B) result in too much of the medication entering the patient's circulation. C) cause the medication to flow up the tubing and away from the patient. D) negate the need to follow the IV bolus with a 20-mL normal saline flush.

Ans: C Page: 522

159. Although medications that are used for maintenance infusions are commonly premixed and prepackaged, you must still: A) add 100 mL of sterile saline to dilute the premixed medication. B) draw 20 mL of fluid from the premixed solution to use as a flush. C) be aware of the concentration of the drug in the premixed solution. D) use the drug within 36 hours after removing it from its foil covering.

Ans: C Page: 523

165. Which of the following statements regarding the mucosal atomizer device (MAD) is correct? A) Narcan is the only emergency medication that can be administered intranasally with the MAD. B) The MAD is used to inject a straight stream of select emergency drugs directly into the nasal canal. C) When administering a drug with the MAD, you should spray half of the dose into each nostril. D) Drugs administered with the MAD have an onset of action that is slightly slower than the intramuscular route.

Ans: C Page: 528

168. When administering a medication via small-volume nebulizer, you should add ___ mL of sterile saline to the medication and set the oxygen flow rate at ___ L/min. A) 1, 3 B) 2, 4 C) 3, 6 D) 6, 10

Ans: C Page: 530-531

5. Which of the following is NOT a part of your overall job as a paramedic? A) Efficiently executing a patient care plan B) Quickly identifying your patient's problem C) Definitively diagnosing the patient's problem D) Establishing your priorities of patient care

Ans: C Page: 589

128. Whether your patient's problem is medical or traumatic in origin, you must: A) always begin transport within 10 minutes. B) contact medical control as soon as possible. C) qualify and quantify the patient's condition. D) perform a head-to-toe secondary assessment.

Ans: C Page: 589, 597

9. When assessing any patient, the paramedic should remember that: A) the past medical history is of even greater importance if the patient has a traumatic injury. B) it is extremely common for patients with a medical complaint to have an underlying injury. C) some patients with a traumatic injury could also have an underlying medical component. D) the patient's underlying medical problem can usually be identified by a rapid assessment.

Ans: C Page: 590

182. You are caring for an unresponsive 54-year-old man with an apparent isolated head injury after he fell from a standing position. Your partner is maintaining manual stabilization of the patient's head while assisting his breathing. Your rapid head-to-toe exam reveals only a large hematoma to the patient's forehead. Further assessment reveals that the patient is wearing a medical alert bracelet that reads "allergic to codeine." You should: A) instruct your partner to ventilate the patient at 24 breaths/min. B) perform a detailed secondary assessment and transport at once. C) assess his blood glucose reading and give dextrose if necessary. D) give epinephrine in case he is experiencing an allergic reaction.

Ans: C Page: 590, 610, 677

176. Upon arriving at the scene of a patient with difficulty breathing, you find the patient, a 300-pound man, sitting on the couch in his living room. The patient is conscious and alert and tells you that he is chronically short of breath but feels worse today and wishes to be transported to the hospital. As you begin your assessment, your partner should: A) obtain vital signs. B) contact medical control. C) request lifting assistance. D) prepare a nebulizer treatment.

Ans: C Page: 594-595

159. The rapid exam of a patient is usually performed: A) as soon as your general impression of the patient suggests that he or she is critically injured. B) immediately after determining that the patient has experienced a significant mechanism of injury. C) after all life-threatening conditions have been identified and addressed in the primary assessment. D) following at least one complete set of vital signs, including assessment of the pupils and blood glucose.

Ans: C Page: 596, 601

139. When the blood vessels supplying the skin are fully dilated, the skin becomes: A) cool and pale. B) cold and moist. C) warm and pink. D) blue or mottled.

Ans: C Page: 599

145. For a responsive patient with a medical problem, you will MOST likely form your working diagnosis based on information gathered during the: A) primary assessment. B) general impression. C) history-taking process. D) detailed physical exam.

Ans: C Page: 606

19. Working to ensure a patient's privacy, confidentiality, and comfort level will: A) make the patient feel comfortable in disclosing personal information to you. B) leave no doubt in the patient's mind that you are truly a professional caregiver. C) establish positive patient rapport and encourage honest, open communication. D) help you gain the trust of the patient's family more than the trust of the patient.

Ans: C Page: 606

14. When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine: A) if the two complaints are related. B) when each of the complaints began. C) which complaint has a higher priority. D) the patient's past medical history.

Ans: C Page: 607

181. A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary assessment, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should: A) apply a rigid cervical collar, start an IV of normal saline, and perform immediate endotracheal intubation. B) apply supplemental oxygen via nonrebreathing mask, place her in a lateral recumbent position, and transport. C) insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions. D) quickly place her on the stretcher, obtain a 12-lead ECG tracing, and perform a detailed physical exam.

Ans: C Page: 610, 677

160. Which of the following is an example of a pertinent negative? A) A family member states that the patient has hypertension. B) A patient tells you that he has developed a plan for suicide. C) A patient with chest discomfort denies shortness of breath. D) An agitated patient tells you that he did not request your help.

Ans: C Page: 612

24. Paying attention, making eye contact, and repeating key information from the patient's answers are examples of: A) reflection. B) clarification. C) facilitation. D) interpretation.

Ans: C Page: 615

30. Which of the following questions will yield the LEAST reliable information when assessing a patient with abdominal pain? A) "In your opinion, how severe is the pain?" B) "Are you experiencing any other symptoms?" C) "Does the pain radiate to your chest or back?" D) "Have you ever experienced pain like this before?"

Ans: C Page: 615

31. Before asking a patient about any mental health issues, the paramedic should: A) speak privately with a family member or trusted friend. B) move the patient to the ambulance, where it is more private. C) ask questions relating to his or her physical health. D) perform a comprehensive head-to-toe assessment.

Ans: C Page: 616

37. When assessing a patient who is under the influence of alcohol, it is MOST important to remember that: A) the amount of alcohol consumed is often overstated. B) the patient often gives a reliable and accurate history. C) alcohol can mask any number of signs and symptoms. D) suspicions of alcohol intoxication must be documented.

Ans: C Page: 617

42. A patient who is overly talkative during your assessment: A) should be interrupted immediately. B) will not give a reliable medical history. C) may have abused methamphetamines. D) is usually an inherently antisocial person.

Ans: C Page: 619

47. If a hostile family member suddenly leaves the room, especially in the middle of a conversation with him or her, you should: A) immediately depart the scene and notify law enforcement personnel. B) ignore the family member's departure and continue to assess your patient. C) have your partner follow the person, while working to defuse the situation. D) ask the patient to follow the person in an attempt to reason with him or her.

Ans: C Page: 620

52. A patient who gives the emergency department physician completely different information than he or she gave to you in the field: A) clearly trusts the physician more than you. B) will cause the physician to question your competence. C) may have an organic condition, such as a brain tumor. D) should be questioned as to why the information was different.

Ans: C Page: 621

154. Serial vital signs: A) are of no value unless they are repeated every 5 minutes. B) provide definitive information about the patient's problem. C) provide comparative data regarding the patient's condition. D) establish a baseline to which further vital signs are compared.

Ans: C Page: 628

60. Blood pressure is the product of: A) stroke volume and heart rate. B) left ventricular ejection fraction and afterload. C) cardiac output and peripheral vascular resistance. D) right atrial preload and ventricular stroke volume.

Ans: C Page: 629

65. An appropriately sized blood pressure cuff should: A) completely encompass the entire upper arm. B) cover at least one third of the patient's upper arm. C) be one half to two thirds the size of the upper arm. D) cover at least two thirds of the patient's upper arm.

Ans: C Page: 631

131. When assessing an injured patient's mental status, the patient knows his name but is unable to recall the events that preceded the injury. From this, you can conclude that: A) the patient's long-term memory is not intact. B) the patient's Glasgow Coma Scale score is at least 13. C) the patient's short-term memory is not intact. D) the patient likely has an intracranial hemorrhage.

Ans: C Page: 635

133. What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? A) 10 B) 11 C) 12 D) 13

Ans: C Page: 636

70. Poor skin turgor in an infant or child is MOST indicative of: A) shock. B) hypoxemia. C) dehydration. D) elastin deficiency.

Ans: C Page: 638

166. When assessing the head and face during the full-body exam, you should: A) apply pressure to the eyes to elicit pain. B) remove any dentures if they are present. C) avoid palpating any cranial depressions. D) pack the ears if blood drainage is present.

Ans: C Page: 639-641

75. A patient who complains of double vision has: A) ptosis. B) anisocoria. C) diplopia. D) hyperopia.

Ans: C Page: 641

80. An opaque black area against the red reflex of the eye is indicative of: A) retinitis. B) conjunctivitis. C) cataracts. D) macular degeneration.

Ans: C Page: 643

87. The fourth heart sound (S4): A) is normal in 25% of the population. B) occurs immediately before the S2 sound. C) indicates increased pressure in the atria. D) represents increased left ventricular stretching.

Ans: C Page: 653-654

151. What type of pain has its origin in a particular location but is described by the patient as pain in a different location? A) Somatic pain B) Visceral pain C) Referred pain D) Radiating pain

Ans: C Page: 658

93. When examining the anterior abdomen of a patient who complains of abdominal pain: A) auscultate bowel sounds for at least 5 minutes. B) you should first percuss over the four quadrants. C) routinely palpate the least painful area(s) first. D) it is often necessary to administer analgesia first.

Ans: C Page: 659

99. Assessment of the female genitalia: A) is not performed by the paramedic. B) is only necessary in pregnant patients. C) should be limited to inspection only. D) is a routine part of the physical exam.

Ans: C Page: 662

101. Clinical signs of an inflamed joint include all of the following, EXCEPT: A) redness. B) swelling. C) deformity. D) increased heat.

Ans: C Page: 663

106. In general, +3 pitting edema is characterized by indentation of the skin to a depth of: A) 0 in to ¼ in. B) ¼ in to ½ in. C) ½ in to 1 in. D) greater than 1 in.

Ans: C Page: 668

116. If a patient's trigeminal nerve is intact, he or she should be able to: A) frown. B) maintain balance. C) clench his or her jaw. D) swallow without difficulty.

Ans: C Page: 672, 675

111. The Babinski sign, grasping, and sucking are: A) voluntary motor responses. B) abnormal findings in infants. C) examples of primitive reflexes. D) signs of nervous system dysfunction.

Ans: C Page: 673

171. A patient with dysarthria has: A) a flat affect. B) painful joints. C) slurred speech. D) severe stuttering

Ans: C Page: 673

117. When assessing muscle strength, a score of 5/5 indicates: A) no muscle contraction or twitch. B) minimal movement against resistance. C) normal muscle tone and strength. D) active movement with evident fatigue.

Ans: C Page: 675

121. When assessing a hemodynamically stable child, the toe-to-head approach is generally indicated for children who are: A) younger than 12 months of age. B) younger than 2 years of age. C) 1 to 3 years of age. D) 4 to 5 years of age.

Ans: C Page: 679

5. The main disadvantage of patient care algorithms is that they: A) are revised or updated too frequently. B) are often overridden by medical control. C) only address classic patient presentations. D) discourage contact with direct medical control.

Ans: C Page: 696

11. Which of the following conditions or situations is the BEST example of a critical life threat that needs immediate care? A) An early onset of renal insufficiency B) A patient with multiple disease etiologies C) Acute presentation of a chronic condition D) Open head injury with exposed brain tissue

Ans: C Page: 698

16. A working diagnosis is MOST accurately defined as: A) a reliable yet unofficial diagnosis of the patient. B) your interpretation of the patient's vital sign values. C) what you feel is the cause of your patient's problem. D) a firm explanation for the patient's symptomatology.

Ans: C Page: 699

7. Documenting difficulties such as darkness, limited access, and unruly crowds that you encounter while caring for a patient is MOST important because it: A) paints a mental picture for the receiving physician. B) is used to help substantiate delayed on-scene times. C) will help justify the patient care decisions you make. D) provides legal immunity if the patient decides to sue.

Ans: C Page: 699

17. Which of the following scenarios MOST accurately depicts reflection in action? A) Noting a patient's heart rate before you administer any medication B) Obtaining a room air pulse oximetry reading before applying oxygen C) Reassessing a patient's blood pressure after administering nitroglycerin D) Administering aspirin and then immediately applying a cardiac monitor

Ans: C Page: 699-700

21. Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? A) A rigid abdomen and signs of shock B) An elderly patient with prolonged asystole C) A driver who passed out and then struck a tree D) Isolated tibia/fibula fracture from minor trauma

Ans: C Page: 701

26. Which of the following would have the LEAST impact on the care you provide to a patient who fell? A) The height of the fall B) How the patient landed C) Object from which the patient fell D) On what the patient landed

Ans: C Page: 702

265. A 40-year-old man fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A) insert a nasopharyngeal airway and assess his respirations. B) carefully open his airway with the head tilt-chin lift maneuver. C) assist his ventilations and prepare to intubate him immediately. D) suction his oropharynx and reattempt the jaw-thrust maneuver.

Ans: B Page: 738

32. When caring for a trauma patient with multiple injuries, it is MOST important for the paramedic to: A) definitively rule out conditions that can result in rapid deterioration. B) first determine which problem will be the least likely to result in death. C) ensure he or she does not overlook anything that can be treated in the field. D) perform a secondary assessment immediately after the primary assessment.

Ans: C Page: 703

52. A patient with orthopnea: A) has blood-tinged sputum. B) awakens at night with dyspnea. C) has dyspnea while lying flat. D) is breathing through pursed lips.

Ans: C Page: 729

23. Records of your education, state or local credentials, and recertification are held by a recognized agency through a process called: A) licensure. B) reciprocity C) registration. D) certification.

Ans: C Page: 9 Type: General Knowledge

The upper airway of an adult consists of all the structures above the: A) carina. B) bronchus. C) vocal cords. D) cricoid ring.

Ans: C Page: 712

The anterior portion of the palate is formed by the: A) hyoid bone and mandible. B) union of the facial bones. C) maxilla and palatine bones. D) soft tissues of the posterior pharynx.

Ans: C Page: 714

41. If a patient does not respond to a question within a couple of seconds, he or she: A) must be assumed to have an altered mental status until proven otherwise. B) should immediately be asked another question to facilitate gathering data. C) should have the question repeated back to him or her using different terms. D) may be deciding if he or she can trust you enough to answer the question.

Ans: D Page: 619

44. The paramedic must always keep in mind that the information he or she fails to obtain: A) is usually the result of the patient's failure to divulge. B) will be obtained by the emergency department physician. C) will usually lead to the provision of substandard treatment. D) may be the information needed to provide appropriate care.

Ans: D Page: 620

50. Situational depression is: A) often characterized by violent bouts of rage. B) ongoing and does not appear to have a cause. C) a condition that usually requires inpatient care. D) a reaction to a stressful event in a patient's life.

Ans: D Page: 621

56. Objective patient information: A) is observed by the patient. B) is perceived by the patient. C) cannot be quantified. D) is based on fact or observation.

Ans: D Page: 626

62. A conscious patient's respiratory rate should be measured: A) by auscultating the lungs. B) by looking at the abdomen. C) with his or her prior knowledge. D) for a minimum of 30 seconds.

Ans: D Page: 629

178. A multi-systems trauma patient opens his eyes in response to pain, moans when you ask him his name, and withdraws from painful stimuli. From this information, you should: A) assign him a Glasgow Coma Scale score of 10 and apply oxygen. B) assume that he has an intracerebral hemorrhage. C) hyperventilate him with a bag-mask at 24 breaths/min. D) conclude that he has severe neurologic dysfunction.

Ans: D Page: 636

69. Flushed skin is commonly seen as a result of all the following, EXCEPT: A) fever. B) heat exposure. C) superficial burns. D) vasoconstriction.

Ans: D Page: 638

74. Bulging of a child's anterior fontanelle is: A) suggestive of significant dehydration. B) benign if the child is not flailing around. C) suggestive of an intracerebral hemorrhage. D) pathologic when observed in a quiet child.

Ans: D Page: 640

78. Asymmetry of the pupils: A) is a normal finding in up to 40% of the population. B) indicates a significant ocular or neurologic pathology. C) is normal when a light is shone into one of the pupils. D) must be correlated with the patient's overall presentation.

Ans: D Page: 642

168. The soft, breezy, and lower pitched sounds found at the midclavicular line are called: A) tracheal sounds. B) vesicular sounds. C) adventitious sounds. D) bronchovesicular sounds.

Ans: D Page: 650

83. All of the following are adventitious breath sounds, EXCEPT: A) rales. B) rhonchi. C) wheezes. D) vesicular sounds.

Ans: D Page: 650-651

89. A bruit indicates _________ blood flow and is MOST significant in the _________ arteries. A) turbulent, femoral B) laminar, carotid C) laminar, brachial D) turbulent, carotid

Ans: D Page: 656

92. Distention of the jugular veins indicates: A) a state of hypovolemia. B) left-sided heart failure. C) decreased venous pressure. D) increased venous capacitance.

Ans: D Page: 656

150. Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called __________ pain. A) somatic B) referred C) radiating D) visceral

Ans: D Page: 657

98. Visceral abdominal pain is: A) highly suggestive of a ruptured hollow abdominal organ. B) characterized by a localized area of abdominal tenderness or pain. C) commonly encountered in patients with cholecystitis or pancreatitis. D) often less localized on palpation and is poorly described by the patient.

Ans: D Page: 657, 661

104. Lower extremity shortening and/or internal or external rotation are findings often associated with: A) pelvic fractures. B) mid-shaft femur fractures. C) pathologic fractures of the hip. D) proximal lower extremity injury.

Ans: D Page: 666

105. Intermittent claudication is defined as: A) transient swelling of the microvasculature of the extremities. B) bulging of the vessels in the legs while in a standing position. C) enlarged lower extremities due to reduced lymphatic drainage. D) cramplike pain in the lower extremities due to poor circulation.

Ans: D Page: 667

110. At its worst, kyphosis can become a source of: A) extremity paralysis. B) complete immobility. C) pathologic fractures. D) restrictive lung disease.

Ans: D Page: 669-670

115. If a patient is able to shrug his or her shoulders and turn his or her head from left to right, the ____________ nerve is likely intact. A) trigeminal B) abducens C) vestibulocochlear D) spinal accessory

Ans: D Page: 672, 675

122. Proper documentation of your physical examination of a patient is MOST important because it: A) becomes a permanent part of the patient's medical record and may be subjected to legal issues. B) reflects your subjective findings and forms the basis for your working field diagnosis of the patient. C) facilitates the paramedic's definitive diagnosis of the patient, leading to the most appropriate care. D) ensures an accurate historical accounting of the patient's problems prior to entering the hospital.

Ans: D Page: 679

172. During a 20-minute transport of a critical patient, you should make a concerted effort to reassess the patient ___ times. A) one B) two C) three D) four

Ans: D Page: 685

2. Synthesizing information about a patient with multiple medical conditions involves: A) determining the validity of each of the patient's medical problems. B) ruling out each condition as the cause of the patient's chief complaint. C) determining the patient's perception of his or her multiple conditions. D) assessing each condition's potential for having a life-threatening impact.

Ans: D Page: 696

4. Protocols, or standing orders, specify the paramedic's performance parameters, which: A) allow the paramedic to function autonomously on every EMS call. B) outline the care that is provided after contacting online medical control. C) limit the skills that the paramedic can perform in his or her EMS system. D) define what the paramedic can or cannot do without direct medical control.

Ans: D Page: 696

9. In order to be a competent and effective paramedic, it is MOST important for you to: A) be familiar with patient care algorithms and guidelines. B) possess the knowledge to diagnose a patient definitively. C) have a high success rate of IV insertions and intubations. D) think and perform quickly and effectively under pressure.

Ans: D Page: 697-698

15. A negative attitude about any patient or patient care situation: A) constitutes negligence and carries legal ramifications with it. B) is usually not sensed by the patient because he or she is frightened. C) is often observed in paramedics with many years of experience. D) almost guarantees that the care you provide will be suboptimal.

Ans: D Page: 699

22. The hormonal effects associated with the fight-or-flight response can affect your performance as a paramedic by: A) decreasing your visual acuity. B) enhancing your critical thinking skills. C) affecting your reflexes negatively. D) diminishing your ability to concentrate.

Ans: D Page: 701

23. Which of the following actions has the LEAST impact on the paramedic's ability to think under pressure? A) Taking a moment to stop and think B) Taking a moment to scan the situation C) Staying calm and maintaining mental control D) Memorizing all patient care algorithms

Ans: D Page: 701-702

28. When a patient advises you of his or her chief complaint, you should: A) quickly perform a head-to-toe exam to identify immediate life threats. B) carefully evaluate all of the medications the patient is taking. C) obtain a 12-lead ECG to rule out a cardiac-related cause of the problem. D) ascertain whether this is a new problem or worsening of a preexisting condition.

Ans: D Page: 703

34. Excellence in prehospital care is: A) dependent on the paramedic's ability to work effectively with his or her partner. B) related directly to the number of continuing education hours a paramedic obtains. C) automatically attained after at least 5 years of experience in a high-volume EMS system. D) the gradual result of the provider constantly striving to improve his or her practice.

Ans: D Page: 704

From an airway management perspective, the MOST important anatomic consideration regarding an adult's tongue is: A) that it is easily lacerated, but bleeds minimally. B) that it attaches directly to the mandible and hyoid bone. C) its proportionately large size compared to a child's tongue. D) its tendency to fall back and occlude the posterior pharynx.

Ans: D Page: 714

Anatomically, the ___________ is directly anterior to the glottic opening. A) thyroid gland B) vallecular space C) cricoid cartilage D) thyroid cartilage

Ans: D Page: 714-715

The function of the lower airway is to: A) warm, filter, and humidify air. B) protect the lungs from aspiration. C) deliver oxygenated blood to the cells. D) exchange oxygen and carbon dioxide.

Ans: D Page: 715

The trachea and mainstem bronchi: A) constrict violently when their beta-2 receptors are stimulated excessively. B) are approximately 10 to 12 cm in length and are joined together at the hilum. C) do not contain mucous-producing cells in patients without a respiratory disease. D) are lined with beta-2 receptors that result in bronchodilation when stimulated.

Ans: D Page: 716

In contrast to negative-pressure ventilation, positive-pressure ventilation occurs when: A) the diaphragm contracts. B) air is drawn into the lungs. C) intrathoracic pressure falls. D) air is forced into the lungs.

Ans: D Page: 719

Physiologic dead space increases with: A) tachypnea. B) deep breathing. C) alveolar inflation. D) pulmonary obstructions.

Ans: D Page: 720

The involuntary control of breathing originates in the: A) diencephalon. B) hypothalamus. C) cerebral cortex. D) pons and medulla,

Ans: D Page: 720

The dorsal respiratory group is primarily responsible for: A) motor control of the inspiratory and expiratory muscles. B) decreasing the respiratory rate when the blood pH is above 7.45. C) terminating inspiration in order to prevent pulmonary overexpansion. D) initiating respiration based on information received from the chemoreceptors.

Ans: D Page: 721

46. All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood, EXCEPT: A) lactic acidosis. B) increased metabolism. C) anaerobic metabolism. D) acute hyperventilation.

Ans: D Page: 727

47. Hypoventilation causes a(n) ___________and leads to ___________ A) increased minute volume, hypocarbia B) decreased minute volume, hypocarbia C) increased minute volume, hypercarbia D) decreased minute volume, hypercarbia

Ans: D Page: 727

260. After opening an unresponsive patient's airway, you determine that his respirations are rapid, irregular, and shallow. You should: A) intubate him at once. B) apply a nonrebreathing mask. C) suction his mouth for 15 seconds. D) begin positive-pressure ventilations.

Ans: D Page: 729

261. Which of the following patients is LEAST likely in need of positive-pressure ventilation? A) Confused 46-year-old woman with labored respirations, adventitious breath sounds, and pallor B) Conscious 41-year-old woman with two-word dyspnea, perioral cyanosis, and tachycardia C) Semiconscious 39-year-old man with shallow chest wall movement, cyanosis, and bradypnea D) Conscious 36-year-old man with difficulty breathing, symmetrical chest rise and fall, and flushed skin

Ans: D Page: 729

56. Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress? A) Fever of 102.5°F B) Productive cough C) Chest pain or pressure D) BP of 148/94 mm Hg

Ans: D Page: 730

62. The pulse oximeter would be LEAST useful when: A) identifying deterioration of the cardiac patient. B) assessing vascular status in orthopaedic trauma. C) monitoring oxygenation status during intubation. D) determining if a patient should receive oxygen.

Ans: D Page: 734

277. You are transporting an intubated patient and note that the digital capnometry reading has quickly fallen below 30 mm Hg. You should: A) hyperventilate the patient to see if the ETCO, reading increases. B) slow your ventilation rate to see if the ETCO, reading decreases. C) promptly extubate the patient and ventilate with a bag-mask device. D) take immediate measures to confirm proper placement of the ET tube.

Ans: D Page: 735-736

148. Capnography can serve as an indicator of: A) proper ventilatory depth. B) cerebral perfusion pressure. C) coronary perfusion pressure. D) chest compression effectiveness.

Ans: D Page: 736

67. It would NOT be appropriate to place a patient in the recovery position if he or she: A) is tachycardic. B) is semiconscious. C) has not been injured. D) is breathing shallowly.

Ans: D Page: 737

78. An artificial airway adjunct: A) effectively protects the airway from aspiration. B) is a suitable substitute for manual head positioning. C) should be inserted in any patient who is semiconscious. D) does not obviate the need for proper head positioning.

Ans: D Page: 742-743

73. Complications of aspiration include all of the following, EXCEPT: A) airway obstruction. B) intrapulmonary infection. C) bronchiolar tissue damage. D) excess surfactant production.

Ans: D Page: 748

267. Two attempts to ventilate an unconscious 10-year-old boy have been unsuccessful. You should next: A) intubate his trachea. B) deliver abdominal thrusts. C) look inside the patient's mouth. D) perform chest compressions.

Ans: D Page: 749-750

83. Supplemental oxygen given to a patient with an acute myocardial infarction: A) will prevent the patient from developing a lethal cardiac dysrhythmia. B) should not exceed 3 L/min in order to prevent oxidative injury. C) oxygenates the myocardium that is distal to the occluded coronary artery. D) enhances the body's compensatory mechanisms during the cardiac event.

Ans: D Page: 750

89. The Venturi mask is MOST useful in the prehospital setting when: A) a patient requires less than 15% oxygen. B) high-flow oxygen is required for severe hypoxia. C) patients cannot tolerate a nonrebreathing mask. D) a COPD patient requires a long-range transport.

Ans: D Page: 755

272. A 66-year-old woman is found to be unresponsive and apneic. Her carotid pulse is weak and rapid. When ventilating this patient, you should deliver: A) each breath over 2 seconds at a rate of 8 to 10 breaths/min. B) one breath over 1 second every 3 to 5 seconds C) one breath over 2 seconds every 5 to 6 seconds. D) each breath over 1 second at a rate of 10 to 12 breaths/min.

Ans: D Page: 759

95. Complications associated with the one-person bag-mask ventilation technique are MOST often related to: A) hyperinflation of the lungs. B) unrecognized rescuer fatigue.. C) improper manual head positioning. D) inadequate tidal volume delivery.

Ans: D Page: 759

96. When two paramedics are ventilating an apneic patient with a bag-mask device, the paramedic not squeezing the bag should: A) apply posterior cricoid pressure. B) manually position the patient's head. C) continually auscultate breath sounds. D) maintain an adequate mask-to-face seal.

Ans: D Page: 760

103. Physiologic effects of CPAP include: A) increased intrathoracic pressure. B) forcing of fluid into the alveoli. C) increased alveolar surface tension. D) opening of collapsed alveoli.

Ans: D Page: 763

108. Signs of clinical improvement during CPAP therapy include: A) a decrease in systolic BP. B) an increase in the heart rate. C) increased ETCO2. D) increased ease of speaking.

Ans: D Page: 764

244. A surgical opening into the trachea is called a: A) stoma. B) laryngectomy. C) laryngectomee. D) tracheostomy.

Ans: D Page: 769

250. In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device: A) it should have a stylet that can be removed easily. B) it should have an internal diameter of at least 6.0 mm. C) the patient's head must be in a hyperextended position. D) it must be equipped with a 15/22-mm proximal adaptor.

Ans: D Page: 770

113. Endotracheal intubation is MOST accurately defined as: A) inserting an ET tube through the vocal cords via the patient's mouth. B) passing an ET tube through an opening in the cricothyroid membrane. C) inserting an ET tube through the glottic opening via the patient's nose. D) passing an ET tube through the glottic opening and sealing off the trachea.

Ans: D Page: 776

258. With regard to intubation difficulty, neck mobility problems are MOST commonly associated with: A) female patients. B) tall, thin patients. C) small children. D) elderly patients.

Ans: D Page: 776

118. An ET tube that is too large for a patient: A) is much more likely to enter the esophagus. B) will lead to an increased resistance to airflow. C) will make ventilating the patient more difficult. D) can be difflicult to insert and may cause trauma.

Ans: D Page: 777

121. The procedure in which the vocal cords are visualized for placement of an ET tube is called direct: A) bronchoscopy. B) tracheostomy. C) pharyngoscopy. D) laryngoscopy.

Ans: D Page: 777

127. Orotracheal intubation should be performed with the patient's head: A) slightly flexed. B) hyperextended. C) in a neutral position. D) in the sniffing position.

Ans: D Page: 780

132. The BURP maneuver usually involves applying backward, upward, and rightward pressure to the: A) upper third of the cricoid cartilage. B) lower third of the cricoid cartilage. C) upper third of the thyroid cartilage. D) lower third of the thyroid cartilage.

Ans: D Page: 783

136. After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then: A) attach the bag-mask device and ventilate. B) secure the tube with a commercial device. C) attach an ETCO, detector to the tube. D) inflate the distal cuff with 5 to 10 mL of air.

Ans: D Page: 783-784

137. If the ET tube has been positioned properly in the trachea: A) breath sounds should be somewhat louder on the right side and the epigastrium should be silent. B) you should not see vapor mist in the ET tube during exhalation when ventilating with a bag-mask. C) breath sounds should be loud at the apices of the lungs but somewhat diminished at the bases. D) the bag-mask device should be easy to compress and you should see corresponding chest expansion.

Ans: D Page: 784

151. Before securing the ET tube in place with a commercial device, you should: A) remove the bag-mask device from the ET tube. B) hyperventilate the patient for 30 seconds to 1 minute. C) move the ET tube to the center of the patient's mouth. D) note the centimeter marking on the ET tube at the patient's teeth.

Ans: D Page: 786

157. When performing nasotracheal intubation, you should use an ET tube that is: A) equipped with a stylet in order to make the tube formfitting. B) uncuffed so as to avoid unnecessary damage to the nasal mucosa. C) slightly larger than the nostril into which the tube will be inserted. D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.

Ans: D Page: 789

159. If you must insert the ET tube into the patient's left nostril, you should: A) insert the tube straight back without rotating it. B) insert the tube with the beveled tip facing upward. C) ensure that the bevel is facing away from the septum. D) rotate the tube 180° as its tip enters the nasopharynx.

Ans: D Page: 790

166. Rigorous tube confirmation protocol must be followed after performing digital intubation because: A) inadvertent extubation of the patient is very common. B) capnography is unreliable in digitally intubated patients. C) ET tubes that are placed digitally do not have a pilot balloon. D) the procedure of digital intubation is truly a blind technique.

Ans: D Page: 794

171. Once you have confirmed that the lighted stylet-ET tube combination has entered the trachea, you should: A) secure the tube manually, remove the stylet, and attach a bag-mask device. B) slightly withdraw the stylet and tube to ensure placement above the carina. C) remove the lighted stylet and inflate the distal cuff with 5 to 10 mL of air. D) hold the stylet in place and advance the tube about 2 to 4 cm into the trachea.

Ans: D Page: 798-799

174. After tracheobronchial suctioning is complete, you should: A) visualize the vocal cords to ensure the tube is still in the correct position. B) hyperventilate the patient at 24 breaths/min for approximately 3 minutes. C) instill 3 to 5 mL of saline down the tube to loosen any residual secretions. D) reattach the bag-mask device, continue ventilations, and reassess the patient.

Ans: D Page: 803-804

181. What size ET tube would be MOST appropriate to use for a 4-year-old child? A) 3.5 mm B) 4.0 mm C) 4.5 mm D) 5.0 mm

Ans: D Page: 805

182. Cuffed ET tubes are generally not used in the field until the child is 8 to 10 years old because: A) the cuff would apply pressure and obstruct the airway. B) the high-pressure cuff would likely rupture the trachea. C) most children are only intubated for short periods of time. D) a cuff at the cricoid ring is not necessary to obtain a seal.

Ans: D Page: 806

282. You are attempting to intubate a 5-year-old girl when you note that her heart rate has fallen from 120 beats/min to 80 beats/min. A patent IV line has been established. The MOST appropriate action is to: A) administer 0.02 mg/kg of atropine to increase her heart rate. B) abort the intubation attempt and begin chest compressions at 100/min. C) give a 20 mL/kg normal saline bolus and continue your intubation attempt. D) abort the attempt and ventilate with a bag-mask device and 100% oxygen.

Ans: D Page: 806-807

188. If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to: A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid cartilage. B) insert a multilumen airway device and confirm placement by means of auscultation of breath sounds and capnography. C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve distension, and reattempt intubation. D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.

Ans: D Page: 807

216. Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia? A) Brevital B) Pentothal C) Sublimaze D) Etomidate

Ans: D Page: 811

220. Nondepolarizing neuromuscular blocking agents include all of the following, EXCEPT: A) vecuronium bromide. B) rocuronium bromide. C) pancuronium bromide. D) succinylcholine chloride.

Ans: D Page: 812

193. The major advantage of the multilumen airway is that: A) it can be used in children and adults as an alternative airway device. B) no mask seal is required to ventilate with either of the multilumen airways. C) intubating the trachea with the multilumen airway in place is extremely easy. D) effective ventilation is possible if the tube enters the esophagus or the trachea.

Ans: D Page: 814

201. When checking the cuff of the LMA prior to insertion, you should: A) stretch the cuff to check for tears or other damage. B) inflate the cuff with 100 mL of air and then deflate. C) gently pull on the cuff at the tube to ensure integrity. D) inflate the cuff with 50% more air than is required.

Ans: D Page: 818-819

203. Proper insertion of the LMA involves: A) inserting the LMA into the patient's mouth by following the curvature of the patient's tongue. B) lifting the patient's jaw upward and blindly inserting the LMA until you meet resistance. C) flexing the patient's neck, depressing the tongue with a tongue blade, and blindly inserting the LMA. D) inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate.

Ans: D Page: 818-819

209. If ventilation is difficult after inserting a King LT airway, you should: A) deflate both of the cuffs, withdraw the device 2 cm, and reattempt ventilation. B) remove the King LT and immediately resume ventilation with a bag-mask. C) attach a manually triggered ventilator and observe for adequate chest rise. D) gently withdraw the device, without deflating the cuffs, until ventilation is easier.

Ans: D Page: 820-821

228. When performing an open cricothyrotomy, you will MOST likely avoid damage to the jugular veins if: A) the patient's head is hyperextended. B) you incise the cricothyroid membrane at a transverse angle. C) the patient's head is in a neutral position. D) the cricothyroid membrane is incised vertically.

Ans: D Page: 826

234. You should be MOST suspicious of tube misplacement following an open cricothyrotomy if: A) bleeding from the subcutaneous tissues is observed. B) there is minimal rise of the chest during ventilations, C) progressive redness is noted around the insertion site. D) a crackling sensation is noted when palpating the neck.

Ans: D Page: 826

240. The MOST significant disadvantage associated with needle cricothyrotomy is: A) air leakage around the insertion site. B) the inability to exhale via the glottis. C) local infection due to poor technique. D) the potential for pulmonary aspiration.

Ans: D Page: 829

The _____________ is the lowest portion of the pharynx and opens into the larynx anteriorly and the esophagus posteriorly. A) oropharynx B) nasopharynx C) hyperpharynx D) laryngopharynx

Ans: D Page: 713

102. Strength of a person's peripheral pulses is related to: A) heart rate and preload. B) stroke volume and pulse pressure. C) physical size and blood pressure. D) cardiac output and heart rate.

104. Which of the following processes occurs during multiple organ dysfunction syndrome (MODS)? A) MODS activates the kallikrein-kinin system, which stimulates the release of bradykinin, a potent vasoconstrictor B) The ischemic pancreas releases myocardial depressant factor, which impairs cardiac contractility C) Vascular endothelial damage causes depression of the coagulation system, which causes the blood to clot D) The liver produces too little of the enzymes aspartate aminotransferase and alanine aminotransferase

11. Nonstriated muscle is also called _________ muscle. A) autonomic B) smooth C) skeletal D) voluntary

110. Unlike basophils, mast cells: A) do not release leukotrienes. B) do not circulate in the blood. C) circulate freely in the bloodstream. D) play a major role in allergic reactions.

111. An injection of immunoglobulin is a form of: A) native immunity. B) passive acquired immunity. C) innate immunity. D) active acquired immunity.

116. Older adults have increased levels of autoantibodies, which: A) increase the person's risk of infection. B) are antibodies directed against the patient. C) predispose the patient to ischemic stroke. D) cause a decreased level of macrophages.

117. The two MOST common causes of inflammation are: A) fever and phagocytosis. B) infection and injury. C) hypercarbia and hypoxemia. D) immunosuppression and fever.

122. The destruction of a blood clot is called: A) adhesion. B) fibrinolysis. C) chemotaxis. D) agglutination.

123. Factor ____ is the antihemophilic factor. A) VII B) VIII C) IX D) XI

129. In general, a child's immune system is not fully developed until he or she is between: A) 1 and 2 years of age. B) 2 and 3 years of age. C) 3 and 4 years of age. D) 4 and 5 years of age.

131. A type I hypersensitivity reaction is: A) a local reaction that primarily involves IgG antibodies. B) an acute reaction that occurs in response to a stimulus. C) an allergic response that occurs within hours of antigen exposure. D) a cytotoxic reaction and destroys many of the body's healthy cells.

18. An endogenous ligand is: A) any medication that binds to a receptor and causes a reaction. B) a molecule that is produced by the body and binds to a receptor. C) any molecule that is not naturally occurring in the human body. D) a synthetically made hormone that acts upon the endocrine system.

1. Which of the following statements regarding pharmacology is correct? A) The selection and administration of most medications are based largely on anecdotal research. B) The action of the human body in response to a particular medication is called pharmacology. C) Evidence-based guidelines, while helpful, are not the primary factor that drives medication administration. D) Despite the advanced science of pharmacology, adverse reactions are commonplace.

Ans: D Page: 423

19. Unlike endocrine hormones, exocrine hormones: A) are carried to their target organs or cell groups via the blood. B) reach their targets via a specific duct that opens into an organ. C) diffuse through intracellular spaces to reach their target organs. D) move through body water and act upon the cell that secreted them.

23. Approximately 45% of a person's body weight is: A) interstitial fluid. B) intracellular fluid. C) extracellular fluid. D) intravascular fluid.

25. Dehydration is generally a more serious concern in older adults than in younger adults because: A) older adults lose significantly more water through perspiration. B) total body water constitutes only 45% of body weight in older adults. C) renal function increases significantly in patients over 60 years of age. D) a person's total body water increases by 10% for each 10 years of life.

29. Lactated Ringer's is a(n) __________ solution because its solute concentration is equal to that of the inside of the cell. A) colloid B) isotonic C) hypotonic D) crystalloid

30. If the sodium potassium pump is impaired due to insufficient potassium in the body: A) the cells will shrink and eventually die. B) sodium accumulates and causes the cells to swell. C) excess sodium fills the extracellular space. D) water shifts from the cell and into the extracellular fluid.

36. Edema in an upper extremity following a mastectomy is the result of: A) localized vasoconstriction. B) decreased lymphatic drainage. C) obstruction of a large blood vessel. D) surgery-induced inflammation.

38. Baroreceptors, which are located in the carotid artery, aorta, and kidneys, are MOST sensitive to changes in: A) fluid volume. B) blood pressure. C) acid-base balance. D) sodium concentrations.

43. The tension exerted on a cell due to water movement across the cell membrane is referred to as: A) osmosis. B) tonicity. C) diffusion. D) active transport.

44. A patient with kidney or liver failure would MOST likely develop: A) severe dehydration. B) an increase in isotonic fluid. C) cellular shrinkage and death. D) excessive hypertonic fluid levels.

49. A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness is MOST likely: A) hypocalcemic. B) hyperkalemic. C) hypokalemic. D) hypoglycemic.

5. The __________, which are found within the cell's cytoplasm, operate in a cooperative and organized fashion to maintain the life of the cell. A) ribosomes B) organelles C) microfilaments D) nuclear pores

54. Acid-base balance normally remains in a physiologic pH range of: A) 7.25-7.35. B) 7.35-7.45. C) 7.45-7.55. D) 7.55-8.25.

56. Which of the following represents an abnormal electrolyte serum level? A) Sodium, 140 mEq/L B) Potassium, 6 mEq/L C) Calcium, 9.5 mEq/L D) Magnesium, 1.7 mEq/L

59. Carpopedal spasm that occurs during respiratory alkalosis is caused by a(n): A) decrease in arterial CO2. B) intracellular calcium shift. C) extracellular sodium shift. D) intracellular potassium shift.

6. What part of the cell produces the body's major energy source in the form of adenosine triphosphate (ATP)? A) Nucleus B) Mitochondria C) Golgi complex D) Endoplasmic reticulum

64. Infectious cellular injury would LEAST likely occur in a patient: A) with metastatic cancer. B) with migraine headaches. C) who is over 70 years of age. D) with long-term diabetes.

65. Foreign material such as bacteria and other microorganisms are engulfed and destroyed by: A) basophils. B) phagocytes. C) eosinophils. D) lymphocytes.

68. Apoptosis is defined as: A) hypoxic cell death. B) normal cell death. C) pathologic cell death. D) premature cell death.

72. Most immunologic diseases that exhibit familial tendencies: A) are caused by immunosuppression. B) involve an overactive immune system. C) are outgrown by the age of 25 years. D) are caused by immune system hypoactivity.

73. Allergies are acquired following: A) most bacterial infections. B) initial exposure to an allergen. C) indirect exposure to an allergen. D) repeated exposure to an allergen.

75. An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called: A) sinusitis. B) asthma. C) bronchitis. D) emphysema.

80. Which of the following statements regarding hemophilia is correct? A) Hemophilia is caused by excessive production of factor VIII. B) Hemophilia is an inherited disorder, is characterized by excessive bleeding, and occurs only in males. C) Hemophilia is characterized by factor VIII deficit and is passed from asymptomatic fathers to daughters. D) Hemophilia is generally not an inherited disorder and affects males and females in equal numbers.

81. Patients with congenital prolongation of the Q-T interval are at GREATEST risk for: A) sudden asystole. B) ventricular arrhythmias. C) coronary artery disease. D) acute myocardial infarction.

86. Gout is a condition in which: A) calcium deposits affect the joints. B) uric acid accumulates in the blood. C) the kidneys fail to excrete sodium. D) synovial fluid is progressively destroyed.

90. Muscular dystrophy is characterized by: A) progressive deterioration of involuntary muscles, specifically the diaphragm. B) weakness and wasting of groups of skeletal muscles, leading to increasing disability. C) relaxation of the vascular smooth muscles, resulting in progressive hypoperfusion. D) involuntary rapid, jerky motions and mental deterioration, leading to dementia.

92. Gross distortions of reality, withdrawal from social contacts, and bizarre behavior are MOST characteristic of: A) depression. B) schizophrenia. C) bipolar disorder. D) obsessive-compulsive disorder.

93. How does the body respond to hypoperfusion? A) Decreased preload, stroke volume, and heart rate B) Catecholamine release and increased systemic vascular resistance C) Splenic retention of red blood cells secondary to systemic hypoxia D) A compensatory decrease in cardiac output and cardiac oxygen demand

98. Distributive shock occurs when: A) central vasoconstriction forces blood from the core of the body. B) blood pools in expanded vascular beds and tissue perfusion decreases. C) microorganisms attack the blood vessels, resulting in vasodilation. D) a significant decrease in cardiac contractility causes decreased perfusion.

99. Anaphylactic shock is characterized by: A) labored breathing and hypertension. B) wheezing and widespread vasodilation. C) intracellular hypovolemia and hives. D) a deficiency of circulating histamines.

A "run" of ventricular tachycardia occurs if at least ____ PVCs occur in a row. A) two B) three C) four D) five

A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient? A) Aspirin B) Adenosine C) IV access D) 12-Lead ECG

A 55-year-old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain? A) Disappearance of radial pulses during inspiration B) Difference in blood pressure between the two arms C) ST-segment depression on the 12-lead ECG tracing D) Bruits to both carotid arteries during auscultation

Shortly after administering a second dose of 4 mg of morphine to a 49-year-old woman who is experiencing chest pain, the patient's level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should: A) administer 0.5 mg of atropine and reassess her. B) assist her ventilations and administer naloxone. C) elevate her legs and give a 500-mL saline bolus. D) immediately intubate her to protect her airway.

Sinus dysrhythmia is: A) observed in all patients. B) an irregular sinus rhythm. C) a sign of myocardial ischemia. D) most common in hypotensive patients.

Stable angina: A) typically subsides within 10 to 15 minutes. B) occurs after a predictable amount of exertion. C) usually requires both rest and nitroglycerin to subside. D) is characterized by sharp chest pain rather than pressure.

After administering 40 units of vasopressin to an elderly woman in bradycardic pulseless electrical activity, you should: A) pause CPR for no longer than 10 seconds and assess for a pulse. B) continue CPR and flush the IV line with 20 mL of normal saline. C) administer 1 mg of epinephrine 1:10,000 while CPR is ongoing. D) give naloxone to rule out opiate overdose as the cause of her arrest.

All of the following are voluntary muscles, EXCEPT: A) skeletal muscle. B) smooth muscle. C) striated muscle. D) somatic muscle.

An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT: A) QRS complexes greater than 0.12 seconds in duration. B) irregular R-R intervals and a rate less than 40 beats/min. C) wide QRS complexes with P waves buried in the T waves. D) regular R-R intervals and a rate between 40 and 100 beats/min.

An unresponsive, pulseless, apneic patient presents with ventricular tachycardia on the cardiac monitor. After defibrillating the patient, you should: A) take no more than 10 seconds to assess for a pulse. B) resume CPR and reassess the patient after 2 minutes. C) reassess the cardiac rhythm to see if it has changed. D) deliver another shock if his cardiac rhythm is unchanged.

Approximately 80% of ventricular filling occurs: A) during systole. B) during diastole. C) when the semilunar valves are open. D) when the AV valves close.

As blood enters the lungs, it enters the alveoli by passing across the: A) pulmonary arteriole. B) pulmonary capillary. C) pulmonary venule. D) pulmonary artery.

Atrial fibrillation can be interpreted by noting: A) PR intervals that vary from complex to complex. B) an irregularly irregular rhythm and absent P waves. C) a regularly irregular rhythm with abnormal P waves. D) the presence of wide QRS complexes and a rapid rate.

Bombardment of the AV node by more than one impulse, potentially blocking the pathway for one impulse and allowing the other impulse to stimulate cardiac cells that have already depolarized, is called: A) fusion. B) reentry. C) ectopy. D) excitability.

Cardiogenic shock occurs when: A) blood backs up into the pulmonary circulation. B) more than 40% of the left ventricle has infarcted. C) left ventricular ejection fraction is less than 50%. D) any condition causes an increase in atrial preload.

Cerebrospinal fluid is manufactured in the: A) subarachnoid space. B) ventricles of the brain C) posterior pituitary gland. D) anterior pituitary gland.

Cholinesterase is a naturally occurring chemical that: A) increases epinephrine production. B) regulates acetylcholine in the body. C) stimulates activity of the vagus nerve. D) causes a natural slowing of the heart rate.

Closure of the tricuspid and mitral valves occur during: A) ventricular relaxation. B) ventricular contraction. C) the diastolic phase. D) atrial contraction.

Common causes of cardiac arrest include all of the following, EXCEPT: A) hypovolemia. B) hyperglycemia. C) cardiac tamponade. D) pulmonary embolism.

Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT: A) fatigue. B) headache. C) chest pain. D) palpitations.

Detoxification of toxic substances, production of bile, and production of certain clotting factors are all functions of the: A) pancreas. B) liver. C) kidney. D) gallbladder.

Drugs that have alpha or beta sympathetic properties are called: A) vagolytics. B) sympathomimetics. C) parasympatholytics. D) adrenergic blockers.

During an acidotic state, the kidneys attempt to maintain a normal pH by: A) excreting bicarbonate. B) retaining bicarbonate. C) retaining hydrogen ions. D) secreting hydrogen ions.

During an allergic reaction, basophils release histamines and heparin. What respective roles do these chemicals play? A) Reduce inflammation and facilitate blood clotting B) Increase tissue inflammation and inhibit blood clotting C) Reduce inflammation and inhibit blood clotting D) Reduce tissue inflammation and inhibit blood clotting

During your assessment of a patient, you note that he is bradycardic, hypotensive, and salivating. These clinical findings suggest: A) sympathetic nervous system stimulation. B) parasympathetic nervous system stimulation. C) sympathetic nervous system depression. D) parasympathetic nervous system depression.

During your assessment of a trauma patient, you note the presence of bilateral femur fractures. This means that: A) one femur is broken. B) both femurs are broken. C) one femur is broken in two places. D) the lateral aspect of one femur is broken.

Electrical capture during transcutaneous cardiac pacing is characterized by: A) the presence of a strong pulse, despite a slow rate. B) a pacemaker spike followed by a wide QRS complex. C) narrow QRS complexes that are preceded by a pacemaker spike. D) low-amplitude QRS complexes preceded by a pacemaker spike.

Epinephrine is used to treat patients in anaphylactic shock because of its effects of: A) vasodilation and bronchoconstriction. B) bronchodilation and vasoconstriction. C) increased heart rate and automaticity. D) parasympathetic nervous system blockade.

Examples of steroid hormones are: A) epinephrine and prolactin. B) cortisol and testosterone. C) oxytocin and growth hormone. D) norepinephrine and antidiuretic hormone.

Excessive stimulation of the parasympathetic nervous system will result in: A) hypertension. B) bradycardia. C) hyperactivity. D) diaphoresis.

Fibrinolytic medications are beneficial to certain patients with an acute myocardial infarction because they: A) decrease circulating platelets and thin the blood. B) convert plasminogen to plasmin and destroy a clot. C) destroy a clot by releasing fibrin into the bloodstream. D) break down the plasmin concentration inside a blood clot.

Following 2 minutes of CPR, you reassess an unresponsive man's pulse and cardiac rhythm. He remains pulseless and the monitor displays coarse ventricular fibrillation. You should: A) continue CPR and intubate his trachea. B) resume CPR as the defibrillator is charging. C) perform 2 minutes of CPR and then reassess. D) continue CPR and establish IV or IO access.

Glycogenolysis is the physiologic process in which: A) the pancreas secretes glycogen. B) glycogen is converted to glucose. C) glucose is converted to glycogen D) the kidneys produce additional glucose.

How do the blood vessels of the skin respond to cold temperatures? A) Dilation, which diverts blood away from the skin B) Constriction, which diverts blood away from the skin C) Dilation, which pulls blood to the skin's surface D) Constriction, which pulls blood to the skin's surface

Human chorionic gonadotropin (HCG) is a major female hormone that: A) thickens the endometrium in preparation for implantation of an egg. B) is manufactured by the developing embryo to sustain the pregnancy. C) is produced by the corpus luteum in preparation for pregnancy. D) regulates the release of estrogen and progesterone from the ovaries.

Hypertension is present when the blood pressure: A) increases by 20 mm Hg above a person's normal blood pressure. B) is consistently greater than 140/90 mm Hg while at rest. C) is above 160 mm Hg systolic during strenuous exertion. D) rises acutely during an emotionally stressful situation.

If a patient's aortic aneurysm is not compressing on any adjacent structures: A) the pain is often confined to the back. B) he or she will likely be asymptomatic. C) a pulsatile mass will usually be absent. D) his or her pain will likely be less severe.

If too much water moves out of a cell, the cell shrinks abnormally. This process is called: A) lysis. B) crenation. C) pinocytosis. D) endocytosis.

Immediate treatment for a patient with an acute myocardial infarction involves: A) elevating the patient's legs 6 to 12 in. B) reducing myocardial oxygen demand. C) giving oxygen via nonrebreathing mask. D) administering up to three doses of nitroglycerin.

In contrast to a patient with asthma, a patient with left-sided heart failure: A) presents with a dry, nonproductive cough and diffuse wheezing in all lung fields. B) experiences acute weight gain and takes medications such as digoxin and a diuretic. C) presents with a hyperinflated chest, use of accessory muscles, and expiratory wheezing. D) is typically a younger patient with a history of a recent upper respiratory infection.

In contrast to stable angina, unstable angina: A) occurs following periods of strenuous exertion. B) often awakens the patient from his or her sleep. C) indicates that myocardial necrosis has occurred. D) is less frequent but is associated with more pain.

In sinus bradycardia, the: A) heart rate is less than 70 beats/min. B) pacemaker site is the SA node. C) QRS complexes are often wide. D) P waves are consistently upright.

In the context of cardiac compromise, syncope occurs due to: A) an increase in vagal tone. B) a drop in cerebral perfusion. C) a sudden cardiac dysrhythmia. D) an acute increase in heart rate.

Increased myocardial contractility secondary to stretching of the myocardial walls is called the: A) Ernest-Henry effect. B) Frank-Starling effect. C) Beck-Cushing's reflex. D) Frank-Beck mechanism.

Injury to or disease of the ______________ may cause prolapse of a cardiac valve leaflet, allowing blood to regurgitate from the ventricle into the atrium. A) coronary sulcus B) chordae tendineae C) interatrial septum D) coronary sinus

Injury to the inferior wall of the myocardium would present with: A) T-wave inversion in leads V1 through V4. B) ST-segment elevation in leads II, III, and aVF. C) pathologic Q waves in leads V4 and V5. D) ST-segment depression in leads V5, V6, and aVL.

Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the: A) adrenal islets. B) islets of Langerhans. C) medullary cortex. D) adrenal medulla.

Monomorphic ventricular tachycardia: A) is characterized by QRS complexes that vary in size. B) presents with wide QRS complexes of a common shape. C) is treated as ventricular fibrillation if a pulse is present. D) is often irregular with occasional nonconducted P waves.

Normal sinus rhythm is characterized by all of the following, EXCEPT: A) minimal variation between the R-R intervals. B) QRS complexes that are less than 140 milliseconds. C) consistent PR intervals and upright P waves. D) a consistent heart rate between 60 and 100 beats/min.

Of the 12 cranial nerves, which 2 do NOT exit from the brainstem? A) Phrenic and vagus B) Olfactory and optic C) Trochlear and abducens D) Hypoglossal and oculomotor

On the 12-lead ECG, extreme right axis deviation is characterized by: A) a positive QRS in lead I and a negative QRS in lead aVF. B) a negative QRS in lead I and a negative QRS in lead aVF. C) a negative QRS in lead I and a positive QRS in lead aVF. D) a positive QRS in lead I and a positive QRS in lead aVF.

On the ECG graph paper, 6 seconds is represented by how many large boxes? A) 20 B) 30 C) 40 D) 50

Once an advanced airway device has been inserted into a cardiac arrest patient: A) you should deliver one breath every 5 to 6 seconds. B) ventilations are delivered at a rate of 8 to 10 breaths/min. C) the compressor should pause so ventilations can be given. D) chest compressions should be increased to 120 per minute.

Q waves are considered abnormal or pathologic if they are: A) greater than 0.02 seconds wide and consistently precede the R wave. B) more than one third the overall height of the QRS complex in lead II. C) not visible in leads I or II when the QRS gain sensitivity is increased. D) present in a patient who is experiencing chest pressure or discomfort.

Supraventricular tachycardia is MOST accurately defined as: A) any tachycardic rhythm with a heart rate greater than 130 beats/min and absent P waves. B) a tachycardic rhythm originating from a pacemaker site above the level of the ventricles. C) an irregular tachycardic rhythm that originates just below the AV junction. D) a regular tachycardic rhythm between 150 and 180 beats/min with P waves buried in the QRS complexes.

The MOST common symptom directly related to blood pressure elevation is: A) epistaxis. B) headache. C) dizziness. D) blurred vision.

The MOST immediate forms of reperfusion therapy for an injured myocardium are: A) high-dose aspirin and high-flow supplemental oxygen. B) fibrinolytics and percutaneous coronary intervention. C) angioplasty and coronary artery bypass grafting. D) supplemental oxygen and an infusion of nitroglycerin.

The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the: A) drug kit and stretcher with a long backboard. B) defibrillator and airway management equipment. C) intubation kit and equipment for vascular access. D) pocket face mask and equipment for intubation.

The P wave represents: A) SA nodal discharge. B) atrial depolarization. C) a delay at the AV node. D) contraction of the atria.

The QT interval would MOST likely be prolonged in patients: A) who take digitalis. B) who are hypocalcemic. C) with a rapid heart rate. D) who are hypercalcemic.

The SA node: A) cannot depolarize faster than 100 times/min. B) will outpace any slower conduction tissue. C) functions as the heart's secondary pacemaker. D) has an intrinsic firing rate of 40 to 60 times per minute.

The _______________ is a deep ridge of nerve fibers, which is separated by a layer of dura mater and connects the two cerebral hemispheres. A) cerebral cortex B) corpus collosum C) presynaptic terminal D) coroid plexus

The administration of dopamine or any other vasopressor drug requires: A) online medical control approval. B) careful titration and blood pressure monitoring. C) an electromechanical infusion pump. D) concomitant crystalloid fluid boluses.

The amount of blood that is pumped out by either ventricle per minute is called: A) ejection fraction. B) cardiac output. C) stroke volume. D) minute volume.

The aorta divides into the two common iliac arteries at the level of the: A) 3rd lumbar vertebra. B) 5th lumbar vertebra. C) 8th thoracic vertebra. D) 12th thoracic vertebra.

The area of conduction tissue in which electrical activity arises at any given time is called the: A) myocyte. B) pacemaker. C) sinus node. D) bundle of His.

The average total body water content of an adult is approximately ____% of his or her body weight. A) 50 B) 60 C) 70 D) 80

The basic structure of nervous tissue that responds to environmental changes by transmitting impulses is the: A) axon. B) neuron. C) dendrite. D) neuroglia.

The body's ability to spontaneously cease bleeding is called: A) fibrinolysis. B) hemostasis. C) homeostasis. D) thrombolysis.

The circumflex branch of the left coronary artery supplies the _________ wall of the left ventricle. A) septal B) lateral C) anterior D) inferior

The duration of the QRS complex should be ____ milliseconds or less. A) 100 B) 120 C) 140 D) 150

The effect on the velocity of electrical conduction is referred to as the _________ effect. A) inotropic B) dromotropic C) chronotropic D) conductivity

The firing of an artificial ventricular pacemaker causes: A) a change in the shape of the preceding P waves. B) a vertical spike followed by a wide QRS complex. C) a small spike followed by a narrow QRS complex. D) a wide QRS complex followed by a vertical spike.

The first and second cervical vertebrae are called the: A) axis and dens. B) atlas and axis. C) dens and atlas. D) odontoid and axis.

The first two cervical vertebrae, in descending order, are called: A) axis and dens. B) atlas and axis. C) dens and odontoid. D) odontoid and atlas.

The heart's primary pacemaker, which is located in the right atrium, is the: A) AV node. B) SA node. C) AV junction. D) bundle of His.

The hormones tetraiodothyronine and triiodothyronine are synthesized by the: A) adrenal glands. B) thyroid gland. C) pituitary gland. D) parathyroid glands.

The ilium is defined as the: A) lower portion of the small intestine. B) bony prominences of the pelvis. C) structure that overlies the bladder. D) ligament that overlies the femoral vessels.

The left main coronary artery rapidly divides into the: A) posterior descending and left ventricular arteries. B) left anterior descending and circumflex arteries. C) left posterior descending and acute marginal arteries. D) circumflex and right anterior descending arteries.

The left main coronary artery subdivides into the: A) left anterior ascending and descending arteries. B) left anterior descending and circumflex arteries. C) left posterior ascending and circumflex arteries. D) right coronary and left posterior descending arteries.

The limbic system, a portion of the cerebrum and diencephalon, contains structures that: A) regulate sleeping and breathing. B) influence emotions and mood. C) control heart rate and blood pressure. D) regulate a person's level of consciousness.

The majority of the body's total body water is contained within the: A) extracellular space. B) intracellular space. C) intravascular fluid. D) interstitial fluid.

The middle muscular layer of the heart is called the: A) pericardium. B) myocardium. C) epicardium. D) endocardium.

The most common solvent in the body, in which solutes or other substances will dissolve, is: A) blood. B) water. C) plasma. D) bile.

The most inferior portion of the heart is called the: A) base. B) apex. C) volar. D) dorsum.

The pain associated with an acute myocardial infarction: A) radiates to the left or right arm in the majority of cases. B) is not influenced by deep breathing or body movement. C) is most often described as a sharp sensation in the chest. D) is often relieved by two or three doses of sublingual nitroglycerin.

The precordial leads do NOT view the __________ wall of the heart. A) septal B) inferior C) anterior D) lateral

The preferred antiarrhythmic medication and initial dose for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is: A) lidocaine, 1.5 mg/kg. B) amiodarone, 300 mg. C) lidocaine, 0.75 mg/kg. D) procainamide, 20 mg/min.

The primary respiratory stimulus in a healthy adult is a(n): A) decreased arterial oxygen level. B) increased arterial carbon dioxide level. C) increased pH level of the venous blood. D) decreased venous level of carbon dioxide.

The process in which malignant cells travel to other organs or tissue and establish secondary tumors is called: A) dysplasia. B) metastasis. C) hemostasis. D) cancer in situ.

The separation of the intracellular and extracellular areas by a selectively permeable membrane helps to maintain: A) endocytosis. B) homeostasis. C) hemostasis. D) exocytosis.

The shoulder joint is a ball-and-socket joint where the humeral head articulates with the: A) acromion process. B) glenoid fossa. C) acetabulum. D) popliteal fossa.

The shoulders and hips are examples of __________ joints. A) biaxial B) triaxial C) monoaxial D) diarthrotic

The substance that contains all the cellular contents between the cell membrane and the nucleus is called the: A) protoplasm. B) cytoplasm. C) Golgi apparatus. D) endoplasmic reticulum.

The sympathetic and parasympathetic nerves arise from the: A) somatic nervous system. B) autonomic nervous system. C) voluntary nervous system. D) adrenal nervous system.

The three small bones in the middle ear are the: A) malleus, anvil, and incus. B) incus, malleus, and stapes. C) stapes, anvil, and malleolus. D) malleus, stapes, and foramina.

The topographic term used to describe the location of body parts that are closer to the midline is: A) lateral. B) medial. C) midaxillary. D) midclavicular.

The treatment for sinus tachycardia should focus on: A) decreasing the heart rate. B) correcting the underlying cause. C) administering IV fluid boluses. D) relieving pain and anxiety.

The two major veins that drain the head and neck of blood are the: A) vertebral veins. B) jugular veins. C) cerebral veins. D) cephalic veins.

Tidal volume is defined as the volume of air that: A) remains in the lungs following maximum exhalation. B) is moved into or out of the lungs during a single breath. C) is moved in and out of the lungs with maximal expiration. D) is exhaled from the lungs following a forceful exhalation.

Under normal conditions, the strength of cardiac contraction is regulated by: A) the heart rate. B) the nervous system. C) physical exertion. D) the Frank-Starling mechanism.

Unlike an idioventricular rhythm, an agonal rhythm: A) is associated with a faster rate. B) does not produce a palpable pulse. C) is associated with a lower mortality rate. D) indicates a regular ventricular pacemaker.

Unlike the parasympathetic nervous system, the sympathetic nervous system: A) is not under the direct control of the autonomic nervous system. B) provides a mechanism for the body to adapt to changing demands. C) is blocked when drugs such as atropine are administered. D) constricts the pupils and increases gastrointestinal function when stimulated.

Ventricular bigeminy occurs when: A) two premature ventricular complexes (PVCs) occur in a row. B) every second complex is a PVC. C) at least two differently shaped PVCs occur. D) a 6-second strip contains at least two PVCs.

What body system is comprised of various glands located throughout the body? A) Urinary system B) Endocrine system C) Respiratory system D) Nervous system

What happens when systemic vasoconstriction occurs? A) Preload decreases. B) Afterload increases. C) Afterload and preload increase. D) Afterload and preload decrease.

What is the function of the lymphatic system? A) Prevention of viruses from entering the body B) Filtration of debris and bacteria from the blood C) Production of antibodies that destroy bacteria D) Secretion of hormones to regulate other body functions

What is the total blood volume for a man who weighs 75 kg? A) 4.8 L B) 5.3 L C) 6.1 L D) 6.6 L

What physiologic effect occurs within the first 5 to 10 minutes after administering furosemide (Lasix)? A) Increased preload B) Peripheral venous pooling C) Excretion of water by the kidneys D) Increase in cardiac afterload

When assessing an anxious patient who presents with tachycardia, you must: A) obtain a 12-lead ECG tracing before initiating any treatment. B) determine if the tachycardia is causing hemodynamic instability. C) prepare for cardioversion if the rate is less than 150 beats/min. D) administer diazepam or midazolam to facilitate your assessment.

When examining the chest of a patient who has an automated implanted cardioverter defibrillator, you would MOST likely find it: A) just below the xiphoid process. B) below the left or right clavicle. C) in the lower aspect of the chest. D) just lateral to the lower sternum.

When oxygen levels are low or absent, the cells revert to a process of: A) aerobic metabolism. B) anaerobic metabolism. C) anaerobic anabolism. D) aerobic catabolism.

Which layer of the blood vessel wall is composed of elastic tissue and smooth muscle cells? A) Lumen B) Tunica media C) Tunica intima D) Tunica adventitia

Which of the following actions should NOT occur while CPR is in progress? A) Advanced airway placement B) Cardiac rhythm assessment C) Assessment for a palpable pulse D) Establishment of vascular access

Which of the following are typically found in the muscle cells, and provide cell movement and contraction via interaction with actin and myosin? A) Mitochondria B) Microfilaments C) Peroxisomes D) Lysosomes

Which of the following clinical findings is LEAST suggestive of left-sided heart failure? A) An S3 gallop B) Sacral edema C) Crackles in the lungs D) Shortness of breath

Which of the following conditions would MOST likely cause the blood pressure to vary between the left arm and right arm? A) Cor pulmonale B) Aortic aneurysm C) Left heart failure D) Cardiac tamponade

Which of the following directional terms describes the front surface of the body? A) Dorsal B) Ventral C) Inferior D) Superior

Which of the following electrolytes maintains the depolarization phase? A) Sodium B) Calcium C) Potassium D) Magnesium

Which of the following is a function of the oculomotor nerve (CN III)? A) Provides the sense of vision via the optic tracts B) Innervates the muscles that cause motion of the eyeballs C) Innervates muscles of the eyeball that allows a downward gaze D) Carries sympathetic nerve fibers that cause dilation of the pupils

Which of the following leads provides the BEST view of the anterolateral wall of the left ventricle? A) V2 to V3 B) V4 to V6 C) V4 to V5 D) V5 to V6

Which of the following medications is a calcium channel blocker? A) Lanoxin B) Cardizem C) Tenormin D) Capoten

Which of the following medications would be the MOST acceptable alternative to morphine for analgesia in patients with an acute coronary syndrome? A) Versed B) Fentanyl C) Diazepam D) Ibuprofen

Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction? A) 49-year-old obese man B) 58-year-old diabetic woman C) 60-year-old man with anxiety D) 71-year-old woman with hypertension

Which of the following statements regarding anaerobic metabolism is correct? A) The waste products of anaerobic metabolism are carbon dioxide and water. B) Anaerobic metabolism can be supported in most cells for only 1 to 3 minutes. C) The lactic acid produced by anaerobic metabolism is needed to make energy. D) Anaerobic metabolism is a normal process that occurs in the presence of oxygen.

Which of the following statements regarding second-degree heart block is correct? A) Most second-degree heart blocks are transient in nature and resolve in the prehospital setting without the need for intervention in the emergency department. B) Second-degree heart block occurs when an impulse reaching the AV node is occasionally prevented from proceeding to the ventricles and causing a QRS complex. C) More than half of all second-degree heart blocks cause hemodynamic compromise and require transcutaneous cardiac pacing in the prehospital or hospital setting. D) Second-degree heart block is characterized by inconsistent PR intervals, a QRS complex greater than 0.12 seconds, and a ventricular rate less than 40 beats/min.

Which of the following statements regarding the right side of the heart is correct? A) It receives blood exclusively from the venae cavae. B) The right side of the heart is a low-pressure pump. C) It pumps against the high resistance of the pulmonary circulation. D) The right side of the heart pumps blood through the pulmonary veins.

Which of the following stimulate(s) hormone secretion and influence(s) sodium and water movements in the kidney, helping to regulate blood pressure? A) Loop of Henle B) Prostaglandins C) Pituitary gland D) Corticosteroids

Which of the following structures comprise different types of tissues that work together to perform a particular function? A) Cells B) Organs C) Organisms D) Body systems

Which of the following vessels or structures is NOT part of the pulmonary circulation? A) Pulmonary artery B) Descending aorta C) Alveolar capillary D) Pulmonic valve

Which portion of the spinal column articulates with the pelvis? A) Thoracic B) Sacral C) Lumbar D) Coccyx

Which of the following represents the correct dose for pancuronium bromide (Pavulon) for a 140-pound adult? A) 3.2 mg B) 6.4 mg C) 7.7 mg D) 8.3 mg

B) 6.4 mg

What is the initial loading dose of amiodarone for a 28-pound child? A) 28 mg B) 65 mg C) 97.5 mg D) 150 mg

B) 65 mg

Which of the following represents a correct repeat dose for lidocaine in a 190-pound patient with refractory ventricular fibrillation? A) 25 mg B) 65 mg C) 130 mg D) 195 mg

B) 65 mg

Which of the following signs or symptoms is associated with digitalis toxicity? A) Acute weight gain and nausea B) Blurred yellow or green vision C) Narrow-complex tachycardia D) Fine motor tremors and vomiting

B) Blurred yellow or green vision

Ondansetron hydrochloride (Zofran) prevents nausea and vomiting by: A) blocking histamine receptors. B) blocking serotonin receptors. C) stimulating histamine receptors. D) stimulating serotonin receptors.

B) blocking serotonin receptors.

Mobile army surgical hospitals (M*A*S*H) saved thousands of soldiers' lives during the Korean war by: A) performing surgery within 30 minutes of the injury. B) bringing the hospital facilities closer to the battlefield. C) deploying combat medics to retrieve wounded soldiers. D) using helicopters to airlift casualties to the United States.

B) bringing the hospital facilities closer to the battlefield.

Plasma protein fraction (Plasmanate) is especially useful for patients with: A) hyponatremia. B) burn shock. C) dehydration. D) blood loss.

B) burn shock.

Dextrose is classified as a(n): A) electrolyte. B) carbohydrate. C) negatively charged ion. D) antihyperglycemic.

B) carbohydrate.

When focusing on childhood injury prevention, the highest priorities are assigned to those injuries that are: A) rare, nonfatal, and difficult to prevent. B) common, severe, and readily preventable. C) common, nonfatal, and difficult to prevent. D) uncommon, serious, and easily preventable.

B) common, severe, and readily preventable.

The BEST teachable moments are those that: A) judge the patient's actions. B) convey positive reinforcement. C) employ the use of scare tactics. D) occur during an acute emergency.

B) convey positive reinforcement.

An effective injury prevention program should focus on all of the following data, EXCEPT: A) common injury locations. B) current EMS call volumes. C) typical injury mechanisms. D) the mean age of the patient

B) current EMS call volumes.

54. Research that is based on observation only, without an attempt to alter or change an event, is called ______________ research. A) prospective B) descriptive C) experimental D) retrospective

B) descriptive

During cardiac arrest, sodium bicarbonate must be used in conjunction with: A) IV fluid boluses. B) effective ventilation. C) calcium chloride. D) high-dose epinephrine.

B) effective ventilation.

If a physician insists that you perform an intervention that you are not properly trained to perform, it would be MOST appropriate to: A: Perform the ordered intervention to the best of your ability B: Ask the physician if he or she can suggest another alternative C: Refuse to perform the intervention and follow your protocols D: Ask the physician to talk you through the procedure over the phone

B: Ask the physician if he or she can suggest another alternative

After asking a patient a question about how he is feeling today, you sense that he is having difficulty putting this feelings into words. You should: A: Ask another question and revisit the previous question later B: Be patient and give the patient time to express his feelings C: Repeat the question, but ask it differently the second time D: Offer suggested responses to facilitate the patient's answer

B: Be patient and give the patient time to express his feelings

126. Wounds that heal by primary intention: A) do not utilize fibrin or fibronectin. B) heal without the formation of a scab. C) are generally clean wounds with opposed margins. D) have a more pronounced and prolonged inflammatory phase.

132. Unlike an allergic reaction, an autoimmune reaction: A) targets an antigen or allergen. B) is generally predictable. C) targets a person's own tissues. D) does not involve antibodies.

133. All of the following diseases are autoimmune diseases, EXCEPT: A) rheumatoid arthritis. B) type 1 diabetes. C) HIV infection. D) myasthenia gravis.

A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on: A) establishing a peripheral IV line B) providing mild hyperventilation. C) searching for reversible causes. D) transcutaneous cardiac pacing

A 56-year-old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should: A) establish vascular access. B) obtain baseline vital signs. C) administer supplemental oxygen. D) acquire a 12-lead ECG tracing.

Atherosclerosis is a process in which: A) the outer wall of a coronary artery becomes lined with masses of fatty tissue. B) calcium precipitates into the arterial walls, greatly reducing the artery's elasticity. C) plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen. D) plaque ruptures from a distant location and lodges in one of the coronary arteries.

Automaticity is defined as the ability of the heart to: A) generate an electrical impulse from the same site every time. B) spontaneously conduct an electrical impulse between cardiac cells. C) generate its own electrical impulses without stimulation from nerves. D) increase or decrease its heart rate based on the body's metabolic needs.

11. Compared to Schedule III drugs, Schedule IV drugs: A) include medications such as Vicodin and have a high potential for psychological dependence. B) have a moderate potential for physical dependence and include cough syrups that contain codeine. C) may lead to severe addiction and include short-acting barbiturates, amphetamines, and opiates. D) have a lower abuse potential and include medications such as diazepam (Valium) and lorazepam (Ativan).

Ans: D Page: 424

12. All of the following are Schedule II substances, EXCEPT: A) Ritalin. B) fentanyl. C) cocaine. D) heroin.

Ans: D Page: 424

2. Which of the following medications is derived from a plant source? A) Lithium B) Insulin C) Heparin D) Digoxin

Ans: D Page: 424

104. What class of medication is typically used to control the heart rate in patients with atrial fibrillation or atrial flutter? A) Sodium channel blocker B) Potassium channel blocker C) Beta-adrenergic blocker D) Calcium channel blocker

Ans: D Page: 451

Beginning with the outermost layer, the three meningeal layers of the central nervous system are the: A) dura mater, pia mater, and arachnoid. B) arachnoid, pia mater, and dura mater. C) dura mater, arachnoid, and pia mater. D) pia mater, dura mater, and arachnoid.

Cardiac muscle comprises the heart. This muscle is: A) smooth and involuntary. B) smooth and voluntary. C) nonstriated and involuntary. D) striated and voluntary.

Cardiac output is influenced by: A) heart rate. B) stroke volume. C) heart rate and/or stroke volume. D) ejection fraction and heart rate.

Cardiac-related chest pain is often palliated by: A) stress. B) exertion. C) nitroglycerin. D) mild exercise.

Changes in cardiac contractility may be induced by medications that have a positive or negative ___________ effect. A) vasoactive B) dromotropic C) inotropic D) chronotropic

Common signs of left-sided heart failure include all of the following, EXCEPT: A) confusion. B) tachycardia. C) hypotension. D) hypertension.

Decreased levels of antidiuretic hormone (ADH) result in: A) oliguria and dehydration. B) anuria and diabetes mellitus. C) polyuria and diabetes insipidus. D) increased fluid retention.

107. A severely burned patient requires 4,500 mL of isotonic crystalloid solution over 8 hours, so medical control orders you to begin the infusion in the field. If your administration set allows 10 gtts/mL, at how many gtts/min will you set the IV flow rate in order to deliver the ordered amount of fluid? A) 76 B) 84 C) 88 D) 94

Ans: D Page: 506-507

127. A nonhypovolemic patient is severely hypotensive and requires a dopamine infusion at 5 µg/kg/min. The patient's estimated weight is 190 lb. You add 800 mg of dopamine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 10 B) 12 C) 14 D) 16

Ans: D Page: 507-508

142. Which of the following medications is appropriate to administer via the rectal route? A) Aspirin B) Glucagon C) Furosemide (Lasix) D) Diazepam (Valium)

Ans: D Page: 510

During the refractory period: A) the heart is in a state of partial repolarization. B) the heart is partially charged, but cannot contract. C) the cell is depolarized or in the process of repolarizing. D) the heart muscle is depleted of energy and needs to recharge.

Dysfunction of the mitral valve may cause backflow of blood into the: A) right ventricle. B) right atrium. C) left atrium. D) left ventricle.

Extracellular fluid accounts for what percentage of all body fluid? A) 15% B) 20% C) 25% D) 30%

Fibrinolysis may be contraindicated in all of the following, EXCEPT: A) major trauma or surgery within the past 4 weeks. B) a history of structural central nervous system disease. C) a history of anaphylactic shock caused by salicylates. D) significant closed head trauma within the past 3 weeks.

How many pairs of ribs are attached directly to the sternum? A) 5 B) 6 C) 7 D) 10

If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles: A) the PR intervals will be greater than 0.20 seconds. B) an upright P wave will appear after the QRS complex. C) an inverted P wave will appear before the QRS complex. D) a small inverted P wave will be buried in the QRS complex.

If the ECG leads are applied correctly, the PQRST configuration should be inverted in lead: A) I. B) II. C) aVR. D) aVL.

If too much water enters a cell during osmosis, it will burst. This process is called: A) diffusion. B) crenation. C) lysis. D) viscosity.

If you are using a biphasic defibrillator, but are unsure of the appropriate starting energy setting, you should set the defibrillator to: A) 120 J. B) 150 J. C) 200 J. D) 360 J.

The proper compression-to-ventilation ratio for two-rescuer adult CPR when an oropharyngeal airway is in place is: A) 5:1. B) 15:2. C) 30:2. D) asynchronous.

The pulmonary circulation is responsible for: A) sending deoxygenated blood to the atria. B) perfusing the vital organs of the body. C) ensuring that blood gets reoxygenated. D) filtering the blood of toxic chemicals.

The reticular activating system is located in the __________ and regulates: A) occipital lobe, sight. B) brainstem, breathing. C) midbrain, consciousness. D) cerebellum, motor function.

The subclavian artery gives rise to the: A) popliteal arteries. B) femoral arteries. C) vertebral arteries. D) carotid arteries.

The term inotropy refers to the: A) rate of cardiac contraction. B) control of electrical conduction. C) strength of myocardial contraction. D) degree of ventricular irritability.

The term perfusion is BEST defined as: A) the production of waste products from metabolism. B) effective exchange of O2 and CO2 in the lungs. C) adequate circulation of blood to the body's cells. D) sufficient removal of waste products from the body.

Thousands of fibrils that are distributed throughout the ventricles, which represent the end of the cardiac conduction system, are called the: A) bundle branches. B) internodal pathways. C) Purkinje fibers. D) cardiac myocytes.

Topographically, the term distal means: A) near the trunk. B) near a point of reference. C) farther from the trunk. D) toward the body's midline

Treatment for a patient with bradycardia and significantly compromised cardiac output includes: A) 1 mg of epinephrine 1:10,000. B) 1 mg of atropine via IV push. C) transcutaneous cardiac pacing. D) a dopamine infusion at 20 mg/min.

Untreated ventricular tachycardia would MOST likely deteriorate to: A) asystole. B) torsade de pointes. C) ventricular fibrillation. D) pulseless electrical activity.

Urea is a result of: A) sodium catabolism. B) lactic acid metabolism. C) amino acid catabolism. D) phosphate metabolism.

Vasoconstriction occurs following stimulation of: A) beta-1 receptors. B) beta-2 receptors. C) alpha receptors. D) alpha and beta receptors.

A bystander physician who assists the paramedic at the scene is not required to accompany the patient in the ambulance unless the physician: A: Is a board-certified emergency physician B: Does not assume responsibility for the patient's care C: Has performed procedures above the paramedic's level D: Practices at the hospital to which the patient is transported

C: Has performed procedures above the paramedic's level

One of the major differences between laws and ethics is that laws: A: Allow a person to determine right from wrong B: Are usually broken because of an unethical act C: Have sanctions for violation that are enforceable D: Are reflective of a person's moral responsibilities

C: Have sanctions for violation that are enforceable

Which of the following statements regarding 12-lead ECG telemetry is correct? A: Telemetry over UHF frequencies enables transmission and analysis of all 12 leads B: Telemetry has never proven to increase diagnosis times for patients with a cardiac event C: Most newer systems use facsimile technology to allow transmission of 12-lead ECGs D: A decoder is required to ensure that voice communication does not filter out the ECG

C: Most newer systems use facsimile technology to allow transmission of 12-lead ECGs

The combination of two or more signals, which allows the paramedic to talk and transmit an ECG simultaneously on one frequency, is called a: A: Simplex system B: Trunking system C: Multiplex system D: Half-duplex system

C: Multiplex system

If you must deviate from your protocols because of unusual circumstances, you should FIRST: A: Advise the patient B: Document the event C: Notify medical control D: Apprise the receiving hospital

C: Notify medical control

Health care powers of attorney are also called "durable" powers of attorney because they: A: Must be in the patient's possession at all times B: Can only be revoked by the patient's personal physician C: Remain in effect once a patient loses decision-making capacity D: Do not require anyone to make decisions on the patient's behalf

C: Remain in effect once a patient loses decision-making capacity

A(n) _____ receives a weak signal and retransmits it at a higher power on another frequency. A: Duplex B: Simplex C: Repeater D: Encoder

C: Repeater

All of the following factors may cause distortion of an ECG signal, EXCEPT: A: Muscle tremors B: Loose electrodes C: Severe tachycardia D: Distant transmission range

C: Severe tachycardia

The concept of consent refers to all of the following EXCEPT the: A: Patient's age B: Patient's mental capacity C: Severity of the patient's injury D: Patient's ability to make rational decisions

C: Severity of the patient's injury

Which of the following actions demonstrates that the paramedic has his or her emotions under control? A: Taking notes while repeating some of the patient's statements back to him of her B: Obtaining the patient's medical history while administering emergency treatment C: Speaking close to the patient's ear in a calm voice in an extremely noisy situation D: Frequently reassuring a seriously injured patient that everything will be okay

C: Speaking close to the patient's ear in a calm voice in an extremely noisy situation

While providing care to a seriously ill public official who is semiconscious, a media representative arrives at the scene and inquires about the patient's condition. You should: A: Give the media representative the patient's name and age only B: Advise the media representative to obtain the information at the hospital C: Tell the media representative that you cannot disclose any information D: Obtain consent from the patient before releasing any personal information

C: Tell the media representative that you cannot disclose any information

Which of the following general statements is correct? A: When faced with an ethical dilemma, you should ask yourself, "What is in my best interest?" B: A patient's religious beliefs should be respected but should not affect how you provide care C: The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others D: If you place your welfare ahead of the patient's, you will rarely commit an unethical act in medical care

C: The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others

Which of the following general statements regarding medical law is correct? A: Medical providers with fewer than 5 years of experience are at highest risk of being sued B: A poor patient outcome typically means that the medical provider was grossly negligent C: The patient or survivor must prove all elements of negligence before a lawsuit will be successful D: A medical liability lawsuit will only be successful if the patient's outcome was unfavorable

C: The patient or survivor must prove all elements of negligence before a lawsuit will be successful

Which of the following patient data is NOT typically communicated during your radio report to the hospital? A: Brief, pertinent history B: Underlying medical conditions C: The patient's ethnicity D: ECG findings

C: The patient's ethnicity

A base station decoder within the emergency department: A: Amplifies the voice signal from the field transmitter B: Is used to increase the range of the radio transmission C: Translates a telemetry signal into an oscilloscope tracing D: Converts a low-band frequency to a high-band frequency

C: Translates a telemetry signal into an oscilloscope tracing

When communicating with a patient whose cultural background differs from the paramedic's, it is MOST important for the paramedic to: A: Agree with the patient's cultural differences B: Know the specifics about the patient's culture C: Treat the patient with the utmost respect at all times D: Use his or her own culture as the sole reference

C: Treat the patient with the utmost respect at all times

When functioning at a crime scene, it is important for the paramedic to: A: Collect and safeguard any and all evidence B: Carefully question witnesses as to what they saw C: Use caution and not disturb the scene unnecessarily D: Avoid performing patient care until cleared by the police

C: Use caution and not disturb the scene unnecessarily

In a medical liability suit involving a paramedic, the plaintiff: A: Must prove that the paramedic broke an established law B: Is the paramedic and is generally represented by a lawyer C: Usually seeks compensation for the injury he or she sustained D: Must convince 6 of 12 jurors to agree with his or her position

C: Usually seeks compensation for the injury he or she sustained

It would be MOST appropriate to ask a patient a closed-ended question when: A: The question requires the patient to think B: You are using complex medical terminology C: You are trying to obtain medical history information D: You are attempting to establish the quality of a patient's pain

C: When you are trying to obtain medical history information

Stereotyping an elderly, very young, or hostile patient during your attempt to communicate with him or her: A: Yields relatively accurate information B: Is proper under certain circumstances C: Works against effective communication D: Is an effective means of communicating

C: Works against effective communication

You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient's wife tells you that he collapsed about 10 minutes ago. You should: A) ask the patient's wife if her husband has a living will. B) apply the defibrillator pads and assess his cardiac rhythm. C) initiate CPR as your partner applies the defibrillator pads. D) begin CPR with a compression to ventilation ratio of 15:2.

You receive a call to a residence for a 44-year-old man who is "ill." The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient's vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is: A) hypocalcemic. B) hypernatremic. C) hyperkalemic. D) having an acute myocardial infarction.

5. The first EMT textbook, Emergency Care and Transportation of the Sick and Injured, was published in 1971 by the: A) National Association of EMS Educators (NAEMSE). B) American College of Emergency Physicians (ACEP). C) American Academy of Orthopaedic Surgeons (AAOS). D) American Association of Critical Care Nurses (AACN).

7. Which of the following was NOT a required component identified by the Emergency Medical Services System Act of 1973? A) EMS research B) Mutual aid agreements C) National EMS certification D) Integration of health services

The prefix value for micro (µ) is: A) 0.00001. B) 0.000001. C) 0.0000001. D) 0.00000001.

C) 0.0000001.

Atropine is supplied in 10-mL prefilled syringes that contain 1 mg. What is the concentration per milliliter? A) 1 mg/mL B) 10 mg/mL C) 0.1 mg/mL D) 0.01 mg/mL

C) 0.1 mg/mL

The initial adult dose of pralidoxime (2-PAM) for organophosphate poisoning is: A) 2 to 4 g by IM injection, repeated one time. B) 20 to 40 mg/kg as an IV infusion over 15 to 30 minutes. C) 1 to 2 g as an IV infusion over 30 to 60 minutes. D) 600 mg by IM injection, repeated at 15-minute intervals.

C) 1 to 2 g as an IV infusion over 30 to 60 minutes.

A dose of 100 μg of fentanyl (Sublimaze) is equivalent to ____ mg of morphine. A) 0.5 B) 5 C) 10 D) 20

C) 10

The adult dose for Phenergan is: A) 1 to 2 mg/kg. B) 50 to 100 mg. C) 12.5 to 25 mg. D) 0.25 to 0.5 mg/kg.

C) 12.5 to 25 mg.

Prior to cardioverting a patient, the paramedic can give up to ____ mg of diazepam. A) 5 B) 10 C) 15 D) 20

C) 15

If an initial dose of amiodarone is not effective in terminating ventricular tachycardia in a patient with a pulse, the paramedic should give: A) 150 mg via rapid IV push. B) 300 mg over 10 minutes. C) 150 mg over 10 minutes. D) 300 mg via rapid IV push.

C) 150 mg over 10 minutes.

The minimum single dose that is recommended for naloxone (Narcan) is: A) 0.4 mg. B) 0.8 mg. C) 2 mg. D) 4 mg.

C) 2 mg.

The typical adult dose for midazolam (Versed) is: A) 0.5 mg/kg. B) 1 to 2 mg. C) 2 to 2.5 mg. D) 5 to 15 mg.

C) 2 to 2.5 mg.

The maximum total dose of atropine for a 190-pound patient is: A) 2 mg. B) 2.5 mg. C) 3 mg. D) 3.5 mg.

C) 3 mg.

What classification of medication is activated charcoal? A) Absorbent B) Antiemetic C) Adsorbent D) Antidote

C) Adsorbent

Which of the following medications antagonizes albuterol? A) Alpha agonists B) Ace inhibitors C) Beta-blockers D) Antidepressants

C) Beta-blockers

Which of the following medications can be given before diltiazem to a patient with borderline hypotension? A) Digoxin B) Labetalol C) Calcium chloride D) Magnesium sulfate

C) Calcium chloride

Which of the following FDA pregnancy categories is a drug assigned if there is positive evidence of human fetal risk, but the benefits for pregnant women may be acceptable despite the risk, as in life-threatening diseases for which safer drugs cannot be used? A) B B) C C) D D) X

C) D

Which of the following medications antagonizes the action of benzodiazepines on the central nervous system? A) Naloxone B) Nalbuphine C) Flumazenil D) Hydroxyzine

C) Flumazenil

Which of the following is NOT a physiologic effect of epinephrine? A) Beta-1 receptor agonist B) Beta-2 receptor agonist C) Histamine receptor agonist D) Alpha-1 receptor agonist

C) Histamine receptor agonist

Which of the following clinical effects would you expect to observe in a patient who is receiving dopamine in a dosing range of 2 to 4 μg/kg/minute? A) Increased heart rate B) Increased vascular resistance C) Increased urine output D) Increased cardiac contractility

C) Increased urine output

Which of the following statements regarding clopidogrel (Plavix) is correct? A) The peak effect of clopidogrel ranges between 10 and 12 hours. B) A major contraindication for clopidogrel is acute ischemic stroke. C) It should not be given to patients taking a proton pump inhibitor. D) It should not be given to patients who are unable to take aspirin.

C) It should not be given to patients taking a proton pump inhibitor.

Which of the following statements regarding morphine sulfate is correct? A) For a suspected acute myocardial infarction, morphine should be given prior to nitroglycerin. B) To be of most benefit, morphine should be given in a dose of 5 to 10 mg over 20 to 30 seconds. C) Morphine is indicated for patients with unstable angina if nitroglycerin does not relieve their pain. D) Although morphine is an opioid, its effects cannot be effectively reversed with naloxone (Narcan).

C) Morphine is indicated for patients with unstable angina if nitroglycerin does not relieve their pain.

Which of the following medications is indicated for patients with delirium tremens? A) Brethine B) Isoptin C) Thiamine D) Luminal

C) Thiamine

Which of the following statements regarding vasopressin (Pitressin) is correct? A) Vasopressin stimulates beta-1 receptors during cardiac arrest. B) The usual adult dose of vasopressin is 40 U every 5 minutes. C) Vasopressin is an alternative to epinephrine in cardiac arrest. D) There are no data to support the use of vasopressin in adults.

C) Vasopressin is an alternative to epinephrine in cardiac arrest.

65. Which of the following is NOT a typical question to answer when evaluating and interpreting research? A) Is your conclusion based on the data? B) Did you account for all confounding variables? C) Will the research study be published in a notable journal? D) Was the study approved and conducted in an ethical fashion?

C) Will the research study be published in a notable journal?

Common factors that contribute to childhood injuries in the home include all of the following, EXCEPT: A) backyard swimming pools. B) stairwells or loaded firearms. C) a lack of sibling supervision. D) toxic agents kept in the home

C) a lack of sibling supervision.

Children are at higher risk for serious injury than adults because of: A) a shorter body stature. B) inadequate parental guidance. C) a proportionately larger head. D) a lack of personal responsibility.

C) a proportionately larger head.

Air bags installed in an automobile are more likely to reduce injuries than educating people to wear their seat belts because: A) failure to wear a seat belt is not punishable by law. B) air bags are more effective than seat belts during a crash. C) air bags do not require conscious effort on a person's part. D) automobile manufacturers are required to install air bags.

C) air bags do not require conscious effort on a person's part.

Diphenhydramine is primarily used for patients with: A) bronchospasm. B) status asthmaticus. C) allergic reactions. D) beta-blocker toxicity.

C) allergic reactions.

Promethazine hydrochloride (Phenergan) can be classified as all of the following, EXCEPT as a(n): A) antiemetic. B) phenothiazine. C) alpha agonist. D) antihistamine.

C) alpha agonist.

Diazepam produces all of the following clinical effects, EXCEPT: A) sedation. B) hypnosis. C) analgesia. D) anticonvulsant.

C) analgesia.

Dextran is classified as a(n): A) natural colloid. B) isotonic crystalloid. C) artificial colloid. D) hypertonic crystalloid.

C) artificial colloid.

For the EMS provider, the process of collecting and analyzing data regarding injury prevention begins with: A) following up on the patient's outcome. B) retrospective research of severe injuries. C) completing a legible prehospital care report. D) his or her initial paramedic training program.

C) completing a legible prehospital care report.

57. The LEAST preferable and reliable method of selecting people to participate in a research study is: A) random sampling. B) systematic sampling. C) convenience sampling. D) alternative time sampling.

C) convenience sampling.

Methylprednisoline (Solu-Medrol) is classified as a: A) beta-2 agonist. B) glucocorticoid. C) corticosteroid. D) nonsteroidal anti-inflammatory.

C) corticosteroid.

Physiologic effects of morphine sulfate include all of the following, EXCEPT: A) decreased afterload. B) decreased venous return. C) decreased venous capacitance. D) decreased cardiac oxygen demand.

C) decreased venous capacitance.

37. When returning your unit to service following a call, the responsibility of ensuring that the unit is restocked and ready for another call rests with: A) the paramedic in charge. B) the medic who was driving. C) everyone on the EMS team. D) the shift captain or supervisor.

C) everyone on the EMS team.

55. A scientific approach to research in which a researcher controls, manipulates, and then measures one or more variables to ascertain how manipulating the variables affects the subjects is called ______________ research. A) prospective B) qualitative C) experimental D) nonexperimental

C) experimental

If an initial dose of adenosine is ineffective for a 130-pound patient, you should: A) give 6 mg rapid IV/IO push. B) give the second dose more slowly. C) give 12 mg after 1 to 2 minutes. D) give a second dose after 10 minutes.

C) give 12 mg after 1 to 2 minutes.

The leading cause of death in the United States is: A) stroke. B) cancer. C) heart disease. D) unintentional injury

C) heart disease.

Glucagon may be indicated for all of the following conditions, EXCEPT: A) hypoglycemia. B) beta-blocker overdose. C) hyperglycemia. D) calcium channel blocker overdose.

C) hyperglycemia.

Sodium bicarbonate may be indicated for all of the following conditions, EXCEPT: A) aspirin overdose. B) cardiac arrest. C) hypokalemia. D) crush injury.

C) hypokalemia.

53. The first part of EMS research is to: A) obtain medical director authorization. B) determine if there is adequate funding. C) identify a specific problem or question. D) determine the style of research to be used.

C) identify a specific problem or question.

In contrast to secondary prevention, primary prevention focuses on: A) rapid transport to an appropriate medical facility. B) rehabilitating a person who has survived an injury. C) keeping an injury from occurring in the first place. D) reducing the effects of an injury that has already occurred.

C) keeping an injury from occurring in the first place.

Racemic epinephrine is commonly administered to patients with: A) epiglottitis. B) heart disease. C) laryngeal edema. D) pneumonia.

C) laryngeal edema.

32. After ensuring your own personal safety, your next priority should be to: A) ensure the safety of your patient. B) proceed quickly with patient care. C) make sure that your partner is safe. D) provide safety for any bystanders.

C) make sure that your partner is safe.

Most unintentional injuries are the result of: A) accidental shootings. B) water-related incidents. C) motor vehicle accidents. D) sports-related incidents.

C) motor vehicle accidents.

0.45% sodium chloride (½ normal saline) should NOT be used when: A) less than 250 mL of fluid is needed. B) your patient has renal impairment. C) rapid fluid rehydration is required. D) your patient has a diabetic disorder.

C) rapid fluid rehydration is required.

Verapamil hydrochloride (Isoptin, Calan) is indicated for patients with: A) stable wide-complex tachycardias. B) atrial flutter with a slow ventricular rate. C) re-entry supraventricular tachycardia. D) Wolff-Parkinson-White syndrome.

C) re-entry supraventricular tachycardia.

Contraindications for nitroglycerin include: A) a systolic BP of less than 110 mm Hg. B) a known allergy to salicylates. C) severe bradycardia or tachycardia. D) recent (within 24 hours) use of aspirin.

C) severe bradycardia or tachycardia.

Lorazepam (Ativan) is a: A) Schedule I long-acting opioid. B) benzodiazepine receptor antagonist. C) short-/intermediate-acting benzodiazepine. D) barbiturate with analgesic properties.

C) short-/intermediate-acting benzodiazepine.

Etomidate is a: A) short-acting barbiturate that induces sedation and retrograde amnesia. B) long-acting benzodiazepine that is useful for patients with severe anxiety. C) short-acting hypnotic that acts at the level of the reticular activating system. D) long-acting narcotic analgesic that stimulates opioid receptor sites in the body.

C) short-acting hypnotic that acts at the level of the reticular activating system.

To be credible, an injury prevention intervention: A) must be approved by the general public. B) should be implemented by a paramedic. C) should have quantitatively measured results. D) must clearly demonstrate decreased mortality.

C) should have quantitatively measured results.

Torsade de pointes: A) presents with wide QRS complexes that are all of the same shape, size, and vector direction. B) is a lethal ventricular rhythm that is usually caused by ingestion or injection of CNS-depressant drugs. C) is generally less serious than monomorphic ventricular tachycardia and is usually not treated in the field. D) is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.

What are the functions of the pancreas? A) Production of renin and regulation of blood pressure B) Storage and movement of food into the small intestine C) Concentration and storage of bile until it is needed for digestion D) Production of insulin and certain enzymes that aid in digestion

What happens when the PaCO2 of the arterial blood increases? A) pH increases and respirations increase B) pH decreases and respirations decrease C) pH increases and respirations decrease D) pH decreases and respirations increase

What is the cardiac output of a person with a stroke volume of 60 mL and a heart rate of 90 beats/min? A) 2.1 L B) 4.2 L C) 5.0 L D) 5.4 L

What is the cribriform plate? A) Superior surface of the cranial vault that protects the cerebrum B) Saddle-shaped depression in the middle of the sphenoid bone C) Opening through which the brainstem passes from the cerebrum D) Horizontal bone through which the olfactory nerve filaments pass

What occurs during the initial phase of hemostasis? A) Thrombin converts fibrinogen to fibrin. B) Fibrin binds to a platelet plug and forms a clot. C) Thromboplastin activates clotting proteins. D) Local vasoconstriction and platelet activation occur.

What prevents the backflow of blood during ventricular contraction? A) The aortic valve B) Semilunar valves C) The pulmonic valve D) AV valves

When asking a patient to supinate his or her hand, you would expect him or her to: A) turn the hand on its side. B) bend the hand at the wrist. C) place the hand palm down. D) place the hand palm up.

When managing cardiac arrest, the appropriate dosing regimen for epinephrine is: A) 1 mL of a 1:10,000 solution every 3 to 5 minutes. B) 0.1 mg/kg of a 1:10,000 solution every 3 minutes. C) 10 mL of a 1:1,000 solution every 3 to 5 minutes. D) 1 mg of a 1:10,000 solution every 3 to 5 minutes.

When performing CPR on an adult patient in cardiac arrest, it is important to: A) deliver at least 80 to 90 compressions per minute. B) limit interruptions in chest compressions to 20 seconds. C) deliver forceful ventilations between compressions. D) allow the chest to fully recoil between compressions.

Which of the following MOST accurately describes an acute myocardial infarction? A) Death of the myocardium secondary to spasm of a major coronary artery B) Injury to a portion of the heart muscle secondary to atherosclerotic disease C) Damage to the left ventricle following occlusion of the left coronary artery D) Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

Which of the following chemicals or drugs causes an increase in heart rate? A) Norepinephrine B) Cholinesterase C) Atenolol and neostigmine D) Atropine and epinephrine

Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder? A) A bruit heard over the carotid artery B) Pain in the calf muscle while walking C) Swelling and pain along the course of a vein D) An S3 sound during auscultation of the heart

Which of the following differentiates an atrial rhythm from a sinus rhythm? A) Tachycardia B) Profound bradycardia C) Dissociated P waves D) Varying shapes in P waves

Which of the following drugs is contraindicated in patients with asthma? A) Albuterol B) Adrenaline C) Norepinephrine D) Propranolol

Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation? A) Dopamine B) Propranolol C) Isoproterenol D) Norepinephrine

Which of the following is NOT a function of the skin? A) Temperature regulation B) Protection from the environment C) Transmission of information to the brain D) Production of antibodies to foreign organisms

Which of the following is NOT a type of white blood cell? A) Eosinophil B) Neutrophil C) Granulocyte D) Histamine

Which of the following is NOT characteristic of multifocal atrial tachycardia? A) Nonvisible P waves with a rapid ventricular rate B) QRS complexes less than 0.12 seconds in duration C) Variable PR intervals and P waves of differing size D) Regular R-R intervals with a rate less than 150 beats/min

Which of the following medications has a direct blood-thinning effect? A) Plavix B) Aspirin C) Accupril D) Warfarin

Which of the following occurs at the AV node during a third-degree heart block? A) There is an abnormal delay in conducting impulses. B) Every third impulse is allowed to enter the ventricles. C) Impulses bypass the AV node and enter the ventricles. D) All impulses are blocked from entering the ventricles.

Which of the following organs occupy all four abdominal quadrants? A) Liver and spleen B) Stomach and pancreas C) Colon and pancreas D) Small intestine and colon

Which of the following processes initiates urine formation? A) Cortisol secretion B) Tubular secretion C) Tubular reabsorption D) Glomerular filtration

Which of the following statements is correct? A) Lead I is contiguous with lead II. B) Lead II is contiguous with leads V6 and aVL. C) Lead V6 is contiguous with leads V4 and V5. D) Lead III is contiguous with leads II and aVF.

Which of the following statements regarding asystole is correct? A) A disconnected ECG lead often mimics asystole. B) Defibrillation is indicated in some cases of asystole. C) Most cases of asystole present with P waves only. D) Asystole is the result of prolonged myocardial hypoxia

The use of 0.9% sodium chloride (normal saline) should NOT be considered for patients with: A) freshwater drowning. B) diabetic ketoacidosis. C) shock due to blood loss. D) congestive heart failure.

D) congestive heart failure.

Streptokinase (Streptase) can stop an evolving acute myocardial infarction by: A) inhibiting platelet aggregation near a vascular occlusion. B) blocking certain clotting factors, which thins the blood. C) dilating the occluded vessel and improving blood flow. D) converting plasminogen to plasmin, which degrades fibrin.

D) converting plasminogen to plasmin, which degrades fibrin.

56. Research that is based on a group of individuals at one point in time is called ______________ research. A) descriptive B) prospective C) retrospective D) cross-sectional

D) cross-sectional

Glucagon would be ineffective in patients with: A) significant hypertension. B) low serum glucose levels. C) severe beta-blocker toxicity. D) depleted glycogen stores.

D) depleted glycogen stores.

Indications for magnesium sulfate include: A) calcium channel blocker toxicity. B) second- or third-degree AV block. C) increased intracranial pressure. D) digitalis-induced dysrhythmias.

D) digitalis-induced dysrhythmias.

Adenosine is contraindicated for patients with: A) reentry tachycardia. B) narrow-complex tachycardia. C) wide-complex tachycardia. D) drug-induced tachycardia.

D) drug-induced tachycardia.

Side effects of atropine sulfate when given in therapeutic doses and at the proper rate may include: A) pupillary constriction. B) excessive urination. C) paradoxical bradycardia. D) dry mouth and nausea.

D) dry mouth and nausea.

The ongoing, systematic collection, analysis, and interpretation of injury data essential to the planning, implementation, and evaluation of public health practice is called: A) mortality review. B) the Haddon matrix. C) morbidity tracking. D) injury surveillance.

D) injury surveillance.

Contraindications to fibrinolytic therapy include: A) any long bone fracture. B) systolic BP greater than 150 mm Hg. C) an allergy to salicylates. D) intracranial surgery within 3 months.

D) intracranial surgery within 3 months.

35. When deciding which medical facility is most appropriate for your patient's needs, it is MOST important to: A) consider the distance from the scene to the hospital. B) ask the patient where his or her physician is located. C) be knowledgeable of the major streets and highways. D) know the capabilities of all the hospitals in your area.

D) know the capabilities of all the hospitals in your area.

60. When using a group of subjects who range in age from 30 to 40 years, 35 years of age would considered the: A) mode. B) mean. C) median. D) midpoint.

D) midpoint.

The leading cause of death from injury is: A) homicide by firearm. B) unintentional fires and burns. C) suicide by poisoning or overdose. D) motor vehicle traffic incidents.

D) motor vehicle traffic incidents.

Rocuronium bromide (Zemuron) is classified as a: A) depolarizing neuromuscular blocker. B) nondepolarizing neuromuscular agonist. C) depolarizing neuromuscular agonist. D) nondepolarizing neuromuscular blocker.

D) nondepolarizing neuromuscular blocker.

In the United States, mobile intensive care units (MICUs) initially were staffed by: A) physicians. B) registered nurses. C) funeral home directors. D) nonphysician providers.

D) nonphysician providers.

Ketorolac tromethamine (Toradol) is a(n): A) opiate agonist. B) corticosteroid. C) non-narcotic anxiolytic. D) nonsteroidal anti-inflammatory.

D) nonsteroidal anti-inflammatory.

Prior to administering dopamine to a patient, the paramedic must ensure that the patient is: A) awake and alert. B) not bradycardic. C) tracheally intubated. D) not hypovolemic.

D) not hypovolemic.

Fentanyl citrate (Sublimaze) is a(n): A) opiate antagonist. B) sedative-hypnotic. C) Schedule I narcotic. D) opioid analgesic.

D) opioid analgesic.

Norepinephrine increases the blood pressure by: A) antagonizing beta receptors. B) increasing cardiac contractility. C) increasing the heart rate. D) stimulating alpha receptors.

D) stimulating alpha receptors.

Pralidoxime (2-PAM) should NOT be used concurrently with: A) atropine. B) epinephrine. C) dextrose solutions. D) succinylcholine.

D) succinylcholine.

Levalbuterol (Xopenex) is classified as a(n): A) beta-1 agonist bronchodilator. B) parasympathetic bronchodilator. C) beta-2 antagonist bronchodilator. D) sympathomimetic bronchodilator.

D) sympathomimetic bronchodilator.

Albuterol is a(n): A) selective beta-1 agonist. B) beta-adrenergic blocker. C) parasympatholytic drug. D) sympathomimetic drug.

D) sympathomimetic drug.

If a particular treatment is in an "indeterminate" class, this means that: A) preliminary research has indicated that it would be reasonable to administer the treatment. B) scientific evidence has concluded that the treatment may be considered for select conditions. C) extensive research has concluded that the treatment has a greater potential to cause harm. D) there is not enough scientific evidence to make a recommendation for or against the treatment.

D) there is not enough scientific evidence to make a recommendation for or against the treatment.

Vasopressin is given for its physiologic effects of: A) increased inotropy. B) bronchodilation. C) decreased chronotropy. D) vasoconstriction.

D) vasoconstriction.

52. The main purpose of research in EMS is to determine: A) if EMS is eligible for federal funding. B) the easiest approach to treating a patient. C) if local EMS protocols should be amended. D) whether treatment is effective or ineffective.

D) whether treatment is effective or ineffective.

Which of the following is NOT an example of an open-ended question? A: "How did you feel when you awoke today?" B: "Can you tell me how this all started?" C: "Can you describe the pain you are feeling?" D: "Does the pain radiate to your arm or jaw?"

D: "Does the pain radiate to your arm or jaw?"

If the wife of a critically ill man asks you if her husband is going to die, the MOST appropriate response should be: A: "The situation appears grim, but you should not lose all hope." B: "It is possible, and you should prepare yourself for the worst." C: "That question is best answered by the physician at the hospital." D: "He is very sick, but we are doing everything we can to help him."

D: "He is very sick, but we are doing everything we can to help him."

Which of the following statements would be inappropriate when documenting your care of a patient with an emotional problem? A: "There was no evidence of suicidal behavior." B: "The patient was uncooperative during the exam." C: "The possible smell of ETOH was noted at the scene." D: "The patient's actions suggest the use of illicit drugs."

D: "The patient's actions suggest the use of illicit drugs."

When a patient thanks you, your MOST appropriate response should be: A: "Any time." B: "That's okay." C: "No problem." D: "You're welcome."

D: "You're welcome."

If a patient asks for your advice regarding a treatment decision that his or her physician made, you should: A: Only give advice if you disagree with the physician B: Give your opinion, but state that you are not a physician C: Obtain specific information about the physician's decision D: Advise the patient to consult with his or her physician

D: Advise the patient to consult with his or her physician

Scope of practice is defined as: A: Protocols agreed upon by a consensus of emergency physicians B: The level of care that an EMS employer allows the paramedic to provide C: National patient care guidelines established by the federal government D: Care that a paramedic is permitted to perform under the certifying state

D: Care that a paramedic is permitted to perform under the certifying state

Generally, the paramedic is not at liberty to disregard a physician's order unless: A: The physician is not the paramedic's medical director B: The physician is not a licensed emergency physician C: It is documented why the order was not carried out D: Carrying out the order will cause harm to the patient

D: Carrying out the order will cause harm to the patient

When transferring a patient between medical facilities, it is MOST important for the paramedic to: A: Ensure that all appropriate paperwork, x-rays, and lab results are delivered to the receiving facility B: Request another paramedic if the patient's clinical condition is too unstable for one paramedic to manage effectively C: Request that a member of the patient's family accompanies the patient in case the patient cannot speak for himself or herself D: Ensure that a physician or nurse accompanies the patient if the patient requires care beyond the paramedics scope of practice

D: Ensure that a physician or nurse accompanies the patient if the patient requires care beyond the paramedics scope of practice

Maintaining eye contact with a patient enables the paramedic to: A: Rapidly gain any patient's trust B: Defuse a potentially violent situation C: Relay the seriousness of the situation D: Evaluate the patient's neurologic status

D: Evaluate the patient's neurologic status

A patient who rolls up his or her sleeve so that you can take his or her blood pressure has given you _____ consent: A: Implied B: Informed C: Rational D: Expressed

D: Expressed

Statements such as, "Please say more," or "Please feel welcome to tell me about that," are examples of: A: Reflection B: Clarification C: Sympathy D: Facilitation

D: Facilitation

A person wishes to be an organ donor. He or she must: A: Have a documented terminal illness B: Be at least 21 years of age in most states C: Have this delineated on his or her driver's license D: Have witnessed informed consent, usually in writing

D: Have witnessed informed consent, usually in writing

If a volunteer paramedic has signed up to work a shift for an EMS system: A: He or she does not have a legal obligation to act B: The Good Samaritan law provides limited immunity C: He or she must be a third responder on the ambulance D: He or she is obligated to respond to calls during the shift

D: He or she is obligated to respond to calls during the shift

When communicating medical information via radio, you should be: A: Thorough yet rapid B: Comprehensive but brief C: As expeditious as possible D: Simple, brief, and direct

D: Simple, brief, and direct

85. A person with a normal total cholesterol level: A) is at high risk for an acute cardiac event if his or her HDL levels are elevated. B) will probably not develop coronary artery disease, even if his or her HDL levels are low. C) will likely not experience an acute cardiac event, even if his or her LDL levels are elevated. D) is still at risk for coronary artery disease if his or her LDL levels are elevated.

91. Early manifestations of Alzheimer's disease include: A) impaired cognition and impaired abstract thinking. B) inability to carry out activities of daily living. C) indifference to food and urinary incontinence. D) memory loss and subtle personality changes.

96. What type of shock occurs when blood flow becomes blocked in the heart or great vessels? A) Cardiogenic B) Peripheral C) Distributive D) Obstructive

97. The MOST common type of exogenous hypovolemic shock is: A) severe diarrhea. B) internal hemorrhage. C) excess plasma loss. D) external bleeding.

Damage to the cardiac electrical conduction system caused by an acute myocardial infarction MOST commonly results in: A) severe tachycardia. B) ventricular dysrhythmias. C) acute bundle branch block. D) bradycardia or heart block.

Death in the prehospital setting following an acute myocardial infarction is MOST often the result of: A) asystole. B) myocardial rupture. C) cardiogenic shock. D) ventricular fibrillation.

Decreases in the PaCO2 result in _____________ pH levels in the respiratory center and a(n) _____________ in ventilation. A) decreased, decrease B) increased, increase C) decreased, increase D) increased, decrease

Efferent nerves of the peripheral nervous system are responsible for: A) carrying impulses from the body to the brain. B) sensations such as pain, temperature, and pressure. C) involuntary functions such as breathing and heart rate. D) carrying commands from the brain to the muscles.

If the R-R interval spans more than ____ large boxes on the ECG graph paper, the heart rate is less than 60/min. A) 1.5 B) 2 C) 3.5 D) 5

If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse: A) the AV junction will begin pacing at 40 to 60 times/min. B) you will see a brief period of bradycardia followed by asystole. C) the P wave and PR interval will have an abnormal appearance. D) you should expect to see a heart rate slower than 40 beats/min.

If the left ventricle contains 80 mL of blood before a contraction and ejects 60 mL during the contraction, the ejection fraction is: A) 60%. B) 65%. C) 70%. D) 75%.

In addition to facilitating the uptake of sugar into the cells, insulin is responsible for: A) the chemical conversion of glycogen to glucose. B) stimulating the liver and kidneys to produce glucose. C) the production of amino acids and carbohydrates. D) the chemical conversion of glucose to glycogen.

In addition to prompt transport, the goal of prehospital management for a patient with a suspected aortic dissection includes: A) lowering the blood pressure. B) IV fluid boluses. C) high-flow oxygen. D) adequate pain relief.

In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes: A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate. B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication. C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents. D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.

In order to ensure proper electrolyte distribution and maintain the polarity of the cell membrane, the sodium-potassium pump: A) moves three sodium ions and three potassium ions back into the cell. B) moves two sodium ions into the cell for every three potassium ions it moves out of the cell. C) moves calcium and potassium ions back into the cell by a process called passive transport. D) moves two potassium ions into the cell for every three sodium ions it moves out of the cell.

In which of the following situations would you likely NOT be able to palpate a pulse despite effective chest compressions? A) Profound hypoxia B) Severe acidosis C) Hyperkalemia D) Tension pneumothorax

Jugular venous distention in a patient sitting at a 45° angle: A) is not clinically significant. B) is a sign of reduced preload. C) suggests left-sided heart failure. D) indicates right-sided heart compromise.

Junctional escape rhythms are CONSISTENTLY characterized by: A) an absence of P waves. B) QRS complexes greater than 0.12 seconds. C) inverted P waves before the QRS complex. D) a ventricular rate of 40 to 60 beats/min.

Leads V1 to V3 allow you to view the ________ wall of the left ventricle. A) septal B) lateral C) anterior D) anteroseptal

On the ECG graph paper, amplitude is measured in _____________ and width is measure in ____________. A) centimeters, seconds B) milliseconds, millimeters C) seconds, centimeters D) millimeters, milliseconds

Paroxysmal nocturnal dyspnea is defined as: A) dyspnea that is brought on by excessive movement during sleep. B) sitting upright in a chair in order to facilitate effective breathing. C) the inability to function at night due to severe difficulty breathing. D) acute shortness of breath that suddenly awakens a person from sleep.

Patients who are experiencing an infarction of the right ventricle: A) should not be given IV fluid boluses. B) often require high doses of nitroglycerin. C) are usually hypertensive and tachycardic. D) may present with significant hypotension.

Premature ventricular complexes (PVCs) that originate from different sites in the ventricle: A) are called unifocal PVCs. B) produce a palpable pulse. C) are also called fusion PVCs. D) will appear differently on the ECG.

Stimulation of alpha and beta receptors affects the: A) heart only. B) heart and blood vessels. C) blood vessels and lungs. D) heart, lungs, and blood vessels.

Stimulation of alpha receptors of the sympathetic nervous system results in: A) tachycardia. B) bronchodilation. C) peripheral vasodilation. D) peripheral vasoconstriction.

Stimulation of the parasympathetic nervous system: A) completely blocks the AV node, preventing ventricular depolarization. B) causes a decrease in the production of epinephrine and norepinephrine. C) is characterized by a large P wave and a PR interval that is shorter than normal. D) slows SA nodal discharge and decreases conduction through the AV node.

Substances that release ions when dissolved in water are called: A) neutrons. B) exocytes. C) endocytes. D) electrolytes.

Sympathetic nerves are regulated primarily by: A) adrenaline. B) epinephrine. C) cholinesterase. D) norepinephrine.

The AV junction: A) includes the AV node but not the bundle of His. B) is the dominant and fastest pacemaker in the heart C) receives its blood supply from the circumflex artery. D) is composed of the AV node and surrounding tissue.

The MOST significant risk associated with the use of fibrinolytic therapy is: A) reocclusion. B) coagulation. C) anaphylaxis. D) hemorrhage.

The _______________ withstands the highest pressures of any vessel in the body. A) aortic arch B) abdominal aorta C) descending aorta D) ascending aorta

The brief pause between the P wave and QRS complex represents: A) depolarization of the inferior part of the atria. B) the period of time when the atria are repolarizing. C) full dispersal of electricity throughout both atria. D) a momentary conduction delay at the AV junction.

The diencephalon, a region of the brain, contains which of the following structures? A) Pons and medulla B) Cerebellum and pons C) Medulla and thalamus D) Thalamus and hypothalamus

The downslope of the T wave: A) is the point of ventricular repolarization to which a defibrillator is synchronized to deliver electrical energy. B) is the strongest part of ventricular depolarization and is often the origin of dangerous ventricular arrhythmias. C) represents a state of absolute ventricular refractoriness in which another impulse cannot cause depolarization. D) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.

The gap that lies between each neuron is called the: A) cleft. B) synapse. C) terminal. D) vesicle.

The integumentary system includes all of the following structures, EXCEPT: A) the epidermis. B) sweat glands. C) hair follicles. D) blood vessels.

The longest portion of the aorta, which subdivides into the thoracic and abdominal aorta, is the: A) ascending aorta B) innominate artery. C) aortic arch. D) descending aorta.

The metabolic breakdown of stored carbohydrates, fats, or proteins in order to provide energy is called: A) metabolism. B) hydrolysis. C) anabolism. D) catabolism.

The midbrain, pons, and medulla oblongata collectively form the: A) cerebellum. B) cerebral cortex. C) diencephalon. D) brainstem.

The most important nerve of the cervical plexus, which innervates the diaphragm, is the: A) vagus nerve. B) trochlear nerve. C) abducens nerve. D) phrenic nerve.

The movement of a solute from an area of higher concentration to an area of lower concentration is called: A) osmosis. B) endocytosis. C) exocytosis. D) diffusion.

The ongoing process by which red blood cells are made is called: A) diapedesis. B) phagocytosis. C) hematopoiesis. D) erythropoiesis.

The parathyroid glands produce and secrete a hormone that: A) regulates the body's basil metabolic rate. B) converts glycogen produced in the liver to glucose. C) controls the function of all other endocrine glands. D) maintains normal levels of calcium in the blood.

The point of maximal impulse usually can be felt on the: A) medial aspect of the chest, just below the third intercostal space. B) left lateral chest, in the midaxillary line, at the fourth intercostal space. C) left anterior chest, in the midaxillary line, at the fifth intercostal space. D) left anterior chest, in the midclavicular line, at the fifth intercostal space.

The presence of a J wave (Osborn wave) on the ECG is an indicator of: A) a delta wave. B) hyponatremia. C) hypercalcemia. D) hypothermia.

The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of: A) fear and anxiety. B) the effects of nitroglycerin. C) acute left-sided heart failure. D) a reduction in cardiac output.

The process in which glucose is broken down to yield lactic or pyruvic acid is called: A) crenation. B) gluconeogenesis. C) glycogenolysis. D) glycolysis.

The process of moving air into and out of the lungs is called: A) respiration. B) oxygenation. C) tidal volume. D) ventilation.

The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: A) atropine sulfate. B) a dopamine infusion. C) an epinephrine infusion. D) transcutaneous pacing.

The right atrium, right ventricle, and part of the left ventricle are supplied by the: A) circumflex artery. B) left anterior descending artery. C) left main coronary artery. D) right coronary artery.

The second heart sound (S2) represents: A) opening of the pulmonic valve. B) closure of the atrioventricular valves. C) opening of the aortic valve. D) closure of the semilunar valves.

The semilunar valves of the heart function by: A) preventing backflow of blood into the atria. B) minimizing the forward flow of blood. C) attaching to the papillary muscles. D) preventing backflow of blood into the ventricles.

The study of the body functions in a diseased state is called: A) anatomy. B) physiology. C) pathogenesis. D) pathophysiology.

The thyroid gland is responsible for the: A) release of TSH. B) breakdown of glycogen. C) production of glucose. D) metabolic rate.

The upper section of the sternum is called the: A) jugular notch. B) xiphoid process. C) angle of Louis. D) manubrium.

109. 1 cc is equal to _____ mL. A) 1 B) 10 C) 100 D) 1,000

Ans: A Page: 503

112. 100 mL is equal to: A) 0.1 L B) 0.01 L C) 0.001 L D) 0.0001 L

Ans: A Page: 503

115. An 80-kg patient weighs ____ lb. A) 176 B) 179 C) 182 D) 185

Ans: A Page: 504

Compared to the frontal region of the skull, the occiput is: A) anterior. B) exterior. C) inferior. D) posterior.

120. If a 10-mL vial contains 1 mg of a drug, how many mg/mL are present? A) 0.1 B) 0.01 C) 0.001 D) 0.0001

Ans: A Page: 505

The peak effect of pancuronium bromide (Pavulon) is: A) 30 seconds. B) 3 to 5 minutes. C) 5 to 10 minutes. D) 45 minutes.

B) 3 to 5 minutes.

The correct second dose of adenosine for a 50-pound child is: A) 2.3 mg. B) 4.6 mg. C) 6 mg. D) 12 mg.

B) 4.6 mg.

The initial dose of furosemide (Lasix) for a 175-pound man is: A) 20 to 40 mg. B) 40 to 80 mg. C) 80 to 100 mg. D) 100 to 120 mg.

B) 40 to 80 mg.

113. B lymphocytes produce antibodies when they are activated by: A) mast cells. B) eosinophils. C) helper T cells. D) phagocytes.

Which of the following represents a correct dose of Solu-Medrol for a 115-pound adult with anaphylaxis? A) 100 mg B) 125 mg C) 135 mg D) 150 mg

A) 100 mg

An appropriate dose of activated charcoal for a patient who weighs 160 pounds is: A) 145 g. B) 164 g. C) 181 g. D) 195 g.

A) 145 g.

To prepare an epinephrine infusion, the paramedic should add ___ mg of a _________ solution to 250 mL of normal saline. A) 1, 1:1,000 B) 10, 1:1,000 C) 10, 1:10,000 D) 1, 1:10,000

A) 1, 1:1,000

By classification, digoxin is a(n): A) inotropic agent. B) anticholinergic. C) catecholamine. D) sympathomimetic.

A) inotropic agent.

Which of the following statements regarding treatment for a first-degree heart block is correct? A) Treatment is generally not indicated unless the rate is slow and cardiac output is impaired. B) Most first-degree heart blocks are associated with significant bradycardia and require atropine. C) First-degree heart block is often accompanied by a compensatory tachycardia that requires treatment. D) Transcutaneous cardiac pacing should be initiated without delay for patients with a first-degree heart block.

Which of the following statements regarding type O blood is correct? A) It contains no surface antigens. B) It contains type A surface antigens. C) It contains type B surface antigens. D) It contains both type A and B surface antigens

Which of the following structures comprise the axial skeleton? A) Skull, face, thoracic cage, vertebral column B) Skull, shoulders, upper extremities, ribs C) Pelvic girdle, vertebral column, skull D) Ribs, shoulders, lower extremities, skull

Which of the following substances are vital in the function of the sympathetic nervous system? A) Epinephrine and norepinephrine B) Aldosterone and dopamine C) Cortisol and epinephrine D) Aldosterone and cortisol

Which of the following underlying medical conditions would be of LEAST pertinence when obtaining the past medical history from a patient who complains of acute chest pain or pressure? A) Cancer B) Diabetes C) Renal disease D) Hypertension

Which part of the blood vessel is made up of elastic fibers and muscle, and provides for strength and contractility? A) Tunica media B) Tunica intima C) Tunica adventitia D) Arterial lumen

You and an EMT are performing CPR on an elderly woman in cardiac arrest as your paramedic partner prepares to intubate her. After the patient has been intubated and proper ET tube placement has been confirmed, you should: A) perform asynchronous CPR while ventilating the patient at a rate of 8 to 10 breaths/min. B) instruct the EMT-B to pause after 30 compressions so your partner can deliver two ventilations. C) administer 2.5 mg of epinephrine via the ET tube and hyperventilate the patient to ensure drug dispersal. D) direct your partner to deliver one breath every 3 to 5 seconds as the EMT-B continues chest compressions.

You are dispatched to a grocery store for a 39-year-old woman with a severe headache. The patient advises you that her headache, which was present when she woke up this morning, is located in the back of her head. She is conscious and alert, with a blood pressure of 194/112 mm Hg, pulse of 100 beats/min and strong, and respirations of 14 breaths/min and regular. She denies a history of hypertension or any other significant medical problems. The closest appropriate facility is located 15 miles away. You should: A) administer supplemental oxygen, start an IV line of normal saline at a keep-open rate, and transport. B) start an IV line of normal saline, give her 0.4 mg of sublingual nitroglycerin, and transport at once. C) give high-flow oxygen, establish vascular access, begin transport, and administer labetalol en route. D) administer oxygen as tolerated, give up to 5 mg of morphine IM, and transport promptly.

You are reviewing the medications of a semiconscious patient as your partner and another paramedic provide patient care. The patient's medications include Lanoxin, enalapril, Coumadin, Lasix, and K-Dur. This medication regimen is MOST consistent with a patient who has: A) CHF, hypertension, and atrial fibrillation. B) COPD, diabetes, and tachydysrhythmias. C) ventricular dysrhythmias and hypertension. D) hypothyroidism, renal failure, and atrial flutter.

You receive a call to a skilled nursing facility for an elderly man with generalized weakness. The patient's nurse tells you that he has not eaten anything in the past 18 hours. She presents you with his chart, which states that he has a history of atrial fibrillation, congestive heart failure, and hypertension. His medications include Vasotec, digoxin, and warfarin. As you apply the cardiac monitor, your partner takes the patient's vital signs, which reveal a blood pressure of 136/76 mm Hg, a rapid and irregular pulse, and respirations of 22 breaths/min. The ECG reveals atrial fibrillation with a variable rate between 110 and 130 beats/min, and a 12-lead ECG tracing reveals the same. After applying supplemental oxygen, you should: A) start an IV line set to keep the vein open, administer diltiazem, and transport. B) place him in a position of comfort and transport with continuous monitoring. C) establish an IV, administer Versed, and perform synchronized cardioversion. D) establish IV access, give a beta blocker to slow his heart rate, and transport.

You respond to the scene of an assault, where a 20-year-old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. The MOST appropriate next intervention is to: A) perform 5 cycles of well-coordinated CPR. B) look for evidence of a pericardial tamponade. C) immediately assess the patient's cardiac rhythm. D) give 2 minutes of 15 compressions and 2 breaths.

8. Which of the following is one of the 10 system elements developed by the National Highway Traffic Safety Administration (NHTSA) in an effort to sustain EMS systems? A) Medical direction B) Fully enhanced 9-1-1 C) Paramedic supervisors D) Continued federal funding

72. Before you are able to clean your uniform after taking care of a patient at a major motor vehicle crash, your unit, which is the only one available, is dispatched to a residence for a patient with chest pain. Though not bloody, your uniform is noticeably dirty and you are still sweating from the previous call. Which of the following statements regarding this scenario is MOST correct? A) You should maintain a professional attitude and care for the patient to the best of your ability. B) The patient will likely be offended by your appearance, but you should not be concerned with this. C) Assess the patient and provide needed care after explaining to the patient why your uniform is dirty. D) It would be wise to remain in the ambulance as your partner performs a primary patient assessment.

A) You should maintain a professional attitude and care for the patient to the best of your ability.

A procainamide infusion should be stopped if: A) a total of 17 mg/kg has been given. B) QRS complex narrowing occurs. C) the patient becomes hypertensive. D) the dysrhythmia is not quickly suppressed.

A) a total of 17 mg/kg has been given.

The side effects of adenosine are limited in most patients because: A) adenosine has such a short half-life. B) the doses of adenosine are relatively small. C) patients who receive adenosine are stable. D) adenosine is subject to first-pass metabolism.

A) adenosine has such a short half-life.

Aspirin is relatively contraindicated in patients with: A) asthma. B) heart failure. C) hypotension. D) tachycardia.

A) asthma.

Furosemide (Lasix) increases urinary output by: A) blocking sodium absorption at the distal and proximal tubules and the loop of Henle. B) promoting the movement of fluid from the intracellular space to the extracellular space. C) alkalinizing the urine, which promotes hydrogen ion excretion via the renal system. D) drawing glucose from the cells into the vascular compartment, which induces diuresis.

A) blocking sodium absorption at the distal and proximal tubules and the loop of Henle.

The MOST effective injury prevention program is one that is: A) broad and ongoing. B) financed by the EMS system. C) targeted to a specific population. D) implemented within 6 months.

A) broad and ongoing.

Fibrinolytic agents dissolve blood clots by: A) converting plasminogen to plasmin, which digests the fibrin strands of the clot. B) reducing the overall number of circulating platelets, which thins the blood. C) blocking certain clotting factors in the liver necessary to hold the clot together. D) converting plasmin to fibrin, which digests the plasminogen matrix of the clot.

A) converting plasminogen to plasmin, which digests the fibrin strands of the clot.

67. A patient has requested to be transported to a specific hospital; however, the hospital does not have the proper resources to meet the patient's needs. You should: A) determine if there is a more appropriate medical facility within a reasonable distance. B) advise the patient that his or her hospital of choice is a poorly equipped medical facility. C) remember that the hospital can always transfer the patient to a more appropriate facility. D) contact medical control and request permission to transport the patient to his or her choice hospital.

A) determine if there is a more appropriate medical facility within a reasonable distance.

59. The qualitative method of gathering data for a research project: A) does not use numerical information and is the least accurate. B) uses variables such as mean, median, and mode for data gathering. C) is highly accurate in gathering reliable data for the research project. D) assigns numerical values to the data and is a highly reliable method.

A) does not use numerical information and is the least accurate.

66. You are dispatched to a residence at 3:00 AM for a 39-year-old man with signs of a common cold. When caring for this patient, you should: A) educate the patient and tactfully discuss why a cold is not an emergency. B) realize that this clearly is not a call to which you should have been dispatched. C) advise the patient that this is not an emergency and obtain a signed refusal. D) tell the patient to schedule an appointment with his physician the next day.

A) educate the patient and tactfully discuss why a cold is not an emergency.

51. EMS protocol development, training methodologies, and equipment use decisions are based mainly on: A) evidence. B) experience. C) personal opinion. D) public preference.

A) evidence.

Succinylcholine (Anectine) is preferred by many paramedics because it: A) has a short duration of action. B) is a nondepolarizing paralytic. C) does not cause fasciculations. D) has a slow onset of action.

A) has a short duration of action.

73. While caring for an elderly man with abdominal pain, you are very open with the patient and answer his questions honestly. These actions will MOST likely show the patient that you: A) have integrity. B) are competent. C) are empathetic. D) are self-motivated.

A) have integrity.

Atropine should NOT be given to patients with: A) hypothermic bradycardia. B) nerve agent exposure. C) beta-blocker overdose. D) calcium channel blocker overdose.

A) hypothermic bradycardia.

Indications for epinephrine include all of the following, EXCEPT: A) hypothermic cardiac arrest. B) bradycardia-induced hypotension. C) atropine-refractory bradycardia. D) mild or severe allergic reactions.

A) hypothermic cardiac arrest.

Calcium chloride may be beneficial to patients with beta-blocker overdose because it: A) increases cardiac contractility. B) stimulates beta-1 receptors. C) blocks calcium channels. D) decreases ventricular automaticity.

A) increases cardiac contractility.

All of the following are economic incentives used to help prevent injury, EXCEPT: A) increasing taxes to install guardrails. B) decreasing insurance rates for safe drivers. C) offering free bike helmets to encourage use. D) threatening a lawsuit against product manufacturers.

A) increasing taxes to install guardrails.

Ipratropium (Atrovent) dilates the bronchioles by: A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors. B) selectively stimulating beta-2 receptors found in the bronchial smooth muscle. C) competitively binding to beta-2 receptors found in the bronchial smooth muscle. D) increasing the interaction of acetylcholine at bronchial smooth muscle receptors.

A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors.

Which of the following scenarios MOST accurately depicts abandonment? A: A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day B: While en route to the hospital with a patient experiencing chest pressure, you encounter a major vehicle accident, call the dispatcher to request assistance, and proceed to the hospital with your patient C: During a mass-casualty incident involving a building collapse, a paramedic triages a patient as being low priority and instructs an EMT to observe the patient and inform the paramedic if the patient's condition deteriorates D: A mentally competent adult with shortness of breath adamantly refuses to be transported to the hospital via EMS, so you arrange for a friend or family member to stay with the patient and call 911 if it becomes necessary

A: A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day

The wrongful act that gives rise to a civil suit is called: A: A tort B: Damage C: Liability D: Negligence

A: A tort

A 17-year old woman presents with acute abdominal pain while at a party with her husband. You arrive at the scene, assess the patient, and advise her of the need fo EMS treatment and transport. However, the patient, who is conscious and alert, refuses EMS treatment and transport and states that her husband will transport her in his car. You should: A: Advise her of the potential risks of refusing EMS treatment and transport B: Begin treatment using implied consent, because she is under 18 years of age C: Ensure that she has decision-making capacity and then obtain a signed refusal D: Accept her refusal because the fact that she is married makes her emancipated

A: Advise her of the potential risks of refusing EMS treatment and transport

Which of the following scenarios is considered by most states to be a medical examiner case? A: Any violent or unexpected death B: Death of a criminal who is on probation C: Death of a person under 45 years of age D: Any patient who dies outside the hospital

A: Any violent or unexpected death

A 39-year old man with severe dehydration requires IV fluid therapy to treat his condition. The patient is conscious, alert, and oriented to person, place, time, and event. You should: A: Ask him if you can start an IV and explain the reason for the IV as well as potential risks of IV therapy B: Tell the patient that you are going to start an IV on him in order to replenish his body with lost fluid and electrolytes C: Start the IV to quickly restore his body fluid balance and then explain to the patient why you started the IV line D: Establish the IV line based on the law of implied consent, because his condition has impaired his decision-making capacity

A: Ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy

Provisions of the medical practice act include all the following, EXCEPT: A: Assigning medical directors to EMS systems B: Defining minimum qualifications of the paramedic C: Establishing a means of certifications for the paramedic D: Defining the skills that the paramedic can legally perform

A: Assigning medical directors to EMS systems

A 77-year old man with end stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apnea and pulseless. The daughter presents you with an our-of-hospital DNR, however the document expired 3 months ago. You should: A: Begin CPR only and contact medical control for further guidance B: Realize that the patient cannot be resuscitated and notify the coroner C: Begin full resuscitative efforts because the DNR order is no longer valid D: confirm that the order has expired before initiating any patient treatment

A: Begin CPR only and contact medical control for further guidance

Ethics related to the practice and delivery of health care is called: A: Bioethics B: Valued ethics C: Applied ethics D: Medical morality

A: Bioethics

Resuscitations efforts would MOST likely be ceased in the prehospital setting on a patient with: A: Blunt trauma arrest B: Witnessed cardiac arrest C: An extensive cardiac history D: Hypothermic cardiac arrest

A: Blunt trauma arrest

If a patient is reluctant to communicate because he or she feels threatened, the paramedic should: A: Cautiously approach the patient and use open posturing B: Maintain a position that is at or slightly above the patient C: Ask a law enforcement officer to help obtain information D: Defer further questioning until the patient appears calm

A: Cautiously approach the patient and use open posturing

Which of the following statements regarding the use of cellular telephones and landline telephones is MOST correct? A: Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies B: Cellular phones are more expensive than radios and give a weaker signal C: Landline phones are in a fixed location and transmit with a simplex system D: Cellular phones do not rely on a repeater to increase the coverage distance

A: Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies

Which of the following statements regarding certification is correct? A: Certification is evidence that an individual has a certain level of credentials based on hours of training and examination B: A certified health care provider has been granted the authority and privilege to practice medicine in a certain municipality C: Certification is a process in which a certifying entity attests to the fact that the health care provider has mastered a certain skill set D: Unlike a licensed health care provider, a certified health care provider is not required to obtain continuing education hours

A: Certification is evidence that an individual has a certain level of credentials based on hours of training and examination

The FIRST principle of communicating by radio is: A: Clarity B: Accuracy C: Calmness D: Thoroughness

A: Clarity

If a mortally injured patient's wishes regarding organ donation are not known: A: Consent should be obtained from a family member B: It should be assumed that the patient would consent C: A physician can legally authorize donation of organs D: A court order is required to initiate the procurement process

A: Consent should be obtained from a family member

When functioning at a noisy scene, communication will be MOST effective if you: A: Move the patient to the ambulance as soon as you can B: Tell noisy patrons or bystanders to be quiet or leave C: Yell into the patient's ear so he or she can hear you D: Find the source of the noise and remove it if possible

A: Move the patient to the ambulance as soon as you can

During the attempted resuscitation of a 79-year old man in cardiac arrest, a young man arrives at the scene and asks you to cease resuscitative efforts. He further tells you that the patient has entrusted him to make all of his medical decisions. You should: A: Continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions B: Limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive C: Cease all resuscitative efforts, contact medical control, and advise medical control that a surrogate decision maker is present and has requested you to stop D: Advise the man that, because he does not have valid documentation that he is authorized to make decisions for the patient, you must continue resuscitation

A: Continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions

At minimum, sending the 12-lead ECG of a patient with chest pain to the emergency department physician via telemetry would: A: Decrease the time from diagnosis to treatment B: Enable the paramedic to begin treatment in the field C: Decrease the likelihood of prehospital cardiac arrest D: Allow the physician to choose the appropriate fibrinolytic

A: Decrease the time from diagnosis to treatment

EMS-enabling legislation: A: Defines how EMS is structured B: Appoints a system's medical director C: Defines a physician's scope of practice D: Develops local or regional EMS protocols

A: Defines how EMS is structured

The first rule of medical practice is to: A: Do no harm B: Provide medical care C: Maintain a sympathetic attitude D: Recognize critically ill patients

A: Do no harm

When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. This is part of: A: Due process B: Licensure revocation C: Licensure suspension D: The appeal process

A: Due process

A legal obligation of public and certain other ambulance services to respond to a call for help in their jurisdiction is called: A: Duty B: Immunity C: Negligence D: Proximate cause

A: Duty

The purpose of a closed-ended question is to: A: Elicit a specific response from the patient B: Enable the paramedic to gauge the patient's mentation C: Obtain reliable information about a partner's complaint D: Allow the patient to describe what he or she is feeling

A: Elicit a specific response from the patient

When the paramedic encounters a patient who has difficulty communicating, he or she should: A: Enlist the help of a family member or primary caregiver B: Try to use sign language when asking a specific question C: Suspect that a patient may have a psychiatric condition D: Transport the patient and advise the hospital of the situation

A: Enlist the help of a family member or primary caregiver

If a paramedic is on duty and receives a 911 call in his or her jurisdiction: A: He or she is not covered by the Good Samaritan law B: The Good Samaritan law will provide limited immunity C: State law requires that he or she respond within 5 minutes D: He or she cannot be held liable if a fee is not charged to the patient

A: He or she is not covered by the Good Samaritan law

When a panicked person calls 911 for help: A: He or she needs immediate confirmations of having reached the right number B: The emergency medical dispatcher must answer the phone within four or five rings C: The dispatcher should not speak to the caller until the caller has calmed down D: An ambulance should be dispatched before the nature of the problem is known

A: He or she needs immediate confirmations of having reached the right number

The term "frequency" as it applies to radio communications, is MOST accurately defined as: A: How frequently a radio wave recurs in a given time B: A predefined station designed for emergency use only C: A relatively long wavelength that produces audible sound D: The number of megahertz per cycle that the radio transmits

A: How frequently a radio wave recurs in a given time

When relaying medical information to a physician in person, you should: A: Include information that you did not provide during your radio report B: Provide a length, detailed report that includes all patient information C: Ensure that another physician or a nurse is present to avoid confusion D: Routinely give your report at a patient's bedside so he or she can hear

A: Include information that you did not provide during your radio report

People who call 911 at the moment of a loved one's death MOST often need: A: Information and support B: Sympathy and reassurance C: Medical care for themselves D: Assurance that everything will be okay

A: Information and support

Most states require the paramedic to report all of the following cases, EXCEPT: A: Injury to the elderly B: Drug-related injuries C: Prehospital childbirth D: Domestic violence

A: Injury to the elderly

Touching a conscious elderly patient in a nursing home without his or her permission: A: Is nonverbally communicating "You are not important enough or mentally competent enough to be asked for permission." B: Is typically acceptable to the patient, because he or she is often frightened and desperately wants someone to help C: May be necessary if the patient appears to have an altered mental status during your visual assessment of his of her behavior D: Is unprofessional and ethically unacceptable unless you have obtained consent from the patient's family or primary caregiver

A: Is nonverbally communicating "You are not important enough or mentally competent enough to be asked for permission."

All of the following are external factors that can affect communication with a patient, EXCEPT: A: Lack of empathy B: Language barriers C: A disruptive scene D: Sensory impairment

A: Lack of empathy

Documenting a false statement that injures a person's good name or reputation constitutes: A: Libel and defamation B: Assault and battery C: Slander and defamation D: Gross negligence

A: Libel and defamation

A backup communication system is especially critical when dealing with: A: Mass-casualty incidents B: Motor-vehicle collisions C: Simultaneous EMS calls D: Any critically injured patient

A: Mass-casualty incidnets

A paramedic who was trained and certified to perform surgical cricothyrotomy successfully performs the procedure on a patient in the field. However, because of the EMS system's medical director does not permit paramedics to perform a needle cricothyrotomy, the paramedic: A: Performed outside his or her scope of practice B: Has committed an act of gross negligence C: Will likely be sued by the medical director D: Did not follow the national standard of care

A: Performed outside his or her scope of practice

A _____ receives a weak signal and retransmits it at a higher power on another frequency. A: Repeater B: Base station C: Multiplex system D: Duplex system

A: Repeater

If a patient provides a confusing or disorganized response to your quest, you should: A: Rephrase the patient's comments with simpler terms and ask if he or she agrees with your synopsis B: Revisit the question later in your assessment and conclude that the patient's mental status is altered C: Attempt to obtain the most pertinent part of the patient's response and continue with further questioning D: Recognize that the patient is likely scared because of the situation and ask him or her to repeat the response

A: Rephrase the patient's comments with simpler terms and ask if he or she agrees with your synopsis

While caring for an 80-year old man with a possible fractured arm, you discover other injury patterns that are suggestive of abuse. The patient is conscious and alert. You should: A: Splint the patient's arm, transport him to the hospital, and report your suspicions to the emergency department physician B: Advise the patient that you suspect he has been abused and that you are required by law to report this to the authorities C: Splint the patient's arm and contact his family to determine if they are aware of the fact that he has been physically abused D: Treat the patient's injury appropriately and then obtain his consent to report your suspicions to the emergency department physician

A: Splint the patient's arm, transport him to the hospital, and report your suspicions to the emergency department physician

Every decision regarding patient care that a paramedic makes should be based on the: A: Standard's of good medical care B: Patient's perception of the problems C: Patient's family's personal requests D: Possible legal ramifications involved

A: Standards of good medical care

General criteria for determining a patient's mental competence include all of the following, EXCEPT: A: The absence of cardiac dysrhythmias B: An appropriate response to questions C: Blood glucose levels within normal limits D: The absence of head injury or other trauma

A: The absence of cardiac dysrhythmias

While attempting to resuscitate a middle-aged woman in cardiac arrest, you perform effective CPR but do not evaluate the patient's cardiac rhythm until 10 minutes into the resuscitation attempt. When the cardiac monitor is finally applied, the patient is in asystole. The patient is transported but is pronounced dead upon arrival at the hospital. Which of the following statements regarding this scenario is correct? A: The delay in evaluating the patient's cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death B: Simple negligence can be established because of the delay in applying the cardiac monitor, but your inaction did not proximately cause her death C: Your inaction reflects gross negligence and it easily could be established that the patient would have survived if the cardiac monitor had been applied earlier D: Although there was a delay in applying the cardiac monitor, you cannot be held liable, because effective CPR was performed throughout the resuscitation attempt

A: The delay in evaluating the patient's cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death

When a person experiences an injury and seems redress for that injury: A: The judicial process must determine who was responsible B; It is usually the paramedic who is found grossly negligent C: It must be established that the injury led to a bad outcome D: He or she must prove that the standard of care was provided

A: The judicial process must determine who was responsible

Which of the following statements regarding the paramedic-physician relationship is correct? A: The paramedic will be held accountable for his or her own actions B: The physician is not authorized to restrict the paramedics practice C: State EMS legislation is responsible for appointing medical directors D: The physician is legally accountable for actions taken by an employer

A: The paramedic will be held accountable for his or her own actions

Historically, most EMTALA violations occurred when: A: The patient did not have medical insurance B: Paramedics transported a woman in active labor C: Paramedics functioned above their scope of practice D: Hospitals refused to accept clinically stable patients

A: The patient did not have medical insurance

When determining the most appropriate hospital to which to transport a patient, the paramedic's FIRST consideration should be: A: The patient's clinical condition B: The wishes of the patient or family C: Traffic conditions and similar variables D: Whether or not the patient has insurance

A: The patient's clinical condition

Ethics is MOST accurately defined as: A: The philosophy of right and wrong, of moral duties, and of ideal professional behavior B: The professional behavior that a person's peers as well as the general public expect C: Behavior that is consistent with the law and an attitude that society in general expects D: A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience

A: The philosophy of right and wrong, of moral duties, and of ideal professional behavior

Because minors have no legal status: A: They can neither consent to nor refuse medical care B: You must obtain consent from both parents before treating C: They must always be treated under the law of implied consent D: You must obtain a court order before you can legally treat them

A: They can neither consent to nor refuse medical care

When touching a patient as a form of reassurance, the paramedic should: A: Touch the patient on a neutral part of his or her body B: Touch the patient in the center of the chest or on the thigh C: Remember that most patients take offense to being touched D: Not touch the patient if he or she leans toward the paramedic

A: Touch the patient on a neutral part of his or her body

All of the following are facial bones, EXCEPT the: A) maxilla. B) parietal. C) palatine. D) lacrimal.

11. If the receiving facility does not have adequate resources to take care of your patient, you should next determine whether: A) there is an appropriate facility within a reasonable distance. B) an emergency physician should be dispatched to the scene. C) transport of the patient by ambulance is absolutely necessary. D) a BLS ambulance can transport the patient to a distant hospital.

Ans: A Page: 10 Type: General Knowledge

16. A paramedic who is licensed in a particular state: A) is required to function under the guidance of a licensed physician. B) has complete autonomy and can function as an independent provider. C) must obtain more continuing education hours than a certified paramedic. D) is authorized to function as medical control for EMTs and advanced EMTs.

Ans: A Page: 12 Type: General Knowledge

147. The focused assessment of a responsive medical patient is guided by: A) the chief complaint. B) SAMPLE history findings. C) baseline vital sign readings. D) the general impression.

Ans: A Page: 14.16

21. It is important to become involved in a national or state EMS organization, such as the National Association of EMTs (NAEMT) or the National Association of State EMS Directors (NASEMSD), because: A) such organizations have an impact on the future direction of EMS. B) these organizations offer continuing education for all EMS providers. C) membership in a professional organization is a tax-deductible expense. D) such organizations promote unique EMS training standards for each state.

Ans: A Page: 15 Type: General Knowledge

26. Openness, honesty, and truthfulness are attributes that demonstrate: A) integrity. B) empathy. C) sympathy. D) advocacy.

Ans: A Page: 16 Type: General Knowledge

29. As an advocate for your patient, you must: A) act in the patient's best interest and remain respectful of his or her wishes and beliefs B) allow your personal feelings to affect the quality of care that you provide to your patients. C) treat all patients the same, regardless of differences in lifestyle, culture, and personal values. D) keep suspicions of abuse or neglect to yourself if the patient fears retribution from the abuser.

Ans: A Page: 16 Type: General Knowledge

31. When responding to an emergency scene, it is MOST important to: A) proceed in a manner that is timely and safe. B) moderately exceed the speed limit when possible. C) stay at least 10' behind any cars in front of you. D) use your siren to move heavy traffic out of the way.

Ans: A Page: 17-18 Type: General Knowledge

2. In contrast to a type II ambulance, a type III ambulance: A) is a specialty van that usually has a modular ambulance body. B) does not allow access from the cab to the patient compartment. C) is a standard van with a walk-through to the patient compartment. D) has an ambulance body that can be transferred to a new chassis.

Ans: A Page: 2174

7. The motor oil level of the ambulance: A) should be checked prior to starting the engine. B) should be checked while the engine is running. C) is checked 5 minutes after the engine is turned off. D) must be checked a minimum of three times per shift.

Ans: A Page: 2176

12. High-performance EMS systems typically use a fractile response time standard, in which: A) a significant fraction of all responses must be achieved within an established time. B) the ambulance must arrive at the scene within 8 minutes in 50% of all dispatches. C) turnaround time for the entire call should be no more than 1 hour in 90% of all calls. D) medics must be in the ambulance and en route within 2 minutes of being dispatched.

Ans: A Page: 2177

14. A third-service EMS system is one in which: A) a public agency not affiliated with the fire department provides EMS service. B) an EMS ambulance is housed in a fire department and is staffed by EMTs. C) responders from a fire department assist the ambulance on every EMS call. D) a privately owned ambulance service works in tandem with a public EMS system.

Ans: A Page: 2177

24. Which of the following statements regarding loading and securing a patient in the back of the ambulance is correct? A) Whether the patient is lying on the stretcher or sitting on the bench seat, he or she must be properly seat-belted. B) All patients transported in the back of the ambulance must be secured on the stretcher, even if they request otherwise. C) It generally takes a minimum of three people to safely load an average-sized adult on the stretcher into the ambulance. D) All patients should initially be loaded into the ambulance on the stretcher, but they can move to the bench seat once loaded.

Ans: A Page: 2178-2179

38. You are operating an ambulance in emergency mode on a two-way street. The driver in front of you will not yield accordingly. You should: A) remain behind the vehicle and anticipate that the driver may slam on the brakes. B) carefully pass the vehicle on the right-hand shoulder if it is safe to do so. C) turn your lights and siren off and use the PA system to alert the driver. D) shine a spotlight into the vehicle's side view mirror to attract the driver's attention.

Ans: A Page: 2181

105. IO cannulation is contraindicated in all of the following situations, EXCEPT: A) penetrating thoracic trauma. B) bilateral knee replacements. C) known osteogenesis imperfecta. D) the presence of a peripheral IV line.

Ans: A Page: 501

42. You are driving in the right-hand lane while transporting a patient to the hospital in nonemergency mode. In your side view mirror, you notice that a small truck is tailgating you. What should you do? A) Maintain your current speed and advise the dispatcher to contact the police. B) Turn on your emergency lights, move to the left lane, and allow the truck to pass. C) Increase your speed to increase the distance between you and the tailgating truck. D) Gently tap your brakes to alert the driver that he or she is following too close behind you.

Ans: A Page: 2181

19. Which of the following statements regarding the use of emergency escorts is correct? A) Many drivers will only see the first emergency vehicle and assume that it is clear once that vehicle has passed. B) If you are using an emergency escort, you should follow closely behind it to avoid a wake effect collision. C) Use of a police escort is an acceptable practice, because it often facilitates a faster response time to the scene. D) The use of emergency escorts is generally discouraged, unless you are traveling through a busy intersection.

Ans: A Page: 2185-2186

29. The MOST important factor to consider when determining if transport of a trauma patient via helicopter is appropriate is: A) the patient's hemodynamic status. B) delays in ground transport due to traffic. C) the injury mechanism that was involved. D) the need for definitive airway management.

Ans: A Page: 2186

30. In contrast to rotary-wing air ambulances, fixed-wing air ambulances: A) are mainly used to transport patients over long distances. B) can get the patient to a definitive care trauma center faster. C) cannot fly safely when inclement weather is within 30 miles. D) are the preferred transport method for acutely injured patients.

Ans: A Page: 2186

32. In which of the following situations should a helicopter generally NOT be utilized? A) A patient in cardiopulmonary arrest who has been unresponsive to defibrillation B) Spinal injury in which the terrain over which the patient must be carried is rough C) Suspected internal hemorrhage in a hypotensive patient who lives in a rural area D) Motor vehicle crash involving a patient whose extrication will take 45 minutes

Ans: A Page: 2187

3. A medication is used "off-label." This means that it: A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA. B) has been determined to be safe by a physician, and is used to treat a patient's illness before the medication has been approved by the FDA for any purpose. C) is administered in clinical trials while the manufacturer conducts further research and before the FDA has approved the medication for use. D) is administered in an extreme emergency situation, but only if initial clinical trials have determined that the medication will not cause harm to the patient.

Ans: A Page: 423-424

10. Unlike Schedule I drugs, Schedule II drugs have: A) accepted medical uses. B) a higher abuse potential. C) limited dependence potential. D) no accepted medical application.

Ans: A Page: 424

8. Medications that are manufactured synthetically: A) do not use animal, mineral, or vegetable sources. B) include insulin, digitalis, and thyroid medications. C) are derived from certain plants and animal organs. D) include calcium, iron, magnesium, and other minerals.

Ans: A Page: 424

20. The term affinity, as it applies to pharmacology, is MOST accurately defined as the: A) ability of a medication to bind to a receptor. B) process of a medication binding to a receptor. C) blocking of a receptor site by a particular medication. D) strength of the bond between a medication and its receptor.

Ans: A Page: 428

21. A medication is called an antagonist if: A) it has a higher affinity for the receptor site than the chemical mediator. B) it stimulates a receptor site to cause the response that that receptor normally causes. C) it attaches to a receptor site and produces an effect or series of effects. D) the chemical mediator of a receptor has a higher affinity than the medication.

Ans: A Page: 428-429

25. In order to cause a negative inotropic effect on the heart, you would have to administer a(n): A) beta-1 adrenergic antagonist. B) alpha-2 adrenergic agonist. C) beta-2 adrenergic agonist. D) alpha-1 adrenergic antagonist.

Ans: A Page: 428-429

27. A medication that possesses a negative chronotropic effect will: A) cause a decrease in the heart rate. B) cause an increase in blood pressure. C) decrease myocardial contractile force. D) increase cardiac electrical conduction velocity.

Ans: A Page: 429

39. A paramedic gives a woman with chronic pain an injection of sterile saline and tells her that it is a narcotic analgesic. The paramedic's action: A) could result in criminal prosecution. B) will likely be of therapeutic benefit. C) is acceptable under the circumstances. D) demonstrates compassion and empathy.

Ans: A Page: 433

43. Certain antibiotics and antiseizure medications are known to cause Stevens-Johnson syndrome, which is a: A) severe, possibly fatal reaction that mimics a burn. B) rare condition characterized by painful neck spasms. C) condition in which the renal system acutely fails. D) nonfatal reaction characterized by a diffuse rash.

Ans: A Page: 434

46. A medication that has a narrow therapeutic index: A) can be given, but not without close patient monitoring. B) should not be given to patients over 50 years of age. C) is safe to give because the chance of toxicity is remote. D) should not be given because its effects are too harmful.

Ans: A Page: 434

51. A patient receives several doses of the same drug within a short period of time, after which point the medication does not relieve his symptoms. Which of the following has MOST likely occurred? A) Tachyphylaxis B) Cross-tolerance C) Down-regulation D) Dependence

Ans: A Page: 435

55. The percentage of an unchanged medication that reaches the systemic circulation is referred to as: A) bioavailability. B) drug interference. C) peak plasma level. D) pharmacodynamics.

Ans: A Page: 436

58. A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of: A) synergism. B) summation. C) potentiation. D) antagonism.

Ans: A Page: 437

60. A medication undergoes first-pass metabolism in the: A) liver. B) spleen. C) stomach. D) bone marrow.

Ans: A Page: 437-438

45. Colloid solutions: A) contain proteins that are too large to pass out of the capillary membranes, so the solutions remain in the vascular compartment. B) include solutions such as lactated Ringer's and normal saline and rapidly expand the intravascular compartment. C) are safe to use in the prehospital setting because they rapidly and effectively expand the intravascular compartment. D) do not contain large molecules and are therefore ineffective in expanding the intravascular compartment.

Ans: A Page: 477

34. Which of the following statements regarding isotonic solutions is correct? A) Isotonic solutions have almost the same osmolarity as bodily fluids. B) D5W becomes an isotonic solution once it is introduced into the body. C) Normal saline is the only isotonic solution used in the prehospital setting. D) Isotonic solutions expand the vascular space by shifting fluid from other compartments.

Ans: A Page: 478

39. Once D5W is infused into the body: A) the body metabolizes the dextrose quickly and the solution becomes hypotonic. B) it causes fluid to shift from the intracellular space into the vascular space. C) cellular uptake of dextrose occurs and the solution quickly becomes isotonic. D) it rapidly expands the vascular space and effectively increases blood pressure.

Ans: A Page: 478

49. All of the following are peripheral veins, EXCEPT the: A) subclavian vein. B) external jugular vein. C) veins of the hand. D) lower extremity veins.

Ans: A Page: 479

54. Once the pigtail is removed from the sterile access port of an IV solution, the solution must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.

Ans: A Page: 479

173. While attempting to start an IV on a patient with large protruding veins, you note that the vein rolls from side to side during your cannulation attempt. The BEST way to remedy this situation is to: A) apply downward manual traction below the venipuncture site to stabilize the vein in position. B) remove the proximal constricting band to improve venous return and decrease the size of the vein. C) use a through-the-needle IV catheter in order to gain better control over the rolling vein. D) place a chemical heat pack over the vein for 10 minutes in order to decrease movement of the vein.

Ans: A Page: 482

59. The purpose of a Volutrol (Buretrol) administration set is to: A) avoid inadvertent fluid overload. B) deliver large volumes of IV fluid. C) facilitate piggyback medication infusions. D) deliver a maximum of 50 mL of IV solution.

Ans: A Page: 482

63. "Track marks" along the course of a patient's vein are usually a sign of: A) sclerosis caused by frequent cannulation. B) numerous one-way valves inside the vein. C) small vein rupture caused by hypertension. D) multiple thromboses deep within the vein.

Ans: A Page: 483

174. An elderly man with congestive heart failure and shortness of breath requires an IV line in case medication administration is necessary. Which of the following IV catheters is MOST appropriate to use when starting the IV? A) 20 gauge, 1 ¼ B) 18 gauge, 2 ¼ C) 16 gauge, 1 ¼ D) 14 gauge, 2 ¼

Ans: A Page: 483-484

68. If an adult patient is in hypovolemic shock, you should attempt to insert a(n) ______ over-the-needle catheter into the _______. A) 14-gauge, antecubital vein B) 16-gauge, metacarpal vein C) 14-gauge, metacarpal vein D) 18-gauge, external jugular vein

Ans: A Page: 484

73. When changing an IV bag, it is important to: A) ensure that fluid remains in the drip chamber. B) attach a new fluid administration set to the bag. C) ensure that the tubing is completely depleted of fluid. D) allow the bag to become completely depleted of fluid.

Ans: A Page: 487

77. If you discover that an IV is not flowing sufficiently, you should: A) check the height of the IV bag. B) reapply the constricting band. C) discontinue the IV infusion. D) pull back on the IV catheter.

Ans: A Page: 492

83. Pain, tenderness, and blood rapidly pooling around the IV site are MOST indicative of: A) hematoma. B) phlebitis. C) vein occlusion. D) thrombophlebitis.

Ans: A Page: 494

84. Which of the following conditions or situations is associated with the HIGHEST risk of vein rupture during IV cannulation? A) Diabetes B) Hypertension C) Ibuprofen use D) Atherosclerosis

Ans: A Page: 494

87. The MOST prominent clinical indicator of a pyrogenic reaction is: A) fever. B) nausea. C) a headache. D) vascular collapse.

Ans: A Page: 494-495

179. As you are preparing to start an IV on a young man, he sees the needle, becomes acutely diaphoretic, and passes out. After placing him in the appropriate position, you should: A) administer high-flow oxygen. B) assess his blood glucose level. C) start the IV in case he needs fluids. D) obtain a complete set of vital signs.

Ans: A Page: 495

91. During IV therapy, the presence of shortness of breath, unequal breath sounds, and cyanosis despite administration of high-flow oxygen should make you MOST suspicious for: A) an air embolus. B) circulatory overload. C) acute pulmonary edema. D) spontaneous pneumothorax.

Ans: A Page: 495

96. IO infusion is a technique of administering IV fluids and medications into: A) the IO space of a long bone. B) the diaphysis of the femur or humerus. C) the epiphysis of the proximal tibia. D) a large vein that lies deep within the neck.

Ans: A Page: 497

98. Which of the following statements regarding IO cannulation and infusion is correct? A) The IO space remains patent, even when peripheral veins have collapsed. B) The IO route is reserved for select medications and certain blood products. C) IO infusion should only be attempted in children younger than 6 years of age. D) Medication absorption occurs more slowly through the IO space than through the IV route.

Ans: A Page: 497

180. While establishing IO access in a critically ill patient, you locate the appropriate anatomic landmark, cleanse the site, and insert the IO catheter at a 45° angle. After attaching the IV line and turning the flow on, you note edema developing on the opposite side of the extremity. What has MOST likely happened? A) Extravasation due to an inappropriate angle of IO catheter insertion B) Inadvertent entry of a large vein, which has caused infiltration C) Fracture of the bone with leakage of bone marrow into the soft tissue D) Acute osteomyelitis secondary to inappropriate cleansing of the site

Ans: A Page: 500

10. Which of the following statements regarding the patient assessment process is correct? A) The assessment process must be organized and systematic, yet flexible enough to allow you to maximize the amount of information you can gather. B) It is critical that you think of patient assessment as a static sequence of events that are carried out on every patient that you encounter. C) Expanding your questioning of a patient in order to elicit more information often confuses the patient and should be avoided if possible. D) As the patient interview unfolds, you must remain focused on the patient's chief complaint, as it is likely his or her most serious problem.

Ans: A Page: 590

124. Which of the following hazards would you LEAST likely encounter at the scene of a motor vehicle crash? A) Unruly patient B) Moving traffic C) Broken glass D) Hazardous materials

Ans: A Page: 592

175. At 3:00 a.m. you receive a call for a "man down." While en route to the scene, you ask the dispatcher to provide additional information, but the dispatcher advises you the caller was abrupt on the phone and then hung up. You should: A) ask the dispatcher if law enforcement is en route to the scene. B) assume the caller was panicked because the patient is critically ill. C) advise the dispatcher to send a second paramedic crew to the scene. D) stage in a safe area until contact with the caller can be reestablished.

Ans: A Page: 593

129. It is MOST important to identify the age and sex of your patient because: A) age and sex can change how your patient presents. B) the differential diagnosis is modified for older patients. C) this is required information for the patient care report. D) the patient should be assessed by a medic of the same sex.

Ans: A Page: 597

134. Sonorous respirations are MOST likely caused by: A) an anatomic airway obstruction. B) secretions or blood in the airway. C) swelling of upper airway structures. D) severe inflammation of the epiglottis.

Ans: A Page: 597

135. A responsive patient who is talking or crying: A) has a patent airway. B) is breathing adequately. C) needs supplemental oxygen. D) has no impending airway problem.

Ans: A Page: 597

177. You arrive at the scene of a motor vehicle crash in which a small passenger car struck a bridge pillar. The patient, a conscious young woman, is still seated in her car. The scene is safe and law enforcement is directing traffic. Upon initial contact with the patient, you should: A) have your partner manually stabilize her head as you assess her mental status. B) assess her respiratory quality and then apply oxygen via nonrebreathing mask. C) apply a rigid cervical collar and obtain an initial Glasgow Coma Scale score. D) open her airway with the jaw-thrust maneuver and assess respiratory quality.

Ans: A Page: 597-598

140. An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would MOST likely have ________ skin. A) cyanotic B) flushed C) mottled D) pale

Ans: A Page: 599

141. Stimulation of the sympathetic nervous system causes: A) sweating. B) bradycardia. C) vasodilation. D) warm, moist skin.

Ans: A Page: 600

158. Which of the following statements regarding the rapid exam of a trauma patient is correct? A) The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport. B) Any trauma patient should receive a rapid head-to-toe exam, even if his or her injury is minor and the mechanism of injury is not significant. C) The rapid exam is the first assessment you will perform on a trauma patient and is designed to find and treat immediate threats to life. D) The rapid exam is a detailed exam that should take between 1 and 2 minutes and should primarily focus on the patient's chief complaint.

Ans: A Page: 601

11. On most runs, the two MOST important pieces of patient history information that you need to obtain initially are the: A) patient's name and chief complaint. B) chief complaint and patient's address. C) patient's name and family physician. D) chief complaint and the patient's sex.

Ans: A Page: 605

18. Your patient will MOST likely develop a good first impression of you if you: A) look and act professional and confident. B) tell him or her that everything will be okay. C) address him or her as "dear" or "honey." D) quickly determine his or her chief complaint.

Ans: A Page: 605

23. When transferring a geriatric patient from a hospital to an extended care facility, it is MOST important to: A) review the patient's transfer paperwork. B) document at least two full sets of vital signs. C) call a radio report to the extended care facility. D) presume that the patient will not wish to speak.

Ans: A Page: 606

146. The history of present illness is MOST accurately described as: A) an elaboration of the chief complaint. B) a clinically significant physical finding. C) the patient's most significant problem. D) the reason why the patient called 9-1-1.

Ans: A Page: 607

16. Which of the following questions would be of LEAST pertinence when trying to determine a patient's current health status? A) "Are your mother and father still living?" B) "Are your immunizations up to date?" C) "Are you currently taking any prescription medicines?" D) "Do you have a history of any specific diseases in your family?"

Ans: A Page: 608-609

153. The MOST reliable means of attempting to determine an unresponsive medical patient's problem is: A) a thorough head-to-toe physical examination. B) cardiac monitoring and blood glucose assessment. C) pulse oximetry, capnography, and serial vital signs. D) information provided by the patient's family members.

Ans: A Page: 610

26. Pausing to consider something significant that you have just been told is called: A) reflection. B) interpretation. C) facilitation. D) clarification.

Ans: A Page: 615

36. Your patient says, "I can't catch my breath." In response, you state, "That's very helpful. Let me think about that for a moment." This dialogue is an example of: A) reflection. B) clarification. C) facilitation. D) interpretation.

Ans: A Page: 615

33. It is appropriate to ask, "Would you say the pain is similar to or worse than with previous episodes?" when determining the _________ of a patient's pain. A) severity B) quality C) region D) progression

Ans: A Page: 616

22. Performing the functions of a paramedic prior to licensure is: A) immoral. B) unlawful. C) unethical. D) permissible.

Ans: B Page: 8 Type: General Knowledge

48. Which of the following statements regarding an intoxicated patient is correct? A) While the patient is trying to explain things to you, his or her anger can escalate faster than if he or she were not intoxicated. B) Although the intoxicated patient is a poor historian, his or her family members usually provide the information that you need. C) You should promptly transport the intoxicated patient, because attempting to obtain a medical history will be unsuccessful. D) The risk of an intoxicated patient's behavior turning violent is low because his or her cognitive skills are impaired significantly.

Ans: A Page: 620

49. The MOST effective way to obtain a medical history from a patient who is crying is to: A) place your hand on his or her shoulder (if appropriate for the patient) and reassure him or her that you are in control of the situation. B) tactfully advise the patient that you cannot effectively help him or her if he or she continues to cry. C) have one family member calm the patient as you gather the medical history from another family member. D) administer a sedative medication, which will calm the patient and facilitate your gathering of the medical history.

Ans: A Page: 620-621

55. Which of the following is NOT an effective way of obtaining a medical history from a patient who is totally deaf? A) Speaking slowly and slightly more loudly to the patient B) Using paper and pencil to write down your questions C) Addressing the patient face-to-face if he or she can read lips D) Using an interpreter who knows American Sign Language

Ans: A Page: 622

165. When caring for an unresponsive trauma patient, a complete secondary assessment: A) will probably not be performed in its entirety. B) must be performed after the primary assessment. C) should be performed before you begin transport. D) will enable you to immediately detect life threats.

Ans: A Page: 626

58. Other than overall patient appearance, the patient's __________ is/are the MOST objective data for determining his or her status. A) vital signs B) medications C) chief complaint D) medical history

Ans: A Page: 627

63. When using a tympanic device to obtain a patient's body temperature, you should: A) be aware of extrinsic factors that can skew the reading. B) hold the device in the patient's ear for 30 to 60 seconds. C) irrigate any wax from the ear with lukewarm water first. D) ensure that the patient is in a laterally recumbent position.

Ans: A Page: 630

64. Which of the following factors would likely NOT skew a pulse oximetry reading? A) Hypertension B) Cold temperature C) Carbon monoxide D) Sickle-cell disease

Ans: A Page: 630

67. The skin becomes _________ when red blood cell perfusion to the capillary beds of the skin is poor. A) pale B) flushed C) cyanotic D) mottled

Ans: A Page: 638

72. The pulse of the superficial temporal artery can be felt: A) just anterior to the ear, in the temporal region. B) inferior to the ear, slightly below the earlobe. C) slightly superior to the ear, in the temporal region. D) posterior to the ear, directly over the mastoid bone.

Ans: A Page: 639

73. Examination of the head is MOST important when assessing a patient who: A) is unresponsive. B) complains of nausea. C) has shortness of breath. D) presents with hemiparesis.

Ans: A Page: 639

79. When assessing a patient's conjunctivae, you note they are injected. This means that the conjunctivae are: A) red. B) pale. C) yellow. D) cyanotic.

Ans: A Page: 642

81. Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): A) basilar skull fracture. B) orbital blowout fracture. C) fracture of the cribriform plate. D) ruptured tympanic membrane.

Ans: A Page: 646

88. When auscultating heart sounds, you should place your stethoscope at the: A) fifth intercostal space, over the apex of the heart. B) second intercostal space, over the base of the heart. C) third or fourth intercostal space, in the midaxillary line. D) sternal border at the second or third intercostal space.

Ans: A Page: 654-655

86. S1, the first heart sound, represents: A) closure of the mitral and tricuspid valves. B) the sound heard at the end of diastole. C) closure of the aortic and pulmonic valves. D) the sound heard at the end of systole.

Ans: A Page: 655

164. Any time you encounter jugular venous distention in a patient, you should determine: A) where the venous obstruction is that is impeding blood return to the heart. B) what body cavity the patient is bleeding into that is causing lost volume. C) what condition the patient has that is causing decreased venous pressure. D) what is happening to the heart to cause such a large increase in preload.

Ans: A Page: 656

94. A patient who is absolutely still and resists any movement should be suspected of having: A) peritonitis. B) kidney stones. C) a bowel obstruction. D) intra-abdominal bleeding.

Ans: A Page: 660

95. Which of the following statements regarding ascites is correct? A) Ascites is a collection of fluid within the peritoneal cavity. B) Percussion of the abdomen will often yield hyperresonance. C) The most common cause of ascites is an acute splenic injury. D) The abdomen of a patient with ascites has a sunken appearance.

Ans: A Page: 660

100. A pathologic fracture occurs when: A) normal forces are applied to abnormal bone structures. B) abnormal forces are applied to abnormal bone structures. C) normal forces are applied to normal bone structures. D) abnormal forces are applied to normal bone structures.

Ans: A Page: 663

107. The MOST clinically significant indicator(s) of ischemia in a limb is/are: A) pulselessness. B) poikilothermia. C) parasthesias. D) pain and pallor.

Ans: A Page: 668

108. You would MOST likely encounter bilateral dependent edema in a patient with: A) heart failure. B) arterial occlusion. C) diabetes mellitus. D) deep vein occlusion.

Ans: A Page: 668

170. Vascular compromise in a lower extremity is characterized by: A) unilateral pulse deficit and pallor. B) bilaterally diminished pedal pulses. C) warm, flushed skin to the extremity. D) inability to feel or move the extremity.

Ans: A Page: 668

183. Approximately how far should you insert a 5.0-mm ET tube in a 4-year-old child? A) 12 cm B) 15 cm C) 17 cm D) 19 cm

Ans: B Page: 806

30. After addressing any life threats in the order in which you find them, you should next: A) consider the worst-case scenario that could be causing the patient's symptoms and either rule it out or rule it in. B) determine the most common and statistically probable cause for the patient's current signs and symptoms. C) formulate a working field diagnosis on the basis of what you discovered in the initial assessment of the patient. D) provide symptomatic care and promptly transport the patient to an appropriate medical treatment facility.

Ans: A Page: 703

31. Given the number of possible diagnoses in any situation and the limited physical and technical resources of the field, you will MOST likely: A) regularly be treating patients who can only be diagnosed at the hospital. B) have difficulty providing supportive care secondary to medical ambiguity. C) regularly be able to formulate a definitive diagnosis of the patient's current condition. D) not be able to stabilize the patient's condition adequately in the field setting.

Ans: A Page: 703

The _____________ are formed by the cranial bones and prevent contaminants from entering the respiratory tract. A) sinuses B) turbinates C) bony nasal shelves D) nasal mucous membranes

Ans: A Page: 713

In contrast to the right lung, the left lung: A) has two lobes. B) has three lobes. C) is encased in the parietal pleura. D) can only hold a small volume of air.

Ans: A Page: 716

Tenting of the skin under the jaw often occurs when airway devices are inadvertently inserted into the: A) pyriform fossae. B) vallecular space. C) laryngopharynx. D) hypopharyngeal space.

Ans: A Page: 716

The _________ is an anatomic space located between the base of the tongue and the epiglottis. A) vallecula B) uvula C) adenoid D) larynx

Ans: A Page: 716

The volume of air that is moved into or out of the respiratory tract in one breath is called: A) tidal volume. B) alveolar volume. C) minute volume. D) inspiratory reserve volume.

Ans: A Page: 719

Following an optimal inspiration, the amount of air that can be forced from the lungs in a single exhalation is called the: A) functional reserve capacity. B) expiratory reserve volume. C) residual expiratory volume. D) fraction of inspired oxygen.

Ans: A Page: 720

The Hering-Breuer reflex is a protective mechanism that: A) terminates inhalation and prevents lung overexpansion. B) decreases pneumotaxic function during severe hypoxia. C) sends messages to the diaphragm via the phrenic nerves. D) allows the apneustic center to influence the respiratory rate.

Ans: A Page: 720

The hypoxic drive stimulates breathing in patients with: A) chronically decreased PaO2 levels. B) emphysema or chronic bronchitis. C) chronically decreased PaCO2 levels. D) mild bronchospasm caused by asthma.

Ans: A Page: 721

All of the following factors would increase a person's respiratory rate, EXCEPT: A) narcotic analgesic use. B) increased metabolism. C) the use of amphetamines. D) a rise in body temperature.

Ans: A Page: 722

45. Intrapulmonary shunting is defined as: A) the return of unoxygenated blood to the left side of the heart. B) a decrease in the surface area of the alveoli caused by damage. C) a condition in which too much carbon dioxide is eliminated. D) failure of blood to bypass an obstruction in a pulmonary artery.

Ans: A Page: 727

Which of the following statements regarding anemia is correct? A) Anemia results in a decreased ability of the blood to carry oxygen. B) Patients with anemia have a chronically low level of hemoglobin. C) Anemia is a condition caused exclusively by a deficiency of iron. D) Anemic patients typically present with flushed skin and bradycardia.

Ans: A Page: 728

51. Which of the following represents the correct sequence for managing a patient's airway? A) Open, clear, assess, intervene B) Clear, open, assess, intervene C) Assess, clear, open, intervene D) Open, assess, clear, intervene

Ans: A Page: 729

55. In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus? A) Moderate asthma attack B) Pericardial tamponade C) Tension pneumothorax D) Decompensating COPD

Ans: A Page: 730

61. Pulse oximetry is used to measure the: A) percentage of hemoglobin that is saturated with oxygen. B) exchange of oxygen and carbon dioxide at the cellular level. C) percentage of carbon dioxide that is eliminated from the body. D) amount of oxygen dissolved in the plasma portion of the blood.

Ans: A Page: 733

63. Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading? A) Carboxyhemoglobin B) Peripheral vasodilation C) A dimly lit environment D) Heart rate above 120 beats/min

Ans: A Page: 734

263. After obtaining a peak expiratory flow reading of 200 mL, you administered one bronchodilator treatment to a 21-year-old woman with an acute episode of expiratory wheezing. The next peak flow reading is 400 mL. You should: A) recognize that the patient's condition has improved. B) give another bronchodilator treatment and reassess. C) try another treatment modality to treat her wheezing. D) assist ventilations and be prepared to intubate her.

Ans: A Page: 734-735

139. Capnography is a reliable method for confirming proper ET tube placement because: A) carbon dioxide is not present in the esophagus. B) it is a reliable indicator of the patient's PaO, level. C) capnographers measure the amount of exhaled oxygen. D) capnographers measure the amount of carbon dioxide in inhaled air.

Ans: A Page: 735

69. If several attempts to open a patient's airway with the jaw-thrust maneuver are unsuccessful, you should: A) carefully tilt the patient's head back while lifting up on the chin. B) maintain the patient's head in a neutral position and intubate at once C) insert an oropharyngeal airway and reattempt the jaw-thrust maneuver. D) suction the mouth for 15 seconds and then reattempt to open the airway.

Ans: A Page: 738

77. Placing a suction catheter past the base of the tongue: A) may cause the patient to gag or vomit. B) will result in aspiration of gastric contents. C) is effective in thoroughly clearing the airway. D) commonly causes bradycardia in adult patients.

Ans: A Page: 741

184. When preoxygenating an uninjured child prior to ET intubation, you should: A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes. B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at 40 breaths/min for at least 2 to 3 minutes. C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1 breath every 10 seconds for at least 3 minutes. D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately hyperventilate the child at 24 breaths/min for 30 seconds.

Ans: A Page: 806

190. Using the DOPE mnemonic, which of the following interventions would you MOST likely have to perform if you suspect "O" as the cause of acute deterioration in the intubated child? A) Tracheobronchial suctioning B) Immediate extubation of the child C) Needle decompression of the chest D) Checking the bag-mask device for defects

Ans: A Page: 807

191. The MOST effective way to minimize the risk of hypoxia while intubating a child d is is to: A) limit your intubation attempt to 20 seconds. B) monitor the child's cardiac rhythm at all times. C) premedicate the child with 0.02 mg/kg of atropine. D) not allow the oxygen saturation to fall below 100%.

Ans: A Page: 810

212. Undersedation of a patient during airway management would likely result in all of the following, EXCEPT: A) respiratory depression. B) trauma to the airway. C) poor patient compliance. D) tachycardia and hypertension.

Ans: A Page: 810

213. Fentanyl (Sublimaze) is a: A) narcotic analgesic. B) benzodiazepine sedative. C) sedative-hypnotic drug. D) butrophenone sedative.

Ans: A Page: 810-811

218. When a patient is given a paralytic without sedation: A) he or she is fully aware and can hear and feel. B) you should only give one tenth of the standard dose. C) placement of an ET tube is less traumatic. D) paralysis is not achieved and intubation is not possible.

Ans: A Page: 811

223. Drugs such as vecuronium bromide (Norcuron) and pancuronium bromide (Pavulon) are MOST appropriate to administer when: A) extended periods of paralysis are needed. B) longer-acting paralytics are contraindicated. C) you have a transport time of less than 15 minutes. D) intubation of the patient is anticipated to be difficult.

Ans: A Page: 812

285. You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves: A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea. B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind nasotracheal intubation. C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and intubating her trachea via direct laryngoscopy. D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing mask, and continuing suction attempts.

Ans: A Page: 812-813

196. Multilumen airways are contraindicated in patients with: A) esophageal cancer. B) cervical spine trauma. C) traumatic cardiac arrest. D) a history of gastric ulcers.

Ans: A Page: 814

199. The main disadvantage of the LMA is that it: A) does not provide protection against aspiration. B) spontaneously dislodges in the majority of patients. C) is associated with significant upper airway swelling. D) is technically more difficult to perform than intubation.

Ans: A Page: 817

200. During ventilation with the LMA, the paramedic should: A) observe the patient for signs of inadequate ventilation. B) maintain the patient's head in a slightly flexed position. C) suction the patient's oropharynx at least every 2 minutes. D) hyperventilate the patient to maximize tidal volume delivery.

Ans: A Page: 817

205. Which of the following statements regarding the King LT airway is correct? A) In the prehospital setting, the King LTS-D is only used in adults.. B) The King LT airway provides better airway protection than the ET tube. C) The King LT airway has two lumens that effectively seal the esophagus. D) In contrast to the King LT-D, the LTS-D is closed at the distal end.

Ans: A Page: 820

207. The King airway should NOT be used in patients: A) with known esophageal disease. B) with prolonged cardiac arrest. C) with a traumatic brain injury. D) who weigh less than 25 kg.

Ans: A Page: 820

227. The external jugular veins run _________and are located _________ to the cricothyroid membrane. A) vertically, lateral B) vertically, medial C) horizontally, lateral D) horizontally, medial

Ans: A Page: 824

229. The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because: A) no important structures lie between the skin covering the cricothyroid membrane and the airway. B) the tough cartilage that comprises the cricothyroid membrane can easily be incised with a scalpel. C) there are no major blood vessels or other structures that lie adjacent to the cricothyroid membrane. D) the cricoid cartilage helps prevent accidental perforation through the back of the airway and into the esophagus.

Ans: A Page: 824

233. Incising the cricothyroid membrane vertically will: A) minimize the risk of damaging the thyroid gland. B) facilitate insertion of an 8.0- to 9.0-mm ET tube. C) completely eliminate the risk of any external bleeding. D) increase the risk of damaging the external jugular veins.

Ans: A Page: 826

243. Proper insertion of the needle into the cricothyroid membrane involves a angle toward the A) 45°, feet B) 90°, posterior trachea C) 45°, posterior trachea D) 90°, feet

Ans: A Page: 829-831

239. Compared with an open cricothyrotomy, needle cricothyrotomy: A) allows for subsequent attempts to intubate the patient. B) requires the paramedic to manipulate the patient's cervical spine. C) is technically more difficult and takes longer to perform. D) is associated with a higher risk of damage to adjacent structures.

Ans: A Page: 829

121. __________ is the protein that bonds to form the fibrous component of a blood clot. A) Kinin B) Plasmin C) Fibrin D) Collagen

40. A man tells you that he will be following the ambulance in his personal vehicle as you transport his wife to the ambulance. You should: A) discourage him from doing this and advise him that it is safer to ride in the ambulance. B) advise him to drive at normal speeds and ensure that he knows where the hospital is located. C) explain that it would be a better idea for him to wait at home until the hospital contacts him. D) advise him to turn on his emergency flashers and keep at least 500 feet behind you at all times.

Ans: B Page: 2186

44. An ambulance and a fire engine are responding to a motor-vehicle crash when both emergency vehicles approach a red light. After the fire engine clears the intersection and proceeds, the operator of the ambulance should: A) turn off all lights and sirens and wait for the red light to turn green. B) come to a complete stop and then proceed after looking in all directions. C) remain close behind the fire engine to ensure visibility of both vehicles. D) use a different siren tone while entering the intersection at a slow speed.

Ans: B Page: 2186

34. A helicopter landing zone should be: A) marked with a strobe light at the front and rear of the proposed site. B) 100 feet by 100 feet in size and on a surface that is firm, level, and free of debris. C) 50 feet by 50 feet in size and in an area that is at least 50 feet from the ambulance. D) at least a quarter of a mile from the ambulance to avoid injury from flying debris.

Ans: B Page: 2189

35. When assisting with a helicopter landing at night, you should: A) leave your headlights on to signify your location. B) avoid shining a spotlight up at the descending aircraft. C) place a single strobe light in the center of the landing zone. D) refrain from parking the ambulance under overhead wires.

Ans: B Page: 2191

13. The generic name of a medication: A) does not require FDA approval. B) is proposed by the manufacturer. C) is proprietary and cannot be reproduced. D) contains a string of letters and numbers.

Ans: B Page: 425

6. Metoprolol has the brand name _____________, which may be a subtle reference to lowering the blood pressure. A) Cordarone B) Lopressor C) Vasotec D) Norpramin

Ans: B Page: 425

14. The paramedic must use caution when referencing a medication in an American Medical Association (AMA) publication because: A) the AMA publication only lists medications that are in human clinical trials. B) not every medication listed in the compendium has received FDA approval. C) medications listed in an AMA publication are typically not for prehospital use. D) all medications in an AMA publication are listed by their chemical name only.

Ans: B Page: 426

7. Common components of a medication profile include all of the following, EXCEPT: A) pregnancy risk factors. B) the weight of the drug. C) potential incompatibility. D) mechanism of action.

Ans: B Page: 426

16. The paramedic should be MOST suspicious that a controlled substance has been tampered with if: A) repeated doses of the same drug are administered and the patient experiences an adverse reaction. B) an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely. C) the box that the drug is stored in is torn, even if the drug cartridge itself is structurally intact. D) there are any stray markings on the drug cartridge or vial, even if the contents are not discolored.

Ans: B Page: 427

18. Newer medications are designed to target only specific receptor sites on certain cells in an attempt to: A) treat more than one condition. B) minimize the adverse effects. C) reduce their therapeutic effect. D) eliminate all side effects.

Ans: B Page: 428

19. A medication that initiates or alters a cellular activity by attaching to receptor sites and prompting a cell response is said to be: A) synergistic. B) an agonist. C) an antagonist. D) a competitive binder.

Ans: B Page: 428

22. The ability of a medication to initiate or alter cell activity in a therapeutic or desired manner is referred to as: A) potency. B) efficacy. C) affinity. D) the threshold level.

Ans: B Page: 428

30. In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist.

Ans: B Page: 428-429

23. Stimulation of alpha-1 receptors results in: A) insulin secretion. B) vasoconstriction. C) arterial dilation. D) glucagon secretion.

Ans: B Page: 429

26. Stimulation of beta-2 receptors will cause: A) bronchoconstriction. B) the airway diameter to dilate. C) vasoconstriction and hypertension. D) a decreased release of norepinephrine.

Ans: B Page: 429

28. When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) _____________ effect. A) inotropic B) dromotropic C) chronotropic D) alpha agonistic

Ans: B Page: 429

33. The ideal body weight for a woman who is 5 ft 5 in tall is: A) 52 kg. B) 57 kg. C) 62 kg. D) 66 kg.

Ans: B Page: 431

34. Patients with primary pulmonary hypertension may experience acute decompensation if they are given a: A) salicylate. B) vasopressor. C) diuretic. D) bronchodilator.

Ans: B Page: 431

36. During a study, a patient experiences measurable clinical improvement or unexplained adverse effects after receiving a medication with no pharmacologic properties. This is referred to as: A) an idiosyncrasy. B) the placebo effect. C) an untoward effect. D) the therapeutic ratio.

Ans: B Page: 432

42. Which of the following conditions would make a patient the MOST susceptible to an adverse effect from a medication? A) Hypertension B) Renal failure C) Minor trauma D) Chronic pain

Ans: B Page: 434

47. Patients who are genetically predisposed to an immune-mediated medication response: A) typically have a history of more than one autoimmune disorder. B) had an initial exposure and sensitization to a particular antigen. C) should be given an antihistamine before receiving the medication. D) will experience a minor reaction that is generally limited to hives.

Ans: B Page: 434-435

48. Which of the following medications MOST often causes an immune-mediated medication response? A) Ibuprofen B) Penicillin C) Fentanyl D) Atropine

Ans: B Page: 435

75. Which of the following statements regarding plasma-protein binding is correct? A) Plasma-protein binding is an irreversible process that decreases the amount of medication necessary for a desired clinical effect. B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action. C) If a patient has a safe level of a protein-bound medication, a second medication with a greater affinity greatly decreases the amount of the original medication. D) As plasma protein levels decrease, the introduction of another protein-bound medication causes the concentration of the original medication to remain unchanged.

Ans: B Page: 441-442

80. Which of the following describes first-order elimination? A) The more of a substance that is in the plasma, the less the body works to eliminate it. B) The rate of elimination is directly influenced by the plasma levels of the substance. C) A fixed amount of a substance is removed, regardless of the total amount in the body. D) Biotransformation in the liver converts a substance to an active or inactive metabolite.

Ans: B Page: 442

82. The paramedic can avoid technical errors in medication administration by: A) using a current, reliable medication reference source before administering the medication. B) having a partner confirm the volume in a syringe or a weight-based medication calculation. C) contacting medical control and confirming that the proposed dose is appropriate for the patient. D) evaluating a patient for medication allergies or hypersensitivity before administering the medication.

Ans: B Page: 443

84. A(n) __________________ agent is used to increase the pH of the serum or urine? A) antacid B) alkalinizing C) anticoagulant D) antihistamine

Ans: B Page: 445

90. Succinylcholine should not be used in patients with: A) a closed head injury. B) known hyperkalemia. C) a rapid heart rate. D) suspected hypokalemia.

Ans: B Page: 448

89. Neuromuscular blocking agents achieve chemical paralysis by: A) agonizing muscarinic receptor sites and increasing acetylcholine production. B) binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine. C) inhibiting cerebellar activity, thereby decreasing voluntary muscle movement. D) blocking the action of the sodium-potassium pump, causing muscle paralysis.

Ans: B Page: 448-449

94. The desired clinical effect after administering a beta-2 agonist medication is: A) dilation of the systemic vasculature. B) relaxation of bronchiole smooth muscle. C) increased cardiac contractility D) contraction of vascular smooth muscle.

Ans: B Page: 449

100. Lidocaine is an antidysrhythmic that works by: A) antagonizing beta-adrenergic receptors in the myocardium. B) blocking sodium channels in the Purkinje fibers and ventricle. C) displacing calcium at certain receptor sites in the myocardium. D) increasing the duration of phases 1, 2, and 3 of the cardiac cycle.

Ans: B Page: 451

101. Beta blockers should be used with extreme caution in patients with reactive airway because: A) beta-1 receptor antagonism will result in profound bronchoconstriction. B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm. C) there are no beta-blockers that selectively target beta-1 receptors only. D) they inhibit catecholamine release, potentially causing bronchoconstriction.

Ans: B Page: 451

106. In general, alpha-adrenergic receptor antagonists: A) decrease the heart rate. B) lower the blood pressure. C) are used for hypotension. D) increase vascular resistance.

Ans: B Page: 452

108. Stimulation of alpha-2 receptors: A) constricts the vascular smooth muscle. B) suppresses the release of norepinephrine. C) causes profound systemic hypertension. D) increases the release of norepinephrine.

Ans: B Page: 452

109. ACE inhibitor medications lower blood pressure by: A) selectively binding to alpha-1 and alpha-2 receptors. B) blocking the conversion of angiotensin I to angiotensin II. C) increasing cardiac afterload and reducing cardiac output. D) blocking the release of angiotensin I from the renal system.

Ans: B Page: 452

114. Massive doses of atropine may be required when: A) a patient strains to defecate and stimulates muscarinic-2 receptors. B) acetylcholine increases dramatically due to acetylcholinesterase inhibition. C) severe bradycardia is the result of a block in the cardiac conduction system. D) a patient's heart rate significantly increases and lowers the cardiac output.

Ans: B Page: 453

116. All of the following are endogenous catecholamines, EXCEPT: A) dopamine. B) atropine. C) epinephrine. D) norepinephrine.

Ans: B Page: 453

121. Dopamine is commonly used in the prehospital setting as the primary medication for: A) right-sided heart failure. B) nonhypovolemic hypotension. C) severe intracranial hemorrhage. D) vagal-induced bradycardia.

Ans: B Page: 454

123. The primary physiologic effect of dobutamine is: A) increased afterload. B) increased inotropy. C) profound vasoconstriction. D) increased chronotropy.

Ans: B Page: 454

126. The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include: A) increased myocardial oxygen consumption. B) decreased preload and coronary vasodilation. C) coronary vasoconstriction and increased preload. D) increased afterload and peripheral vasodilation.

Ans: B Page: 454

128. What type of medication is used to eliminate certain toxins from the body? A) Inotrope B) Diuretic C) Vasopressor D) Vasodilator

Ans: B Page: 455

133. A unit of packed red blood cells contains approximately _____ to _____ mL of concentrated red blood cells. A) 125, 200 B) 225, 250 C) 250, 500 D) 500, 725

Ans: B Page: 456

138. What is the mechanism of action of anticoagulant medications? A) They dissolve existing clots, thereby restoring distal blood flow. B) They prevent new clot formation and the growth of existing clots. C) They inhibit platelet aggregation during acute coronary syndrome. D) They promote hemostasis in patients with pulmonary emboli.

Ans: B Page: 457

139. When is aspirin indicated for the treatment of a stroke? A) Within the first 15 minutes after the onset of symptoms B) Only after an intracranial hemorrhage has been ruled out C) Only if the patient is prescribed antiplatelet medications D) Immediately upon arrival at the emergency department

Ans: B Page: 457

41. A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution: A) may cause the cells to expand and rupture due to the increased intracellular osmotic pressure exerted by the solution. B) has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. C) contains high concentrations of proteins and can result in fluid overloading in patients with impaired cardiac function or renal insufficiency. D) has a lower ionic concentration than serum and pulls fluid and electrolytes from the intravascular compartment into the intracellular and interstitial compartments.

Ans: B Page: 479

47. Which of the following statements regarding synthetic blood substitutes is correct? A) Type O-negative blood is a synthetic blood substitute. B) They have the ability to carry oxygen to the body's cells. C) They do not possess the ability to carry and deliver oxygen. D) Hespan is the most commonly used synthetic blood substitute.

Ans: B Page: 479

48. The use of O-negative blood in the prehospital setting is impractical because: A) it expires in 24 hours. B) it requires refrigeration. C) not everyone can receive O-negative blood. D) the blood cannot be typed and cross-matched.

Ans: B Page: 479

53. Once an IV solution is removed from its protective sterile plastic bag, it must be used: A) immediately. B) within 24 hours. C) within 36 hours. D) within 48 hours.

Ans: B Page: 479

55. A microdrip administration set: A) allows 10 or 15 drops per milliliter. B) delivers 1 mL for every 60 drops. C) should be used when patients need fluid replacement. D) does not contain a needlelike orifice in its drip chamber.

Ans: B Page: 480

172. You are transporting a 1-year-old child with moderate dehydration. Your estimated time of arrival at the hospital is 45 minutes. When administering an isotonic crystalloid solution to this child, you should: A) deliver the crystalloid fluid boluses with blood tubing and frequently ausculate the child's breath sounds. B) use a Volutrol administration set and fill the calibrated drip chamber with a precalculated volume of fluid. C) give 30 mL/kg crystalloid fluid boluses through a microdrip administration set until the child's condition improves. D) set the IV flow rate to KVO but be prepared to infuse 10 mL/kg boluses if the child's condition deteriorates.

Ans: B Page: 482

60. When selecting a vein for cannulation, you should avoid areas of the vein that: A) are straight. B) pass over joints. C) are firm and springy. D) appear to be straight.

Ans: B Page: 482

65. In contrast to butterfly catheters, over-the-needle catheters: A) are more likely to rupture the vein due to excessive movement of the patient. B) allow for greater patient movement without the need to immobilize the entire limb. C) are more difficult to insert and are more cumbersome to secure in place effectively. D) may cause blood cell damage when drawing blood through the Teflon catheter.

Ans: B Page: 483

66. Through which of the following over-the-needle catheters can you infuse the greatest amount of fluid over the shortest period of time? A) 16 gauge, 1 ¼ B) 14 gauge, 1 ¼ C) 18 gauge, 2 ¼ D) 14 gauge, 2 ¼

Ans: B Page: 483

71. After attaching the prepared IV line to the hub of the IV catheter and removing the constricting band, you should: A) set the IV flow rate to keep the vein open (KVO). B) open the IV line and observe for swelling or infiltration. C) apply a sterile gauze pad directly over the venipuncture site. D) secure the catheter and tubing in place with a commercial device.

Ans: B Page: 487, 489

74. The first step in discontinuing an IV line is to: A) stabilize the catheter as you remove the tape. B) shut off the flow of fluid with the roller clamp. C) remove the tubing from the hub of the catheter. D) ensure that all of the fluid has been administered.

Ans: B Page: 490

76. Prior to cannulating an external jugular vein, it is MOST important to: A) cleanse the puncture site. B) palpate for the carotid pulse. C) turn the patient's head to the side. D) occlude the vein distal to the puncture site.

Ans: B Page: 490

177. Shortly after establishing an IV line of normal saline, your patient complains of a burning sensation along the course of the vein. You should: A) increase the IV flow rate until the patient expresses relief. B) observe the patient for signs and symptoms of an allergic reaction. C) inject 10 mL of lidocaine into the IV line to provide pain relief. D) immediately discontinue the IV and reestablish it in another location.

Ans: B Page: 493

81. When determining whether an occluded IV line should be reestablished, you should: A) attempt to improve the IV flow rate by applying a pressure infuser device around the IV bag. B) infuse 10 mL of normal saline through the injection port to attempt to disrupt the occlusion. C) lower the IV bag below the level of the patient's heart and observe for blood return in the IV tubing. D) apply manual pressure to the IV bag while observing for a sudden increase in the IV flow rate.

Ans: B Page: 493

82. Vein irritation during IV therapy is usually caused by: A) the formation of a thrombus. B) an infusion rate that is too rapid. C) contaminants in the IV solution. D) IV solutions that are not warmed.

Ans: B Page: 493

88. Pyrogenic reactions can be largely avoided by: A) determining if the patient has any allergies. B) inspecting the IV solution carefully before use. C) premedicating the patient with 1 gram of acetaminophen. D) keeping the piercing spike sterile after it is exposed.

Ans: B Page: 495

89. The MOST common cause of circulatory overload in the prehospital setting is: A) overestimating the patient's baseline hydration level and giving too much IV fluid. B) failure to readjust the drip rate after flushing the IV line immediately after insertion. C) not using a Volutrol administration set when administering IV fluids to the elderly. D) administering excessive crystalloid solutions to patients with hypovolemic shock.

Ans: B Page: 495

93. The signs and symptoms that occur when an IV catheter is sheared and becomes a free-floating segment in the circulatory system MOST closely resemble: A) pneumothorax. B) an air embolus. C) left-sided heart failure. D) right-sided heart failure.

Ans: B Page: 495

49. Decreased efficacy or potency of a medication when taken repeatedly by a patient is called: A) addiction. B) immunity. C) tolerance. D) habituation.

Ans: C Page: 435

46. If a patient's family member is hostile and begins shouting at you, you should: A) remain professional and ignore the family member so that you can provide appropriate patient care. B) tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement. C) have your partner physically remove the family member from the patient care area and continue your assessment. D) firmly tell the patient that his or her behavior is unacceptable and childish, and that he or she is worsening the situation.

Ans: B Page: 620

51. If your patient becomes seductive or makes sexual advances toward you, you should advise the patient that your relationship with him or her is strictly professional and then: A) continue providing care as usual. B) ensure that a witness is present at all times. C) ask your partner to assume care of the patient. D) threaten the patient with a sexual harassment lawsuit.

Ans: B Page: 621

53. When caring for a patient who is mentally challenged: A) it is highly unlikely that you will obtain a reliable medical history. B) you may have to obtain the medical history from a family member. C) your priority should be to transport the patient to a psychiatric facility. D) you should speak to the patient as though he or she is younger in age.

Ans: B Page: 621

54. When your patient is a non-English-speaking person, his or her child is often able to function as an interpreter because: A) you can usually teach a child English quickly. B) children quickly absorb a new language in school. C) the child is usually not as scared as his or her parent is. D) most children of non-English-speaking parents speak English.

Ans: B Page: 622-623

57. __________ entails gently striking the surface of the body, typically where it overlies various body cavities. A) Palpation B) Percussion C) Inspection D) Auscultation

Ans: B Page: 627

61. To obtain a heart rate in infants younger than 1 year of age, you should: A) apply a cardiac monitor. B) palpate the brachial artery. C) auscultate directly over the heart. D) count the pulse for a full minute.

Ans: B Page: 628

59. The residual pressure in the circulatory system while the left ventricle is relaxing is called the: A) pulse pressure. B) diastolic pressure. C) systolic pressure. D) mean arterial pressure.

Ans: B Page: 629

66. Which of the following statements regarding your general survey of the patient is correct? A) Little information can be gained from the patient without a hands-on assessment. B) It is not uncommon for patients in severe pain to present with a quiet and still affect. C) The environment in which the patient is found is more significant than his or her appearance. D) The general patient survey begins as you perform the initial assessment of the patient.

Ans: B Page: 631

132. Cognitive function can be MOST accurately defined as: A) one's state of awareness. B) the ability to use reasoning. C) functional use of the extremities. D) general level of consciousness.

Ans: B Page: 635

71. Changes in hair growth or loss of hair are LEAST suggestive of: A) diabetes. B) an infection. C) the aging process. D) radiation therapy.

Ans: B Page: 638-639

76. When assessing visual acuity in the prehospital setting, you should: A) use a Snellen chart. B) examine each eye in isolation. C) check both eyes simultaneously. D) remove any corrective lenses the patient is wearing.

Ans: B Page: 641

77. The diameter of a patient's pupils and their reactivity to light provide information about the: A) amount of vitreous humor. B) status of cerebral perfusion. C) intactness of the first cranial nerve. D) level of carbon dioxide in the brain.

Ans: B Page: 641

82. Swollen lymph nodes in the anterior neck usually indicate: A) malignancy. B) an infection. C) viral replication. D) an allergic state.

Ans: B Page: 647

167. When assessing a trauma patient's chest, you should remember that: A) the presence of hyporesonance to percussion is an indicator of air trapping in the pleural space. B) paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms. C) breath sounds should be assessed routinely in at least two fields prior to visual or tactile assessment. D) a structurally non-intact chest wall should be stabilized by circumferentially wrapping the chest with bandages.

Ans: B Page: 649

149. The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT: A) heart failure. B) bronchospasm. C) toxic inhalation. D) pulmonary edema.

Ans: B Page: 650-651

148. The presence of rhonchi during auscultation of the lungs is MOST suggestive of: A) asthma. B) pneumonia. C) pneumothorax. D) toxic inhalation.

Ans: B Page: 651

84. Percussion of the chest produces ____________ if the pleural space is full of blood. A) a hollow sound B) a dull sound C) a high-pitched note D) hyperresonance

Ans: B Page: 651

85. You would NOT expect to encounter decreased breath sounds in a patient with: A) opiate intoxication. B) cardiac tamponade. C) status asthmaticus. D) pulmonary edema.

Ans: B Page: 651

90. To appreciate the S1 sound: A) the patient should be sitting upright and leaning slightly backward. B) ask the patient to breathe normally and hold his or her breath on expiration. C) the patient should be supine with his or her body tilted to the right. D) ask the patient to breathe normally and hold his or her breath on inhalation.

Ans: B Page: 654-655

163. What are Korotkoff sounds? A) Abnormal sounds heard over the carotid arteries B) The sounds heard when taking a blood pressure C) Sounds that indicate a significant heart murmur D) Sounds over an artery that indicate turbulent blood flow

Ans: B Page: 656

91. Arterial pulses are a physical expression of: A) pressure in the vena cavae. B) left ventricular contraction. C) the diastolic blood pressure. D) right ventricular contraction.

Ans: B Page: 656

The nasal cavity: A) contains two bony shelves known as turbinates. B) is extremely delicate and has a rich blood supply. C) requires significant trauma to result in hemorrhage. D) is separated by a septum that is midline in all people.

Ans: B Page: 713

152. A patient is generally considered to have orthostatic vital signs when: A) the systolic BP increases and the diastolic BP decreases when going from a lying to a sitting position. B) the heart rate increases by 20 beats/min or more when going from a supine to a standing position. C) the respiratory rate becomes fast and the depth becomes shallow when he or she suddenly stands up. D) he or she experiences chest pain and a rapid, irregular heart rate when going from a seated to a standing position.

Ans: B Page: 658

169. Bruising in the periumbilical area is indicative of: A) a leaking aortic aneurysm. B) intraperitoneal hemorrhage. C) ruptured ectopic pregnancy. D) a ruptured urinary bladder.

Ans: B Page: 660

96. What part of the abdominal exam is of LEAST value in the prehospital setting? A) Percussion B) Auscultation C) Inspection D) Palpation

Ans: B Page: 660

97. Abdominal guarding is MOST commonly encountered in patients with: A) acute renal failure. B) peritoneal irritation. C) intra-abdominal bleeding. D) chronic liver inflammation.

Ans: B Page: 660

103. The diagnosis of a problem involving the shoulder can often be made by simply: A) assessing range of motion. B) noting the patient's posture. C) palpating for gross deformities. D) asking the patient to bend the elbow.

Ans: B Page: 663

102. Structural integrity of the pelvis should be assessed by: A) carefully rocking the pelvis back and forth. B) gently pushing in and down on the iliac crests. C) applying firm upward pressure to the pelvic wings. D) placing the patient on his or her side to elicit pain.

Ans: B Page: 663-664

109. An inward curve of the lumbar spine just above the buttocks is called: A) scoliosis. B) lordosis. C) kyphosis. D) sclerosis.

Ans: B Page: 669

114. The vestibulocochlear nerve is responsible for the functions of: A) facial and eye movements. B) hearing and balance perception. C) swallowing and gland secretion. D) tongue and neck movements.

Ans: B Page: 672

112. If a patient is able to sense smell, his or her __________ nerve is intact. A) abducens B) olfactory C) trigeminal D) trochlear

Ans: B Page: 672, 675

118. When scoring a patient's deep tendon reflexes, normally active reflexes would be assigned a score of: A) 1+. B) 2+. C) 3+. D) 4+.

Ans: B Page: 677

123. Documentation of your physical examination should be: A) subjective in all regards. B) factual and nonjudgmental. C) representative of your perceptions. D) reviewed by the EMS administrator.

Ans: B Page: 679

173. Which of the following reassessment findings is MOST significant in a patient with penetrating chest trauma? A) Loud heart tones to auscultation B) Blood pressure of 90/76 mm Hg C) Symmetrical chest rise and fall D) Heart rate of 78 beats per minute

Ans: B Page: 685-686

1. After gathering information from the patient, scene, and any bystanders, you must next: A) formulate a care plan based on the information. B) determine which information is valid and which may be invalid. C) synthesize the information to form a thought process. D) determine the most likely cause of the patient's problem.

Ans: B Page: 695

6. If a patient's clinical presentation is not addressed in a specific algorithm, the paramedic must: A) focus exclusively on the patient's ABCs. B) determine what is in the patient's best interest. C) perform a comprehensive head-to-toe exam. D) provide supportive care and transport promptly.

Ans: B Page: 696

10. Once you determine that your patient is sick, you must next: A) provide aggressive care. B) quantify how sick he or she is. C) contact online medical control. D) transport him or her immediately.

Ans: B Page: 698

12. In EMS, the process of concept formation involves: A) determining the validity of obtained data. B) gathering information about your patient. C) knowing which treatment algorithm to use. D) interpreting a patient's signs and symptoms.

Ans: B Page: 698

18. The MOST effective way for the paramedic to avoid tunnel vision is to: A) perform a secondary assessment on every patient he or she encounters. B) keep an open mind to all of the possible causes of the patient's problem. C) reassess all patients at least every 15 minutes until patient care is transferred. D) possess a detailed knowledge of anatomy, physiology, and pathophysiology.

Ans: B Page: 700

19. _______________ occurs after a call is over and commonly is associated with the run review or critique. A) Reflection in action B) Reflection on action C) Data interpretation D) Application of principle

Ans: B Page: 700-701

24. When reading the scene, the paramedic must remember that: A) noting the mechanism of injury is the first element to evaluate. B) scene information becomes unavailable once transport is initiated. C) safety issues must be addressed while you are caring for the patient. D) bystanders are a reliable source of information regarding an incident.

Ans: B Page: 702

27. When you introduce yourself to your patient and ask why 9-1-1 was called, the patient looks at you, shakes your hand, and answers your questions appropriately. From these findings, you can gather that the patient: A) has not experienced a traumatic injury. B) has a Glasgow Coma Scale score of 15. C) will likely not require medication therapy. D) does not have a life-threatening condition.

Ans: B Page: 702-703

29. When caring for a critically ill patient, three or more sets of vital signs will allow you to: A) determine how fast the patient's condition is deteriorating and whether cardiac arrest is imminent. B) assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse. C) quantify that the patient's condition is stabilizing, even if he or she has an altered level of consciousness. D) determine what body system is in dysfunction, which will further facilitate the provision of specific care.

Ans: B Page: 703

33. No matter how sure he or she is of the working diagnosis, the thinking paramedic must: A) confer with online medical control to confirm his or her diagnosis. B) always keep part of the thought process open to other possibilities. C) implement a treatment plan based solely on the working diagnosis. D) remain confident that his or her working diagnosis is an accurate one.

Ans: B Page: 703

Paramedics must use extreme caution when accessing the airway via the cricothyroid membrane because: A) the cricothyroid membrane is highly vascular and tends to bleed profusely when it is incised. B) the cricothyroid membrane is bordered laterally and inferiorly by the highly vascular thyroid gland. C) cricothyrotomy is associated with a high incidence of inadvertent laceration of a carotid artery. D) the thyroid cartilage is smaller than the cricoid cartilage and makes the cricothyroid membrane difficult to locate.

Ans: B Page: 715

Atelectasis occurs when: A) the alveoli are overinflated and rupture. B) a deficiency of surfactant causes alveolar collapse. C) deoxygenated blood diffuses across the alveoli. D) surface tension on the alveolar walls is decreased.

Ans: B Page: 716

Laryngospasm is defined as: A) aspiration of foreign material. B) spasmodic closure of the vocal cords. C) voluntary closure of the glottic opening. D) spontaneous collapsing of the trachea.

Ans: B Page: 716

Negative-pressure ventilation occurs when: A) the diaphragm ascends and the intercostal muscles retract. B) air is drawn into the lungs when intrathoracic pressure decreases. C) pressure within the chest decreases and air is forced from the lungs. D) the phrenic nerves stop sending messages to the diaphragm.

Ans: B Page: 718-719

What is the alveolar minute volume of a patient with a respiratory rate of 12 breaths/min, a tidal volume of 450 mL, and a dead space volume of 135 mL? A) 3,650 mL B) 3,780 mL C) 4,260 mL D) 5,400 mL

Ans: B Page: 719-720

259. Which of the following patients has the lowest minute volume? A) Tidal volume of 400 mL; respiratory rate of 14 breaths/min B) Tidal volume of 350 mL; respiratory rate of 12 breaths/min C) Tidal volume of 400 mL; respiratory rate of 24 breaths/min D) Tidal volume of 300 mL; respiratory rate of 16 breaths/min

Ans: B Page: 720

When a patient's respirations are too rapid and too shallow: A) the majority of inhaled air lingers in areas of physiologic dead space. B) inhaled air may only reach the anatomic dead space before being exhaled. C) the increase in tidal volume will compensate for a rapid respiratory rate. D) minute volume increases because a larger amount of air reaches the lungs.

Ans: B Page: 720

Changes in the rate and depth of breathing are regulated primarily by the: A) pH of venous blood. B) pH of the CSF. C) saturation of oxygen and hemoglobin. D) amount of oxygen in the blood plasma.

Ans: B Page: 720-721

Chemoreceptors located in the carotid bodies and aortic arch sense minute changes in the ____________ and send signals to the respiratory centers via the ___________ nerves. A) Pao2 vagus and intercostal B) PACO2, glossopharyngeal and vagus C) PaCO2, phrenic and glossopharyngeal D) PaO2, hypoglossal, vagus, and intercostal

Ans: B Page: 721

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the: A) PaO, level falls quickly. B) pH of the CSF decreases. C) PACO, decreases slowly. D) pH of the CSF increases.

Ans: B Page: 721

Oxygen that is dissolved in the blood plasma: A) can be measured with a pulse oximeter. B) makes up the partial pressure of oxygen. C) is quickly absorbed by bicarbonate ions. D) cannot participate in pulmonary respiration.

Ans: B Page: 721-722

The exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries is called: A) internal respiration. B) external respiration. C) pulmonary ventilation. D) intrapulmonary shunting.

Ans: B Page: 723

50. The condition in which the body's tissues and cells do not receive enough oxygen is called: A) anoxia. В) hуpоxia C) asphyxia. D) hypoxemia.

Ans: B Page: 725

48. Normally, an adult at rest should have respirations that: A) are 20 to 24 breaths/min with adequate chest rise. B) follow a regular pattern of inhalation and exhalation. C) have a slightly reduced tidal volume and normal rate. D) are adequate to sustain a heart rate of 80 beats/min.

Ans: B Page: 729

53. Asymmetric chest wall movement is characterized by: A) chest rise that is minimally visible. B) one side of the chest moving less than the other. C) alternating movement of the chest and abdomen. D) a part of the chest wall that bulges during exhalation.

Ans: B Page: 729

58. A patient with a suppressed cough mechanism: A) should be intubated at once. B) is at serious risk for aspiration. C) often requires ventilation support. D) will have a positive eyelash reflex.

Ans: B Page: 730

59. Biot respirations are characterized by: A) slow, shallow irregular respirations or occasional gasping breaths. B) an irregular pattern of breathing with intermittent periods of apnea. C) deep, gasping respirations that are often rapid but may be slow. D) increased respirations followed by apneic periods.

Ans: B Page: 731

65. The average peak expiratory flow rate in a healthy adult is approximately: A) 450 mL. B) 550 mL. C) 650 mL. D) 750 mL.

Ans: B Page: 735

66. When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should: A) ask the patient to fully exhale before blowing into the mouthpiece. B) perform the test three times and take the best rate of the three readings. C) administer one bronchodilator treatment before obtaining the first reading. D) ensure that the patient is in a supine position to obtain an accurate reading.

Ans: B Page: 735

142. Typically, ETCO, is approximately: A) 2 to 5 mm Hg higher than the arterial PACO2 B) 2 to 5 mm Hg lower than the arterial PACO2 C) 5 to 10 mm Hg higher than the arterial PACO2 D) 5 to 10 mm Hg lower than the arterial PaCO2

Ans: B Page: 736

143. What point(s) on the capnographic waveform represent(s) a mixture of alveolar gas and dead space gas? A) A-B В) В С) В-С D) D

Ans: B Page: 736

144. What phase of the capnographic waveform is called the expiratory upslope? A) A-B В) В-С C) С-D D) D-E

Ans: B Page: 736

52. The physical, emotional, or behavioral need for a medication in order to maintain a certain level of "normal" function is called: A) withdrawal. B) synergism. C) dependence. D) habituation.

Ans: C Page: 436

271. A 19-year-old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The MOST appropriate airway management for this patient involves: A) inserting an oral airway and assisting ventilations with a bag-mask device. B) inserting a nasal airway and assisting ventilations with a bag-mask device. C) inserting an oral airway and administering oxygen via nonrebreathing mask. D) suctioning her airway, inserting an oral airway, and administering 100% oxygen.

Ans: B Page: 746, 756

72. Which of the following conditions would MOST likely cause laryngeal spasm and edema? A) Croup B) Inhalation injury C) Viral pharyngitis D) Mild asthma attack

Ans: B Page: 748

266. A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival, you note that she is conscious, coughing, and wheezing between coughs. Further assessment reveals that her skin is pink and moist. In addition to transporting her to the hospital, you should: A) perform abdominal thrusts until she becomes unconscious. B) encourage her to cough and closely monitor her condition. C) deliver positive-pressure ventilations via bag-mask device. D) look in her mouth and attempt to visualize a foreign body.

Ans: B Page: 748-749

54. When ventilating a patient with a bag-mask device, you note increased compliance. This means that: A) you are meeting resistance when ventilating. B) air can be forced into the lungs with relative ease. C) a lower airway obstruction should be suspected. D) the patient likely has an upper airway obstruction.

Ans: B Page: 749

74. Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by: A) sweeping the patient's mouth with your fingers. B) reopening the airway and reattempting to ventilate. C) performing 30 chest compressions and reassessing. D) administering 15 subdiaphragmatic thrusts at once.

Ans: B Page: 749

84. A full (2,000 psi) D cylinder will last approximately ___________ minutes if you are administering oxygen at 12 L/min. A) 22 B) 24 C) 26 D) 28

Ans: B Page: 751

88. The nasal cannula is of MOST benefit to patients: A) who require high oxygen concentrations. B) with mild hypoxemia and claustrophobia. C) with an acute exacerbation of emphysema. D) who are hypoxic and are mouth-breathers.

Ans: B Page: 754

90. Oxygen that is entirely devoid of moisture: A) is less combustible than humidified oxygen. B) will dry the patient's mucous membranes quickly. C) is optimum for patients requiring long-term oxygen. D) should be given in conjunction with bronchodilators.

Ans: B Page: 756

94. Hyperventilating an apneic patient: A) is appropriate if the patient is an adult. B) may decrease venous return to the heart. C) is beneficial if the pulse rate is too slow. D) reduces the incidence of gastric distention.

Ans: B Page: 756-757, 759

97. An 8-year-old child in cardiac arrest has been intubated. When ventilating the child, the paramedic should: A) observe for full chest expansion. B) deliver 8 to 10 breaths per minute. C) allow partial exhalation between breaths. D) deliver one breath every 15 seconds.

Ans: B Page: 759

101. The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with all of the following conditions, EXCEPT: A) airway obstruction. B) prolonged apnea. C) poor lung compliance. D) increased airway resistance.

Ans: B Page: 762

104. Indications for CPAP include: A) cardiopulmonary arrest. B) acute pulmonary edema. C) severe opiate toxicity. D) acute bacterial pneumonia.

Ans: B Page: 763

105. CPAP is NOT appropriate for patients with: A) acute or chronic bronchospasm. B) slow, shallow respiratory effort C) an oxygen saturation less than 90%. D) evidence of congestive heart failure.

Ans: B Page: 763

110. Which of the following is NOT proper procedure when inserting a nasogastric tube in a responsive patient? A) Administering a topical alpha agonist to constrict the nasal vasculature B) Keeping the patient's head in an extended position while inserting the tube C) Injecting 40 mL of air into the tube while auscultating over the epigastrium D) Encouraging the patient to swallow or drink to facilitate passage of the tube

Ans: B Page: 766-768

245. Patients with a partial laryngectomy: A) have had their entire larynx removed and breathe through an opening in the neck called a stoma. B) are called partial neck breathers because they breathe through both a stoma and the nose and mouth. C) are easy to differentiate from patients who have had a total laryngectomy, especially when they are apneic. D) cannot be ventilated with the mouth-to-mask technique because there is no connection between the pharynx and lower airway.

Ans: B Page: 770

246. Patients with laryngectomies MOST commonly develop mucous plugs in their stoma because: A) they are at higher risk for pneumonia. B) they do not possess an efficient cough. C) the diameter of the stoma is small. D) their swallowing mechanism is suppressed.

Ans: B Page: 770

249. Whether you are providing ventilations to a patient with a stoma using a resuscitation mask or bag-mask device, you must FIRST: A) perform a head tilt-chin lift maneuver. B) place the patient's head in a neutral position. C) adequately cleanse the stoma site with iodine. D) suction the stoma for no longer than 10 seconds.

Ans: B Page: 770, 772-773

251. When replacing a dislodged tracheostomy tube, it is MOST important that you: A) insert the tube 2 cm beyond the cuff. B) take appropriate standard precautions. C) lubricate the tube before insertion. D) use a tracheostomy tube of the same size.

Ans: B Page: 771, 774

176. The MOST obvious risk associated with extubation is: A) moderate airway swelling as the ET tube is removed. B) overestimating the patient's ability to protect his or her own airway. C) patient retching and gagging as you remove the ET tube. D) stimulation of the parasympathetic nervous system with resulting bradycardia.

Ans: B Page: 803

13. What instructions or guidance would an emergency medical dispatcher MOST likely provide to a caller? A) How to properly use a bag-mask device B) How to obtain a blood pressure by palpation C) How to control bleeding and perform CPR D) How to administer prescribed antihypertensives

Ans: C Page: 11 Type: General Knowledge

A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves: A) vigorously suctioning her oropharynx for no longer than 15 seconds and then inserting a multilumen airway device. B) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway. C) suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present. D) providing positive-pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy.

Ans: B Page: 773

128. Intubation of the trauma patient is MOST effectively performed: A) with a curved blade. B) by two paramedics. C) with a cervical collar in place. D) with the patient's head elevated.

Ans: B Page: 773, 780

255. If the distance between the hyoid bone and the thyroid notch is at least ________ cm wide, the difficulty of intubation should be low. A) 1 B) 2 C) 3 D) 4

Ans: B Page: 775

116. A disadvantage of ET intubation is that it: A) is associated with a high incidence of vocal cord damage and bleeding into the oropharynx. B) bypasses the upper airway's physiologic functions of warming, filtering, and humidifying. C) does not eliminate the incidence of gastric distention and can result in pulmonary aspiration. D) is only a temporary method of securing the patient's airway until a more definitive device can be inserted

Ans: B Page: 776

117. Murphy's eye, an opening on the distal side of an ET tube, allows ventilation to оссur: A) whether the tube is in the trachea or in the esophagus. B) even if the tip of the tube is occluded by blood or mucus. C) if the tube is inserted into the right mainstem bronchus. D) even if the ET tube does not enter the patient's trachea fully.

Ans: B Page: 776

122. In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designed to: A) move the patient's tongue to the left. B) extend beneath the epiglottis and lift it up. C) fit into the vallecular space at the base of the tongue. D) indirectly lift the epiglottis to expose the vocal cords.

Ans: B Page: 777-778

124. Which of the following statements regarding orotracheal intubation is correct? A) Orotracheal intubation should be performed on any patient who is apneic. B) Orotracheal intubation is the most common method of performing ET intubation. C) You cannot perform orotracheal intubation on patients who are breathing. D) Orotracheal intubation is most commonly performed without a laryngoscope.

Ans: B Page: 778

126. Most of the complications caused by intubation-induced hypoxia: A) are easily reversible. B) are subtle and occur gradually. C) can be predicted with pulse oximetry. D) are dramatic and occur immediately.

Ans: B Page: 780

133. The BEST way to be certain that the ET tube has passed through the vocal cords is to: A) feel the ridges of the tracheal wall with the ET tube. B) visualize the tube passing between the vocal cords. C) note the appropriate color change of the capnographer. D) ensure the presence of bilaterally equal breath sounds.

Ans: B Page: 783-784

138. Decreased ventilation compliance following intubation is LEAST suggestive of: A) gastric distention. B) left bronchus intubation. C) esophageal intubation. D) tension pneumothorax.

Ans: B Page: 784

276. After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should: A) slightly withdraw the tube as your partner auscultates breath sounds. B) suspect that the patient has a pneumothorax on the right side of the chest. C) immediately remove the ET tube and oxygenate the patient for 30 seconds. D) increase the force of your ventilations as your partner reauscultates the lungs.

Ans: B Page: 784

149. If using a bulb-style esophageal detector device to assist you in confirming proper ET tube placement, you should expect the bulb to: A) inflate slowly when you let go of it. B) refill briskly if the tube is in the trachea. C) stay collapsed if the tube is in the trachea. D) expand quickly if the tube is in the esophagus.

Ans: B Page: 784-785

278. You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should: A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once. B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation. C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once. D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.

Ans: B Page: 786

153. Which of the following is NOT a contraindication for nasotracheal intubation? A) Apnea B) Spinal injury C) Frequent use of cocaine D) Patients taking an anticoagulant

Ans: B Page: 786, 788

158. When nasally intubating a patient, the ET tube is advanced: A) as the patient exhales. B) when the patient inhales. C) when the patient swallows. D) in between the patient's breaths.

Ans: B Page: 789

162. Digital intubation is absolutely contraindicated if the patient: A) has copious airway secretions. B) is unconscious but breathing. C) is trapped in a confined space. D) is extremely obese or has a short neck.

Ans: B Page: 792

169. Which of the following represents the MOST correct technique for performing transillumination-guided intubation? A) Place the patient's head in a hyperflexed position and insert the tube-stylet combination into the left side of the mouth. B) Grasp the lower jaw with your thumb and forefinger, displace it forward, and insert the tube-stylet combination in the midline of the patient's mouth. C) Hyperextend the patient's head, pull the jaw down, and insert the tube-stylet combination into the right side of the patient's mouth. D) Place the patient's head in a neutral position, displace the tongue with a tongue blade, and insert the tube-stylet combination in the midline of the mouth.

Ans: B Page: 798-799

211. If used properly, and under the correct circumstances, sedation during airway management: A) chemically paralyzes the patient, thus facilitating placement of an advanced airway device. B) effectively increases patient compliance, thus making definitive airway management safer to perform. C) significantly reduces the pain and discomfort associated with laryngoscopy and ET intubation. D) minimizes the risks of bradycardia and hypotension that occasionally occur during advanced airway management.

Ans: B Page: 810

215. Diazepam and midazolam provide all of the following therapeutic effects, EXCEPT: A) sedation. B) analgesia. C) anxiolysis. D) retrograde amnesia.

Ans: B Page: 810-811

217. Neuromuscular blocking agents: A) are most commonly used as the sole agent to facilitate placement of an ET tube. B) convert a breathing patient with a marginal airway into an apneic patient with no airway. C) induce total body paralysis within 10 to 15 minutes following administration via IV push. D) have a negative effect on both cardiac and smooth musele and commonly cause dysrhythmias.

Ans: B Page: 811

221. Which of the following is NOT characteristic of a depolarizing neuromuscular blocking agent? A) Bradycardia B) Tachycardia C) Muscle fasciculations D) Short duration of action

Ans: B Page: 812

222. To prevent muscular fasciculations associated with the use of succinylcholine, you should administer: A) 0.5 mg of atropine sulfate via rapid IV push. B) 10% of the usual dose of a nondepolarizing paralytic. C) an infusion of potassium chloride set at 5 mEq per hour. D) 1 to 1.5 mg/kg of lidocaine over 10 to 15 minutes.

Ans: B Page: 812

225. Which of the following medications has been shown to blunt the increase intracranial pressure associated with suctioning and laryngeal stimulation? A) Atropine B) Lidocaine C) Amiodarone D) Furosemide

Ans: B Page: 813

226. If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should: A) stop and hyperventilate the patient at a rate of 24 breaths/min. B) abort the intubation attempt and ventilate with a bag-mask device. C) apply posterior cricoid pressure and continue the intubation attempt. D) continue the intubation attempt and monitor the cardiac rhythm closely.

Ans: B Page: 813

194. The MOST significant complication associated with the use of multilumen airways is: A) laryngospasm or vomiting during insertion of the tube. B) unrecognized displacement of the tube into the esophagus. C) vocal cord damage if the tube inadvertently enters the trachea. D) pharyngeal or esophageal trauma secondary to poor technique.

Ans: B Page: 814

195. In general, a multilumen airway should not be used in patients who are: A) greater than 6 ft tall. B) younger than 16 years of age. C) older than 65 years of age. D) less than 4 ft 5 in tall.

Ans: B Page: 814

284. You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should: A) perform laryngoscopy to visualize placement of the Combitube. B) continue to ventilate and use additional confirmation techniques. C) continue ventilating the patient at a rate of 10 to 12 breaths/min. D) ventilate through the clear tube and auscultate all four lung fields.

Ans: B Page: 815-816

198. The LMA is: A) a suitable airway device for use in morbidly obese patients. B) an alternative to bag-mask ventilation when intubation is not possible. C) associated with a higher risk of damage to the vocal cords than intubation. D) especially effective for CHF patients who require high pulmonary pressures.

Ans: B Page: 817

204. The King LT airway can be used to: A) administer certain cardiac medications directly into the trachea. B) maintain a patent airway in spontaneously breathing patients. C) establish a patent airway in patients of any age and body size. D) suction pulmonary secretions from the tracheobronchial tree.

Ans: B Page: 818, 820

208. Proper placement of the King LT airway is performed by all of the following techniques, EXCEPT: A) auscultation of bilateral breath sounds. B) the esophageal detector device. C) quantitative waveform capnography. D) observation for symmetrical chest rise.

Ans: B Page: 820

210. When correctly placed, the distal tip of the Cobra perilaryngeal airway (CobraPLA): A) enters the esophagus and provides complete obturation. B) is proximal to the esophagus and seals the hypopharynx. C) is in almost perfect alignment with the esophageal opening. D) rests against the arytenoid cartilage and enters the glottis.

Ans: B Page: 821

231. Open cricothyrotomy is generally contraindicated in all of the following situations, EXCEPT: A) tracheal tumors or subglottic stenosis. B) any patient who is younger than 16 years of age. C) crushing laryngeal injuries or tracheal transection. D) inability to identify the correct anatomic landmarks.

Ans: B Page: 825

232. In contrast to a needle cricothyrotomy, an open cricothyrotomy: A) involves the use of a high-pressure jet ventilator. B) enables the paramedic to provide greater tidal volume. C) is the preferred technique in patients with short, fat necks. D) is easier to perform in children younger than 8 years of age.

Ans: B Page: 826

237. Needle cricothyrotomy is contraindicated in patients with: A) uncontrolled oropharyngeal bleeding. B) obstruction above the catheter insertion site. C) massive maxillofacial trauma and trismus. D) a suspected injury to the cervical spine..

Ans: B Page: 828-829

238. Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, _________ and _________ may result. A) hypercarbia, hypoxia B) barotrauma, pneumothorax C) hypoventilation, hypocarbia D) esophageal rupture, hemorrhage

Ans: B Page: 829

115. The major advantage of ET intubation is that it: A) facilitates tracheal suctioning. B) protects the airway from aspiration. C) is an easy skill to learn and perform. D) provides a route for certain medications.

Ans: B Page: 776

40. A drug that possesses the same desired clinical effect in several smaller doses as it does in a larger single dose has demonstrated: A) an idiosyncratic reaction. B) the placebo effect. C) a cumulative action. D) cross-tolerance.

Ans: C

14. If an emergency medical responder is appropriately trained and competent, he or she should be able to: A) detect signs of patient deterioration, obtain baseline vital signs, and give IV fluids to maintain adequate perfusion. B) perform lifesaving interventions and transport the patient after paramedics have performed a detailed physical exam. C) recognize the seriousness of a patient's condition, provide basic life support care, and relay information to the paramedic. D) develop a field diagnosis of the patient's problem, perform limited advanced airway techniques, and update responding paramedics.

Ans: C Page: 11 Type: General Knowledge

18. A major recommendation made by the 2009 EMS Education Standards for paramedic training was the: A) removal of endotracheal intubation from the minimum core content of the training program. B) addition of 750 hours of clinical and field training above and beyond classroom education. C) inclusion of a college-level anatomy and physiology course as part of the training program. D) prerequisite that all paramedic students possess a minimum of an associate's degree.

Ans: C Page: 12 Type: General Knowledge

27. Being empathetic toward a patient means that you: A) reassure the patient of your competence. B) know exactly how the patient feels. C) acknowledge the patient's feelings. D) feel a sense of sorrow for the patient.

Ans: C Page: 16 Type: General Knowledge

4. The equipment and supplies that are carried in the back of an ambulance: A) are dictated by the medical director. B) should follow standard federal guidelines. C) must be stowed safely yet easily accessible. D) should be standardized in every ambulance.

Ans: C Page: 2173

10. Which of the following statements regarding belt noise is correct? A) Belt noise is a low-pitched drone that is synchronous with road speed. B) The noise made from an engine belt is usually harmless and corrects itself. C) Belt noise is a squealing sound related to a load on one of the belt-operated appliances. D) Belt noise is a sign that the engine's alternator or water pump is malfunctioning.

Ans: C Page: 2175

9. When checking the ambulance engine, you note the odor of sewer gas. What should you do? A) Thoroughly clean the battery terminals and cables. B) Open the coolant cap and check the coolant level. C) Close the hood and take the ambulance out of service. D) Start the ambulance and check the voltage on the battery.

Ans: C Page: 2176

15. In a tiered-response EMS system: A) every ALS ambulance that responds has at least three paramedics on board. B) an ambulance with two paramedics makes the initial response to every EMS call. C) an EMS system attempts to assign ALS ambulances only where they are needed. D) a first response vehicle, BLS ambulance, and ALS ambulance respond to every call.

Ans: C Page: 2177

25. The paramedic should NOT operate an emergency vehicle if he or she: A) has worked more than 12 straight hours. B) is a personal acquaintance of the patient. C) is taking a cold remedy or an analgesic. D) just finished an intense exercise regimen.

Ans: C Page: 2180

20. The decision to use lights and siren when transporting a patient to the hospital is MOST dependent upon: A) your EMS system's protocols. B) the number of vehicles on the road. C) judgment on the part of the paramedic. D) the opinion of the receiving physician.

Ans: C Page: 2181

26. An ambulance operator's cushion of safety can be maintained by: A) carefully passing other motorists on the right. B) using the siren only when at an intersection. C) checking for tailgaters behind the ambulance. D) staying at least 10 feet behind other vehicles.

Ans: C Page: 2181

43. As you approach the scene of a car crash, you see two badly damaged vehicles that are off the road to the right. Where should you park the ambulance? A) 100 feet before the crash site on the left side of the road B) 100 feet past the crash site on the left side of the road C) 100 feet past the crash site on the right side of the road D) 100 feet before the crash site on the right side of the road

Ans: C Page: 2182

39. While responding to an emergency scene, you approach a sharp turn in the road. What should you do? A) Corner the turn at its widest point, unless you see an oncoming vehicle. B) Carefully apply the brakes while cornering the turn at your current speed. C) Slow the vehicle to the posted speed limit and avoid braking during the turn. D) Slow the vehicle's speed and smoothly pump the brakes will making the turn.

Ans: C Page: 2184

33. Which of the following disadvantages of using an air ambulance should concern you the LEAST when utilizing it for a critically injured patient? A) Aircraft cabin size B) Current weather conditions C) The cost that will be incurred D) The presence of uneven terrain

Ans: C Page: 2188

5. All of the following medications fall in the same classification, EXCEPT: A) captopril B) enalapril C) diazepam D) lisinopril

Ans: C Page: 425

15. The United States Pharmacopeia (USP) recommended temperature range for MOST medications in the prehospital setting is: A) 40°F to 76°F. B) 45°F to 80°F. C) 55°F to 86°F. D) 60°F to 90°F.

Ans: C Page: 427

17. The action of the body in response to a medication is called: A) pharmacology. B) biotransformation. C) pharmacokinetics. D) pharmacodynamics.

Ans: C Page: 427

29. Which adrenergic receptor, when stimulated, inhibits norepinephrine release? A) Beta-1 B) Alpha-1 C) Alpha-2 D) Beta-2

Ans: C Page: 429

31. Lipid-soluble medications require higher weight-based doses in elderly patients because: A) there are fewer barriers to absorption in elderly patients. B) elderly patients have a much faster basil metabolic rate. C) elderly patients have a higher body fat percentage and fat distribution. D) elderly patients have a higher overall percentage of body water.

Ans: C Page: 430

35. Which of the following factors would be the LEAST likely to affect a patient's response to a medication? A) Body temperature B) Pregnancy C) Past medical history D) Age and weight

Ans: C Page: 430-432

44. An abnormal susceptibility to a medication that is peculiar to an individual patient is called an: A) untoward effect. B) adverse reaction. C) idiosyncratic reaction. D) exaggerated therapeutic effect.

Ans: C Page: 434

The olfactory nerve (CN I) is responsible for: A) vision. B) sight. C) smell. D) hearing.

58. Blood tubing is a: A) special type of microdrip administration set that contains an inline filter designed to cleanse transfused blood of impurities. B) macrodrip administration set that is designed to be used exclusively with 1,000-mL bags of type O-negative blood. C) macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or a combination of IV fluids and blood. D) special administration set with dual piercing spikes that allows the paramedic to administer IV fluids to two critically ill or injured patients at the same time.

Ans: C Page: 482

62. Large protruding arm veins in an otherwise healthy adult can be difficult to cannulate because they often: A) are covered by thick skin that bends the IV catheter. B) constrict in response to insertion of the IV catheter. C) roll from side to side during the cannulation attempt. D) rupture spontaneously when punctured with the needle.

Ans: C Page: 482

67. If an adult patient does NOT require fluid replacement, which of the following over-the-needle catheters is usually an appropriate size to use? A) 14 or 16 gauge B) 16 or 18 gauge C) 18 or 20 gauge D) 22 or 24 gauge

Ans: C Page: 484

72. In the prehospital setting, saline locks are used primarily for patients who: A) have cancer and require continuous infusions of chemotherapy. B) are in compensated shock and only require small IV fluid boluses. C) do not need additional fluids but may need rapid medication delivery. D) have fragile veins that are easily infiltrated by rapid IV fluid boluses.

Ans: C Page: 490

175. After starting an IV in an arm vein of a patient with chest pain and properly securing the catheter in place, you note that the IV is not flowing. You should: A) gently manipulate the catheter and reassess the flow. B) discontinue the IV and reestablish it in the other arm. C) ensure that the constricting band has been removed. D) use a pressure infuser device to improve the IV flow.

Ans: C Page: 492

176. After inserting an 18-gauge over-the-needle catheter into the hand vein of a 30-year-old woman and securing the IV line in place, you note edema at the catheter site despite continued flow of the IV. The woman complains of pain and tightness around the IV site. You should: A) apply direct pressure to the venipuncture site and elevate her extremity. B) reapply the proximal constricting band to reduce edema at the catheter site. C) recognize that infiltration has occurred and immediately discontinue the IV. D) discontinue the IV and circumferentially wrap a dressing around the extremity.

Ans: C Page: 492-493

78. Edema at the IV catheter site and continued IV flow after occlusion of the vein above the insertion site are signs of: A) phlebitis. B) infection. C) infiltration. D) thrombophlebitis.

Ans: C Page: 492-493

79. Thrombophlebitis is MOST commonly caused by: A) abuse of IV drugs. B) long-term IV therapy. C) lapses in aseptic technique. D) any type of hypotonic solution.

Ans: C Page: 493

85. Damage to nerves, tendons, or ligaments would MOST likely occur during venipuncture if: A) the patient has diabetes. B) the patient moves suddenly. C) the selected IV site is near a joint. D) a small vein in the hand is cannulated.

Ans: C Page: 494

90. Signs and symptoms of circulatory overload include: A) diarrhea. B) headache. C) hypertension. D) collapsed jugular veins.

Ans: C Page: 495

95. Which of the following blood tubes contains the preservative EDTA and is used to determine a patient's prothrombin time (PT) and partial thromboplastin time (PTT)? A) Red top B) Green top C) Blue top D) Lavender top

Ans: C Page: 496

100. Which of the following IO devices is NOT used in children? A) EZ-IO B) Jamshedi needle C) FAST1 D) Bone Injection Gun (BIG)

Ans: C Page: 497-498

101. The site MOST commonly used for inserting an IO needle is the: A) manubrium of the sternum. B) medial malleolus of the leg. C) flat bone of the proximal tibia. D) tibial tuberosity below the knee.

Ans: C Page: 498

104. Which of the following statements regarding osteomyelitis is NOT correct? A) Osteomyelitis is the result of an infection. B) Osteomyelitis is an inflammation of the bone and muscle. C) Osteomyelitis occurs in up to 15% of IO insertions. D) The risk of osteomyelitis during IO infusion is relatively low.

Ans: C Page: 500

108. 1 mg is equal to ______ µg. A) 10 B) 100 C) 1,000 D) 10,000

Ans: C Page: 503

187. You are preparing to administer a dopamine infusion to a severely hypotensive patient. What is the concentration on hand if you add 800 mg of dopamine to a 500-mL bag of normal saline? A) 1.6 µg/mL B) 1,600 mg/mL C) 1,600 µg/mL D) 0.16 mg/mL

Ans: C Page: 503, 505

114. A 130-lb patient weighs ____ kg. A) 49 B) 55 C) 59 D) 62

Ans: C Page: 504

118. A prefilled syringe of lidocaine contains 100 mg/5 mL of volume. How many milligrams per milliliter (mg/mL) are present in the syringe? A) 5 B) 10 C) 20 D) 25

Ans: C Page: 505

121. How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/50 mL? A) 100 B) 250 C) 500 D) 1,000

Ans: C Page: 505

106. Medical control orders you to administer 500 mL of normal saline over 1 hour to your patient. You have a macrodrip administration set that allows 15 gtts/mL and an 18-gauge catheter in the patient's antecubital vein. At how many gtts/min should you set the IV flow rate? A) 100 B) 110 C) 125 D) 150

Ans: C Page: 506-507

181. Medical control orders an infusion of 1 L of normal saline over 4 hours during a long-distance transport. You have a 1,000-mL bag of normal saline and a macrodrip administration set that allows 10 gtts/mL. At how many gtts/min will you set the IV flow rate? A) 29 B) 36 C) 42 D) 50

Ans: C Page: 506-507

126. Following return of spontaneous circulation, you are ordered to begin a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 15 B) 30 C) 45 D) 60

Ans: C Page: 507

102. Toxic effects from beta blockers include all of the following, EXCEPT: A) hypotension. B) bradycardia. C) conduction delays. D) tachycardia.

Ans: D Page: 451

268. Several cycles of basic life support maneuvers have failed to relieve a severe airway obstruction in an unresponsive 44-year-old woman. You should: A) intubate the patient and attempt to push the foreign body into one of the mainstem bronchi. B) continue basic life support maneuvers and transport the patient to the hospital immediately. C) perform direct laryngoscopy and attempt to remove the obstruction with Magill forceps. D) place the patient's head in a neutral position and perform an emergency cricothyrotomy.

Ans: C Page: 750

75. If chest compressions and repositioning of the airway are unsuccessful in removing a severe airway obstruction in an unconscious patient, you should: A) perform a blind finger sweep of the mouth. B) alternate chest compressions and abdominal thrusts. C) perform laryngoscopy and use Magill forceps. D) gain airway access via the cricothyroid membrane.

Ans: C Page: 750

86. Which of the following statements regarding oxygen is correct? A) Oxygen is a highly flammable gas. B) Grease prevents oxygen from exploding. C) Oxygen supports the process of combustion. D) Oxygen must be stored in a warm environment.

Ans: C Page: 751-752

87. When administering oxygen via a nonrebreathing mask, you must ensure that the: A) reservoir is half-filled first. B) one-way valves are disabled. C) patient has adequate tidal volume. D) flow rate is set to at least 6 L/min.

Ans: C Page: 754

93. When ventilating an apneic adult with a pulse with a bag-mask device, you should: A) deliver 8 to 10 breaths/min and make the chest wall rise visibly. B) make the chest rise visibly and deliver one breath every 8 seconds. C) deliver each breath over 1 second at a rate of 10 to 12 breaths/min. D) squeeze the bag once every 3 seconds until the chest expands widely.

Ans: C Page: 759

99. Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag-mask device? A) The patient's heart rate slows down. B) One breath is given every 10 to 12 seconds. C) About 12 to 20 breaths/min are being delivered. D) Each ventilation is delivered over 1 second.

Ans: C Page: 761

100. Which of the following statements regarding the automatic transport ventilator (ATV) is correct? A) The ATV should not be used to ventilate a patient who is intubated and in cardiac arrest. B) Inadvertent variations in the rate and duration of ventilations often occur when the ATV is used. C) The paramedic can control an apneic patient's minute volume with accuracy when using an ATV. D) Most ATVS are large and cumbersome and are therefore impractical to use in the prehospital setting.

Ans: C Page: 762

107. When administering CPAP therapy to a patient, it is important to remember that: A) acute symptomatic bradycardia has been directly linked to CPAP therapy. B) Spo, of 100% must be achieved as quickly as possible. C) the increased intrathoracic pressure caused by CPAP can result in hypotension. D) the head straps must be secured immediately in order to achieve an adequate seal.

Ans: C Page: 763-764

273. You have been providing bag-mask ventilations to an unresponsive, apneic patient with facial trauma for approximately 10 minutes. After intubating the patient, you should: A) hyperventilate the patient with 100% oxygen. B) insert a nasogastric tube to decompress the stomach. C) insert an orogastric tube to relieve gastric distention. D) ventilate the patient at a rate of 12 to 20 breaths/min.

Ans: C Page: 765-766

109. A gastric tube is MOST useful for: A) performing prehospital gastric lavage in patients with a toxic ingestion. B) blocking off the esophagus so that an ET tube can be placed. C) decompressing the stomach and decreasing pressure on the diaphragm. D) removing blood from the esophagus in patients with esophageal varices.

Ans: C Page: 766

248. If a patient has a stoma and no tracheostomy tube in place: A) you should not seal the nose and mouth when ventilating. B) suctioning of the stoma must be performed before ventilating. C) ventilations can be performed by placing a mask over the stoma. D) you must perform a head tilt-chin lift maneuver before ventilating.

Ans: C Page: 770

You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should: A) suspect that he has bilateral pneumothoraces. B) ventilate with a demand valve and transport at once. C) remove the bag-mask and suction his tracheostomy tube. D) remove his tracheostomy tube and replace it with a new one.

Ans: C Page: 770

254. When ventilating a patient with facial injuries, it is MOST important to: A) ventilate with a higher-than-normal volume. B) suction the oropharynx every 2 to 3 minutes. C) be alert for changes in ventilation compliance. D) ensure that a cervical collar has been applied.

Ans: C Page: 774

114. All of the following are complications associated with orotracheal intubation, EXCEPT: A) laryngeal swelling. B) damage to the vocal cords. C) necrosis of the nasal mucosa. D) barotrauma from forceful ventilation.

Ans: C Page: 776

257. When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class: A) I. В) II С) III. D) IV.

Ans: C Page: 776

119. Normally, an adult male will require an ET tube that ranges from: A) 6.5 to 7.0 mm. B) 7.0 to 7.5 mm. C) 7,5 to 8.5 mm. D) 8.5 to 9.0 mm.

Ans: C Page: 777

125. Before performing orotracheal intubation, it is MOST important for the paramedic to: A) monitor the patient's cardiac rhythm. B) preoxygenate with a bag-mask device. C) wear gloves and facial protection. D) apply a pulse oximeter to the patient.

Ans: C Page: 778

130. After correctly positioning the laryngoscope blade in the patient's mouth, you should: A) ask your partner to apply firm posterior pressure to the cricoid cartilage. B) gently pry back on the laryngoscope to obtain a view of the vocal cords. C) exert gentle traction at a 45° angle to the floor as you lift the patient's jaw. D) pull slightly back on the laryngoscope blade in order to view the epiglottis.

Ans: C Page: 781

280. You have intubated a 70-year-old man with chronic bronchitis and are en route to the hospital. During transport, you note that ventilations are becoming increasingly difficult and the digital capnometry reading is falling. Your partner tells you that she can still hear bilaterally equal breath sounds, but they are faint. She further tells you that there are no sounds over the epigastrium. What intervention is MOST likely indicated for this patient? A) Immediate extubation B) Withdrawing the tube 2 cm C) Tracheobronchial suctioning D) Hyperventilation at 24 breaths/min

Ans: C Page: 803

178. Which of the following statements regarding pediatric ET intubation in the prehospital setting is correct? A) An average-sized toddler would require a 4.5-mm cuffed ET tube to secure the airway adequately. B) When intubating an infant or small child, it is important to remember that the epiglottis is less floppy. C) Bag-mask ventilation can be as effective as intubation for EMS systems that have short transport times. D) Because the pediatric airway is smaller than an adult's, paramedics should routinely intubate children in the field.

Ans: C Page: 805-806

185. In some cases, atropine sulfate, in a dose of _________ may be given to children to prevent vagal-induced bradycardia during ET intubation. A) 0.5 mg B) 1 to 2 mg C) 0.02 mg/kg D) at least 0.01 mg

Ans: C Page: 806

186. When intubating a 3-year-old child, you should insert the ET tube until: A) the distal cuff is 1 to 2 cm beyond the vocal cords. B) you meet resistance, and then withdraw the tube 2 cm. C) the vocal cord mark is 2 to 3 cm beyond the vocal cords. D) the cm marking on the tube reads 15 cm at the child's lips.

Ans: C Page: 806

214. Which of the following medications does NOT possess hypnotic properties? A) Versed B) Brevital C) Alfentanil D) Etomidate

Ans: C Page: 810-811

219. Paralytic medications exert their effect by: A) blocking the release of epinephrine and norepinephrine from the sympathetic nervous system. B) competitively binding to the motor neurons in the brain, thus blocking their ability to send messages. C) functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acetylcholine. D) blocking the function of the autonomic nervous system and impeding the action of acetylcholinesterase.

Ans: C Page: 811

224. Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to: A) administer 0.5 mg of atropine sulfate. B) hyperventilate the patient at 24 breaths/min. C) adequately preoxygenate with 100% oxygen. D) suction the oropharynx to clear any secretions.

Ans: C Page: 813

192. Which of the following statements regarding multilumen airways is correct? A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful. B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy. C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal. D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation.

Ans: C Page: 814

197. After inserting the Combitube to the proper depth, you should next: A) inflate the distal cuff with 5 mL of air. B) ventilate through the pharyngeal tube. C) inflate the pharyngeal cuff with 100 mL of air. D) apply a cervical collar to minimize head movement.

Ans: C Page: 815-816

202. A size 3 or 4 LMA: A) is most suitable for use in morbidly obese patients. B) is less likely to become dislodged than smaller sizes. C) will accommodate the passage of a 6.0-mm ET tube. D) is appropriate to use in children younger than 6 years of age.

Ans: C Page: 818

206. The King LT-D airway features a: A) straight tube with two inflatable cuffs that hold an equal amount of air. B) port through which gastric contents can be suctioned from the stomach. C) curved tube with ventilation ports located between two inflatable cuffs. D) universal size with two inflation ports and is used for patients of any age.

Ans: C Page: 820

230. Open cricothyrotomy is indicated when: A) ET intubation is unsuccessful after three attempts. B) all other methods of advanced airway management have failed. C) you are unable to secure a patent airway with less invasive means. D) the patient has a head injury that precludes nasotracheal intubation.

Ans: C Page: 824

235. When performing an open cricothyrotomy, you should FIRST: A) maintain aseptic technique as you cleanse the area with iodine. B) slide your index finger between the thyroid and cricoid cartilages. C) palpate for the V notch of the thyroid cartilage and stabilize the larynx. D) hyperextend the patient's neck and then palpate the cricoid cartilage.

Ans: C Page: 826

236. Which of the following statements regarding translaryngeal catheter ventilation is correct? A) It is more difficult to perform than an open cricothyrotomy. B) It provides a more definitive airway than an open cricothyrotomy. C) Ventilation is achieved by the use of a high-pressure jet ventilator. D) The technique uses the tracheal wall as an entry point to the airway.

Ans: C Page: 828

241. After inserting the needle into through the cricothyroid membrane, you should пext: A) change your angle to 90° and advance the catheter over the needle. B) aspirate with the syringe and then insert the needle about 2 cm farther. C) insert the needle about 1 cm farther and then aspirate with the syringe. D) advance the catheter over the needle until the hub is flush with the skin.

Ans: C Page: 829

242. You should turn the jet ventilator release valve off when: A) the audible alarm sounds. B) wide chest expansion is noted. C) the patient's chest visibly rises. D) you can auscultate breath sounds.

Ans: C Page: 829

A 36-year-old man experienced significant burns to his face, head, and chest following an incident with a barbeque pit. Your assessment of his airway reveals severe swelling. After administering medications to sedate and paralyze the patient, you are unable to intubate him. Furthermore, bag-mask ventilations are producing minimal chest rise. The quickest way to secure a patent airway in this patient is to: A) ventilate with a demand valve. B) insert a LMA. C) perform a needle cricothyrotomy. D) perform an open cricothyrotomy.

Ans: C Page: 829

27. A working hypothesis of the nature of a patient's problem is called the: A) chief complaint. B) field impression. C) history of present illness. D) differential diagnosis.

Ans: D Page: 614

9. The Comprehensive Drug Abuse Prevention and Control Act of 1970: A) regulated the import, manufacture, prescription, and sale of several nonnarcotic medications and cocaine, opium, and their derivatives. B) was aimed at protecting the public from mislabeled, poisonous, or otherwise harmful food, medications, and alcoholic beverages. C) increased the penalties for violation of the Harrison Narcotic Act, made the possession of heroin illegal, and outlawed the acquisition and transportation of marijuana. D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

Ans: D Page: 424

4. A(n) _________ medication typically includes a "stem" that links it to other medications in the same class. A) trade B) official C) brand D) generic

Ans: D Page: 425

24. Stimulation of beta-1 adrenergic receptors would produce all of the following effects, EXCEPT: A) an increase in heart rate. B) increased renin secretion. C) increased cardiac electrical conduction. D) decreased myocardial contractility.

Ans: D Page: 429

32. What term is used to describe a situation in which a patient experiences clinical effects from a medication that are opposite from the intended effects? A) Side effect B) Subtherapeutic effect C) Idiosyncrasy D) Paradoxical reaction

Ans: D Page: 430

37. A drug is assigned a pregnancy category "A" if: A) there is evidence of fetal risk based on human experience, and the risk of using the drug in pregnant women clearly outweighs any possible benefit. B) there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the documented risk. C) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available. D) controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

Ans: D Page: 432

38. If studies in animals or human beings have demonstrated fetal abnormalities, or if there is evidence of fetal risk based on human experience, a pregnancy category ___ is assigned to a medication. A) B B) C C) D D) X

Ans: D Page: 432

41. An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n): A) side effect. B) idiosyncrasy. C) placebo effect. D) adverse effect.

Ans: D Page: 434

45. The therapeutic index of a medication is defined as the: A) plasma level at which the medication begins to exert its effect. B) period of time in which the medication is excreted from the body. C) duration of therapeutic action for a given medication on the body. D) difference between the median effective dose and the median toxic dose.

Ans: D Page: 434

50. Cross-tolerance to a medication occurs when: A) the body's metabolism increases, resulting in a decreased concentration of the medication present near receptor sites. B) repeated doses of a medication within a short time rapidly cause tolerance, which renders the medication ineffective. C) repeated exposure to a medication causes an abnormal tolerance to the adverse or therapeutic effects of the medication. D) repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.

Ans: D Page: 435

56. Medications administered by the ___________ route, by definition, have 100% bioavailability. A) sublingual B) intramuscular C) endotracheal D) intravenous

Ans: D Page: 436

62. Which of the following statements regarding the endotracheal route of medication administration is correct? A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given. B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level. C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water. D) The endotracheal route is no longer considered a reliable method of medication administration.

Ans: D Page: 438

63. Which of the following medications can be administered via the intranasal route? A) Atropine B) Diazepam C) Morphine D) Naloxone

Ans: D Page: 438

69. Which of the following statements regarding the sublingual administration of nitroglycerin is correct? A) Large doses of IV nitroglycerin are required to achieve the same effect as a single sublingual nitroglycerin dose B) Sublingual nitroglycerin administration involves placing a tablet in between the patient's cheek and gum C) Sublingual nitroglycerin has a delayed onset of action, but nearly a 100% bioavailability D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

Ans: D Page: 439

71. The rectal route is preferred over the oral route for certain emergency medications because: A) rectal medications are altered significantly by first-pass metabolism. B) bioavailability of rectal medications does not exceed 50 percent. C) the vasculature of the rectal mucosa allows for slow drug absorption. D) rectal medications are usually not subject to first-pass metabolism.

Ans: D Page: 440

76. As a medication undergoes biotransformation, it becomes a(n): A) compound. B) molecule. C) electrolyte. D) metabolite.

Ans: D Page: 442

83. Etomidate is a medication that: A) chemically paralyzes a patient prior to intubation. B) requires multiple doses to provide adequate sedation. C) has a duration of action of approximately 45 minutes. D) induces profound sedation following a single dose.

Ans: D Page: 445

88. If seizures occur following the administration of flumazenil (Romazicon): A) an opiate medication should be given immediately because of its potent antiseizure properties. B) the patient should receive half the normal dose of a benzodiazepine in order to control the seizure. C) the paramedic should give naloxone immediately in order to reverse the effects of the flumazenil. D) benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

Ans: D Page: 448

95. Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia? A) Terbutaline B) Ipratropium C) Levalbuterol D) Albuterol

Ans: D Page: 449

110. Under normal conditions, the renin-angiotensin system functions by: A) dilating the systemic vasculature and reducing cardiac afterload when arterial blood pressure increases. B) stimulating alpha-1 receptors, thereby increasing the blood pressure in response to acute blood loss. C) blocking alpha-2 receptors, thereby increasing the release of norepinephrine and raising blood pressure. D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion.

Ans: D Page: 452

115. Paradoxical bradycardia may occur if atropine is given: A) too rapidly. B) in doses greater than 2 mg. C) for acetylcholinesterase inhibition. D) in doses less than 0.1 mg.

Ans: D Page: 453

117. Which of the following statements regarding sympathomimetic chemicals is correct? A) They are not synthetically manufactured. B) They block the release of acetylcholine. C) They only stimulate alpha-1 receptors. D) They are not found naturally in the body.

Ans: D Page: 453

122. At 15 μg/kg/min, dopamine: A) reduces cardiac contractility. B) antagonizes alpha-1 receptors. C) activates beta-2 receptor sites. D) causes vigorous vasoconstriction.

Ans: D Page: 454

127. For which of the following conditions is sodium nitroprusside used? A) Severe refractory hypotension B) Vagal-induced bradycardia C) Intracerebral hemorrhage D) Unstable vascular aneurysm

Ans: D Page: 454-455

134. Which of the following statements regarding packed red blood cells (PRBCs) is correct? A) For every 3 mL of whole blood that is lost, the patient should be given 1 to 2 mL of PRBCs. B) PRBCs should not be given to patients with hemolysis, as this will cause a transfusion reaction. C) In a patient with ongoing RBC loss, one unit of PRBCs will increase the hematocrit by about 5%. D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

Ans: D Page: 456

135. Fresh frozen plasma is used to: A) increase the hematocrit. B) increase circulating volume. C) replace red blood cells. D) replace critical clotting factors.

Ans: D Page: 457

142. Which of the following medications actually dissolves a clot? A) Plavix B) Aggrastat C) Warfarin D) Activase

Ans: D Page: 458

147. When administering naloxone to a patient who overdosed on an opioid, it is important for the paramedic to remember that: A) small doses of naloxone often cause severe withdrawal symptoms in long-term opioid users. B) complete reversal of the opioid is essential if the patient receives opioids on a long-term basis. C) an IV infusion of naloxone should be used for patients who are addicted to opioids. D) the duration of action of naloxone in the body is less than that of many opioid chemicals.

Ans: D Page: 459

149. Phenothiazine medications exert their antiemetic properties by: A) promoting the secretion of hormones in the brain that depress the function of the medulla oblongata. B) antagonizing dopaminergic receptor sites in the brain, which suppresses the function of the hypothalamus. C) blocking histamine-2 receptors, which inhibits gastric acid production and slows peristalsis. D) activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

Ans: D Page: 459

154. What classification of medication is ketorolac (Toradol)? A) Opioid analgesic B) Corticosteroid anti-inflammatory C) Histamine-1 receptor antagonist D) Non-steroidal anti-inflammatory

Ans: D Page: 461

132. A drug that is contraindicated for a particular patient: A) will likely result in immediate death. B) is usually given at half its usual dose. C) should be given with extreme caution. D) should not be administered to the patient.

Ans: D Page: 470

133. After administering Fentanyl, a controlled medication, to a patient for severe pain, you should: A) discard any medication that was not used and document the amount you wasted on the patient care report. B) ensure that any unused medication is disposed of properly and then have the patient's family member sign as a witness. C) properly dispose of any remaining medication and ask your partner to sign as the person who wasted the medication. D) have your partner or a supervisor witness you properly disposing of any of the unused medication and then sign as a witness.

Ans: D Page: 471

138. Which of the following statements regarding sharps containers is correct? A) There should be at least one sharps container in the back of the ambulance. B) A small sharps container is ideal for carrying in your cargo pants or pocket. C) Needles should be placed in a sharps container after patient care is complete. D) Sharps containers should be puncture-proof and should bear a biohazard logo.

Ans: D Page: 472-473

6. Solutes are defined as: A) atoms that carry an electrical charge. B) solutions that exclusively carry electrolytes. C) solutions that contain dissolved components. D) the dissolved particles contained in a solvent.

Ans: D Page: 473

9. Major cations of the body include all of the following, EXCEPT: A) sodium. B) calcium. C) potassium. D) bicarbonate.

Ans: D Page: 473-474

15. Potassium: A) helps stimulate the release of insulin. B) is found predominantly outside the cell. C) is a bivalent cation that tends to follow water. D) plays a major role in neuromuscular function.

Ans: D Page: 474

21. The antidiuretic hormone (ADH) prevents the loss of water from the kidneys during the process of: A) osmosis. B) dialysis. C) diffusion. D) filtration.

Ans: D Page: 475

25. The tonicity of a solution is determined by the: A) velocity with which potassium ions shift outside of the cell and sodium ions shift inside the cell. B) permeability of the cell and the ability of sodium and potassium to actively move across its membrane. C) amount of antidiuretic hormone the body produces and the volume of water that is reabsorbed in the tubules of the kidneys. D) concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell.

Ans: D Page: 475-476

30. Overhydration occurs when: A) a patient experiences prolonged periods of severe hyperventilation. B) the left side of the heart fails and blood backs up into the systemic circulation. C) the intracellular compartment becomes engorged due to a decrease in vascular volume. D) fluid is forced from the engorged interstitial compartment into the intracellular compartment.

Ans: D Page: 476

171. You are treating a 29-year-old man who was struck in the abdomen with a steel pipe. He is confused, has weak radial pulses, and has a blood pressure of 88/58 mm Hg. You should administer: A) 1 mL of isotonic crystalloid for every 3 mL of estimated internal blood loss. B) 1,000 mL of normal saline or lactated Ringer's solution and then reassess him. C) enough isotonic crystalloid to increase his systolic BP to at least 120 mm Hg. D) 20 mL/kg saline fluid boluses until his mental status and radial pulses improve.

Ans: D Page: 477

43. Administering large amounts of an isotonic crystalloid solution to a patient with internal bleeding would MOST likely: A) expand the vascular space and improve systemic perfusion. B) cause acute hypotension as fluid is drawn from the vascular space. C) change the ratio of hemoglobin and red blood cells. D) increase the severity of internal bleeding by interfering with hemostasis.

Ans: D Page: 477

46. All of the following are examples of colloid solutions, EXCEPT: A) dextran. B) hetastarch. C) Plasmanate. D) lactated Ringer's.

Ans: D Page: 477

35. A solution of water with 0.9% sodium chloride is: A) hypotonic until it is introduced into the body. B) capable of carrying oxygen when it is infused. C) of minimal value in expanding the vascular space. D) also called normal saline and is an isotonic solution.

Ans: D Page: 478

37. Lactated Ringer's (LR) solution should not be given to patients with liver problems because: A) LR is a hypertonic solution and cannot be metabolized by the liver. B) the lactate contained within LR can cause necrosis of the liver tissue. C) patients with liver disease commonly experience renal insufficiency. D) the liver cannot metabolize the lactate in the solution.

Ans: D Page: 478

52. In the prehospital setting, the MOST commonly used IV solutions are: A) colloid solutions. B) hypotonic crystalloids. C) hetastarch and saline. D) isotonic crystalloids.

Ans: D Page: 479

57. When preparing an IV administration set, you should NOT: A) invert the bag if the drip chamber contains too much fluid. B) run IV fluid through the administration set to flush air out. C) fill the drip chamber of the administration set with IV fluid. D) cleanse the piercing spike before inserting it into the IV bag.

Ans: D Page: 480-481

61. When initiating an IV line in the upper extremity of a stable patient, you should: A) always use the antecubital vein. B) look at the anterior forearm first. C) start proximally and work distally. D) start distally and work proximally.

Ans: D Page: 482, 484

64. When selecting the most appropriate IV catheter, you should routinely consider all of the following, EXCEPT: A) the age of the patient. B) the purpose of the IV. C) the location of the IV. D) the patient's gender.

Ans: D Page: 483

69. Regardless of the technique you use to start an IV, you should always: A) apply a tight constricting band proximal to the selected vein for approximately 5 minutes. B) use an over-the-needle catheter that features an automatic needle retraction system for added safety. C) obtain blood samples for emergency department staff by attaching a syringe to the hub of the IV catheter. D) keep the beveled side of the catheter up during insertion and maintain adequate traction on the vein during cannulation.

Ans: D Page: 484-485, 487-488

70. After observing a flash of blood in the IV catheter's flash chamber, you should: A) remove the proximal constricting band and then slide the catheter off the needle and into the vein. B) carefully raise the angle of the catheter to approximately 45° and thread the catheter off of the needle. C) apply pressure to the vein just proximal to the end of the indwelling catheter and remove the needle. D) immediately drop the angle of the catheter to about 15° and advance the catheter a few more centimeters.

Ans: D Page: 485

75. Common risks associated with cannulation of the external jugular vein include all of the following, EXCEPT: A) an air embolism. B) carotid artery damage. C) a rapidly expanding hematoma. D) cannulation of the subclavian vein.

Ans: D Page: 490

80. The first sign(s) of IV occlusion is/are: A) a varying flow rate when the IV catheter is manipulated. B) local tissue swelling and a progressively slowing drip rate. C) point tenderness and an abrupt cessation of the IV flow rate. D) a decreasing drip rate or the presence of blood in the IV tubing.

Ans: D Page: 493

86. To avoid inadvertently cannulating an artery, you should: A) routinely cannulate veins on the anterior aspect of the arm. B) refrain from attempting to cannulate an external jugular vein. C) recall that most patients' veins and arteries are transpositioned. D) always check for a pulse in any vessel you intend to cannulate.

Ans: D Page: 494

178. Approximately 20 minutes after starting an IV on a 40-year-old man, he begins complaining of a backache and chills. You should be MOST suspicious of: A) an air embolus. B) an allergic reaction. C) circulatory overload. D) a pyrogenic reaction.

Ans: D Page: 494-495

92. A vasovagal reaction is the result of: A) acute bradycardia. B) sudden hypertension. C) massive vasoconstriction. D) dilation of the vasculature.

Ans: D Page: 495

99. If a manually inserted IO needle is placed properly in an adult, it should: A) not require a pressure infuser. B) be easily movable in the bone. C) rest at a 45° angle to the bone. D) rest at a 90° angle to the bone.

Ans: D Page: 497

113. To convert 2.5 liters to milliliters, you should: A) divide 2.5 by 500. B) multiply 2.5 by 500. C) divide 2.5 by 1,000. D) multiply 2.5 by 1,000.

Ans: D Page: 502-503

122. A 1% lidocaine (Xylocaine) concentration contains: A) 1 mg/10 mL. B) 100 mg/100 mL. C) 500 mg/50 mL. D) 1,000 mg/100 mL.

Ans: D Page: 505

183. An unconscious 4-year-old child with a blood glucose reading of 30 mg/dL requires 2 mL/kg of D50. The child's estimated weight is 35 lb. You have a prefilled syringe of D50 at a concentration of 25 g/50 mL. How many grams of dextrose will you administer to the child? A) 12,400 B) 13,800 C) 14,000 D) 16,000

Ans: D Page: 506

156. Which of the following significant mechanisms of injury is unique to the infant and child? A) Vehicle-pedestrian collision B) Penetrating injury to the head C) Ejection from a car's back seat D) Fall from greater than 10 ft

Ans: D Page: 610

148. Drug reconstitution involves: A) shaking a medication vial vigorously so that the drug is appropriately separated from its liquid base. B) adding 3 mL to 5 mL of sterile saline to an already existing liquid medication to achieve the appropriate concentration. C) injecting a certain volume of a medication into a 500-mL bag of normal saline to achieve the correct concentration. D) injecting diluent or sterile water from one vial into the vial that contains the powdered form of the medication.

Ans: D Page: 513-514

153. After inserting the needle during an intramuscular or subcutaneous injection, but before delivering the medication, you should: A) ensure that you stretch the skin taut. B) inquire about any medication allergies. C) look in the barrel of the syringe for blood. D) pull back on the plunger to aspirate for blood.

Ans: D Page: 517, 519

156. When administering a drug via IV bolus, you are giving the drug: A) slowly. B) rapidly. C) over time. D) in one mass.

Ans: D Page: 521

162. All of the following medications or preparations are commonly given via the transdermal route, EXCEPT: A) nicotine. B) analgesia. C) nitroglycerin. D) acetaminophen.

Ans: D Page: 526

163. Medication absorption through a nitroglycerin patch would be increased if the patient has: A) scar tissue under the patch. B) peripheral vascular disease. C) a low systolic blood pressure. D) skin that is thin or nonintact.

Ans: D Page: 526

167. Which of the following inhaled medications is NOT a beta2 agonist bronchodilator? A) Proventil B) Albuterol C) Isoetharine D) Ipratropium

Ans: D Page: 528

189. You are treating an unconscious 39-year-old man who overdosed on heroin. You are unable to establish an IV line because his veins are severely sclerosed, and your protocols do not allow for IO cannulation. You should: A) assist ventilations and transport immediately. B) use the subcutaneous route to administer Narcan. C) intubate the patient and give Narcan via the ET tube. D) administer naloxone via the mucosal atomizer device.

Ans: D Page: 528

2. Gathering a patient's medical history and performing a secondary assessment should occur: A) immediately after you form your visual general impression of the patient. B) shortly after making patient contact and determining his or her complaint. C) after initial treatment has been rendered and you are en route to the hospital. D) after life threats have been identified and corrected in the primary assessment.

Ans: D Page: 589

7. You are in the BEST position to decide what, if any, care needs to be provided at the scene versus en route to the hospital once you: A) can qualify that a patient is indeed sick. B) determine how far away the hospital is. C) perform a detailed secondary assessment. D) are able to quantify how sick a patient is.

Ans: D Page: 589

125. Which of the following actions will provide the BEST personal protection when caring for a patient on uneven terrain? A) Wearing a back brace whenever you lift B) Wearing boots that provide good traction C) Using at least four personnel when moving a patient D) Making lifts and moves as controlled as possible

Ans: D Page: 594

17. More often than not, the paramedic will form his or her general impression of a patient based on: A) baseline vital signs and SAMPLE history. B) a rapid, systematic head-to-toe assessment. C) conditions found in the primary assessment. D) the initial presentation and chief complaint.

Ans: D Page: 597

68. A patient who does not respond to verbal or tactile stimuli is: A) lethargic. B) semiconscious. C) disoriented. D) unresponsive.

Ans: D Page: 597

137. Tidal volume is MOST effectively assessed by: A) auscultating breath sounds. B) noting the patient's respiratory rate. C) looking for accessory muscle use. D) observing for rise and fall of the chest.

Ans: D Page: 598

142. The body's reaction to increased internal or external temperature would MOST likely cause the skin to become: A) warm and dry. B) hot and dry. C) pale and hot. D) hot and moist.

Ans: D Page: 599-600

162. Upon completing your rapid exam of an unresponsive trauma patient's head and neck, you should next: A) log roll the patient onto a long backboard. B) assess the integrity of the 12 cranial nerves. C) ventilate the patient at 12 to 20 breaths/min. D) apply a properly sized rigid cervical collar.

Ans: D Page: 601

130. After performing your primary assessment of a patient, your next action should be to: A) transport the patient to the closest medical treatment facility. B) move the patient to the ambulance as expeditiously as possible. C) perform a secondary assessment to narrow your differential diagnosis. D) decide what care is needed at the scene versus en route to the hospital.

Ans: D Page: 601, 603

144. Which of the following clinical presentations warrants immediate transport? A) Two days of vomiting; heart rate of 110 beats/min; warm, dry skin B) 38 weeks gestation; crowning; history of hypertension; tachycardia C) 250 mL external blood loss; systolic BP of 130 mm Hg; moderate pain D) Chest discomfort; heart rate of 110 beats/min; systolic BP of 90 mm Hg

Ans: D Page: 603

12. After determining that the scene is safe, the FIRST step in approaching a patient is to: A) determine the chief complaint. B) ask the patient his or her name. C) ascertain the age of the patient. D) introduce yourself to the patient.

Ans: D Page: 605

21. Using casual nicknames can be especially problematic when: A) the patient is a male who was involved in an assault. B) assessing geriatric patients who fear losing their independence. C) the patient is critically ill or injured and is semiconscious. D) cultural differences exist between the patient and the paramedic.

Ans: D Page: 606

34. The mnemonic "OPQRST" is a tool that: A) is only effective when assessing a patient who is experiencing severe pain. B) allows the paramedic to reach a field diagnosis quickly and initiate treatment. C) is used commonly to rule out conditions that are immediately life threatening. D) offers an easy-to-remember approach to analyzing a patient's chief complaint.

Ans: D Page: 607

155. Which of the following mechanisms of injury would be the LEAST likely to cause life-threatening injuries? A) Ejection from an all-terrain vehicle B) Motorcycle crash without a helmet C) Penetrating injury to the chest or abdomen D) Restrained occupant in a vehicle rollover

Ans: D Page: 610

A 56-year-old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats/min. After administering high-flow oxygen, you should: A) attempt to slow his heart rate with vagal maneuvers and then start an IV line. B) establish IV access, consider sedation, and perform synchronized cardioversion. C) establish vascular access and administer 150 mg of amiodarone over 10 minutes. D) obtain a 12-lead ECG tracing to determine the origin of his tachycardic rhythm.

A classic sign of atrial flutter is: A) a constant 2:1 conduction ratio. B) the presence of sawtooth F waves. C) a ventricular rate less than 100 beats/min. D) an irregular but consistent R-R interval.

A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by: A) myocardial stretching due to increased preload. B) decreases in stroke volume and ventricular filling. C) increased automaticity of the cardiac pacemaker. D) ectopic pacemaker sites in the atria or ventricles.

A first-degree heart block has a PR interval greater than 0.20 seconds because: A) depolarization of the atria occurs at a slightly slower rate than one would expect. B) each impulse that reaches the AV node is delayed slightly longer than expected. C) impulses generated by the SA node traverse the AV node at an accelerated rate. D) the primary pacemaker is not the SA node, but rather an ectopic atrial pacemaker.

A medication that possesses a positive chronotropic effect is one that: A) decreases heart rate. B) increases heart rate. C) decreases cardiac contractility. D) increases the conduction of electricity.

A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next? A) Rapidly infuse 2 liters of normal saline solution B) Administer 300 mg of amiodarone via rapid IV push C) Give 40 units of vasopressin followed by defibrillation D) Give amiodarone followed by 1.5 mg/kg of lidocaine

A patient is placed in the Fowler's position. In this position, the body is: A) on its side with the head lowered. B) in a semireclining position. C) supine with the legs elevated. D) on its side with the head elevated.

A patient with a left-hemispheric stroke would be expected to have: A) contralateral facial drooping. B) ipsilateral facial drooping. C) ipsilateral extremity weakness. D) contralateral pupillary changes.

A patient with an elevated cholesterol level would MOST likely take: A) Inderal. B) Altacor. C) Isordil. D) Diovan.

A patient with cardiogenic shock and pulmonary edema should be positioned: A) in the Trendelenburg position. B) in a semi-Fowler's position. C) supine with the legs elevated. D) in a lateral recumbent position.

A prolonged QT interval indicates that the heart: A) has a shorter-than-normal refractory period, increasing the likelihood of severe bradycardia. B) is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias. C) is depolarizing too quickly, which significantly increases the potential for reentry in the AV junction. D) has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis.

A pulse that alternates in strength from one beat to the next beat is called: A) pulse deficit. B) pulsus alternans. C) pulsus paradoxus. D) paradoxical pulse.

A right ventricular infarction is characterized by: A) ST-segment elevation greater than 1 mm in lead V5R and ST-segment depression in leads II, III, and aVF. B) ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. C) ST-segment depression greater than 2 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. D) ST-segment elevation greater than 2 mm in lead V5R and ST-segment elevation in leads II, III, and aVF.

A second-degree heart block, Mobitz type I, occurs when: A) every other impulse generated by the SA node is blocked at the AV node and does not depolarize the ventricles. B) each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. C) the PR interval progressively grows narrower, until there is a P wave that is not followed by a QRS complex. D) more than one successive impulse from the SA node is blocked at the AV node and is not allowed to enter the ventricles.

A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should: A) start an IV line, administer 5 mg of midazolam, intubate the patient's trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital. B) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine. C) place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure. D) elevate the patient's legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

A(n) ___________ is a substance that can absorb or donate hydrogen. A) acid B) buffer C) base D) ion

Aberrant conduction is _____________ conduction. A) rapid B) abnormal C) very slow D) irregular

The adult dose of procainamide for recurrent V-Fib or pulseless V-Tach is: A) 1 to 2 g IV push. B) 20 to 50 mg/min. C) 0.5 to 1 mg/kg/min. D) 15 mg/kg over 30 minutes.

B) 20 to 50 mg/min.

You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a "stomach bug." He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should: A) give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport. B) administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport. C) advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician. D) apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.

You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving supplemental oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should: A) repeat the nitroglycerin. B) reassess her blood pressure. C) give her a 250-mL saline bolus. D) administer 2 to 4 mg of morphine.

You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. You should: A) desynchronize the defibrillator, defibrillate one time, and check for a pulse. B) ensure that the synchronizer is off, defibrillate, and immediately begin CPR. C) increase the energy setting on the defibrillator and repeat the cardioversion. D) perform five cycles of CPR, reassess the cardiac rhythm, and defibrillate if needed.

You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient's blood pressure is 96/60 mm Hg, and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient includes: A) 0.5 mg of atropine sulfate. B) an infusion of amiodarone. C) a 20-mL/kg crystalloid bolus. D) a low-dose dopamine infusion.

10. Which of the following statements regarding the EMS system is correct? A) The paramedic is usually the public's first contact with the EMS system. B) The paramedic is a public servant who often responds to non-emergency calls. C) The public's perception of an emergency is often the same as the paramedic's. D) Dispatch information is usually an accurate depiction of what really happened.

9. The EMS network begins: A) by educating dispatchers. B) with citizen involvement. C) when an injury has occurred. D) when paramedics are notified.

Which of the following represents the correct adult dose for etomidate (Amidate)? A) 50 to 100 mg B) 0.2 to 0.6 mg/kg C) 0.2 to 0.4 μg/kg D) 0.01 to 0.02 mg/kg

B) 0.2 to 0.6 mg/kg

Which of the following represents the correct dosing regimen for nitroglycerin? A) 0.3 mg every 3 minutes, up to 6 times B) 0.4 mg every 5 minutes, up to 3 times C) 0.6 mg every 3 minutes, up to 4 times D) 400 μg every 10 minutes, up to 5 times

B) 0.4 mg every 5 minutes, up to 3 times

The onset of action of rocuronium bromide (Zemuron) is: A) 30 seconds. B) 1 to 2 minutes. C) 3 to 5 minutes. D) about 10 minutes.

B) 1 to 2 minutes.

The standard adult dose for levalbuterol (Xopenex) is: A) 0.25 to 0.5 mg in 3 mL of normal saline every 20 minutes, up to 3 times. B) 1.25 to 2.5 mg in 3 mL of normal saline every 20 minutes, up to 3 times. C) 2.5 to 3 mg in 3 to 5 mL of normal saline every 20 minutes, up to 3 times. D) 5 to 7.5 mg in 5 to 10 mL of normal saline every 10 minutes, up to 6 times.

B) 1.25 to 2.5 mg in 3 mL of normal saline every 20 minutes, up to 3 times.

In general, the paramedic can administer up to ___ mg of naloxone (Narcan) before contacting medical control. A) 4 B) 10 C) 15 D) 20

B) 10

Vasopressin is supplied in 1-mL vials that contain 20 units. How many vials should you give to achieve the initial adult dose? A) 1 B) 2 C) 3 D) 4

B) 2

Which of the following represents the correct adult dose of albuterol when given via nebulizer? A) 90 μg diluted in 5 mL of normal saline B) 2.5 mg diluted in 2.5 mL of normal saline C) 180 μg diluted in 10 mL of normal saline D) 1.25 mg diluted in 2.5 mL of normal saline

B) 2.5 mg diluted in 2.5 mL of normal saline

A 5-mL prefilled syringe of lidocaine contains 100 mg. How many mg/mL are present? A) 10 B) 20 C) 30 D) 50

B) 20

Which of the following statements regarding dobutamine is correct? A) The adult dose for dobutamine is 2 to 20 mg/kg/min, titrated to the desired clinical effect. B) Dobutamine increases myocardial contractility, but has minimal effect on the heart rate. C) Dobutamine is especially beneficial for patients who are in shock due to poisons or drugs. D) Patients with hypotension due to left ventricular failure should not be given dobutamine.

B) Dobutamine increases myocardial contractility, but has minimal effect on the heart rate.

Which of the following general statements regarding injuries and injury prevention is correct? A) Injury is defined as intentional damage inflicted upon a person. B) EMS has the greatest impact in preventing unintentional injuries. C) Most assaults and suicides can be prevented effectively by EMS. D) Intentional injuries outnumber unintentional injuries every year

B) EMS has the greatest impact in preventing unintentional injuries.

If it is reasonable to administer a particular treatment to a patient, the American Heart Association assigns the treatment a class: A) I. B) IIa. C) IIb. D) III.

B) IIa.

70. You and your team are attempting to resuscitate a 50-year-old woman in a traumatic cardiac arrest. Your team consists of two EMTs and an AEMT. Which of the following tasks would be MOST appropriate to assign to the AEMT? A) Chest compressions B) IV therapy and fluid boluses C) Cardiac drug administration D) Emotional support for the family

B) IV therapy and fluid boluses

Which of the following is NOT a reason why EMS providers are in the ideal position to serve as advocates for injury prevention? A) In many rural communities, the EMT might be the most medically sophisticated person. B) Most EMS systems require their personnel to participate actively in injury prevention programs. C) EMS providers are high-profile role models and are perceived as champions of their patients. D) EMS providers are distributed widely in the population and are welcome in environments conducive to delivering prevention messages.

B) Most EMS systems require their personnel to participate actively in injury prevention programs.

For which of the following conditions is diphenhydramine contraindicated? A) Severe motion sickness B) Narrow-angle glaucoma C) Acute dystonic reaction D) Phenothiazine toxicity

B) Narrow-angle glaucoma

49. Which of the following statements regarding peer review is correct? A) The EMS administrator is the ideal person to conduct the review. B) Peer review is not a tool to demean or belittle a fellow paramedic. C) It is preferable to use the same people to conduct all peer reviews. D) Review findings should be shared with others to facilitate learning.

B) Peer review is not a tool to demean or belittle a fellow paramedic.

Which of the following is NOT an example of a passive injury prevention intervention? A) The manufacture of child-resistant bottles B) Providing public education on the use of AEDs C) The use of softer materials for playground surfaces D) Installing sprinkler systems in commercial buildings

B) Providing public education on the use of AEDs

41. Which of the following is NOT a typical function of the EMS medical director? A) Interfacing between EMS systems and other agencies B) Responding to an emergency scene with the paramedics C) Participating in the hiring process of new EMS personnel D) Developing protocols in cooperation with other EMS experts

B) Responding to an emergency scene with the paramedics

For which of the following is midazolam (Versed) indicated? A) Paralysis induction for intubation B) Sedation prior to cardioversion C) Analgesia for orthopaedic trauma D) To potentiate the effects of barbiturates

B) Sedation prior to cardioversion

What is the mechanism of action of adenosine (Adenocard)? A) Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites; increases heart rate B) Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on sinus pacemaker cells C) Blocks sodium channels and myocardial potassium channels; delays repolarization; increases the duration of the action potential D) Decreases heart rate, myocardial contractility, and cardiac output; inhibits dilation of bronchial smooth muscle

B) Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on sinus pacemaker cells

What is the mechanism of action of nitroglycerin? A) Vascular constriction; increased preload; decreased afterload B) Smooth muscle relaxation; decreased preload and afterload C) Vascular dilation; increased preload and afterload D) Smooth muscle relaxation; decreased preload; increased afterload

B) Smooth muscle relaxation; decreased preload and afterload

Which of the following statements regarding unintentional injuries and death is correct? A) Their incidence cannot be reduced. B) They do not involve premeditation. C) Few motor vehicle deaths are unintentional. D) Unintentional falls are the leading cause of death.

B) They do not involve premeditation.

The entity that was created in 1966 and that provides authority and financial support for the development of basic and advanced life support programs is the: A) National Association of EMTs. B) United States Department of Transportation. C) National Highway Safety Department. D) Centers for Disease Control and Prevention.

B) United States Department of Transportation.

Procainamide is contraindicated for all of the following conditions, EXCEPT: A) third-degree atrioventricular block. B) Wolff-Parkinson-White syndrome. C) tricyclic antidepressant overdose. D) preexisting QT interval prolongation.

B) Wolff-Parkinson-White syndrome.

It is especially important for the paramedic to administer naloxone (Narcan) with caution to patients who are: A) in cardiac arrest. B) addicted to narcotics. C) severely bradycardic. D) chronic alcoholics.

B) addicted to narcotics.

Epinephrine is deactivated by: A) catecholamines. B) alkaline solutions. C) magnesium sulfate. D) sympathomimetics.

B) alkaline solutions.

Atropine sulfate is classified as a(n) __________________ medication. A) adrenergic B) anticholinergic C) sympatholytic D) sympathomimetic

B) anticholinergic

Clopidogrel (Plavix) is a(n): A) anticoagulant. B) antiplatelet aggregant. C) coronary vasodilator. D) fibrinolytic.

B) antiplatelet aggregant.

63. In order to link research and evidence to patient care, one must: A) conduct research at least every 10 years and then perform a retrospective analysis of the data. B) ensure that the quality of the evidence is sufficient to justify changing patient care protocols. C) recognize that evidence is less reliable than scientific data that produce sound statistics. D) understand that only level 1 evidence can be used to justify changing patient care protocols.

B) ensure that the quality of the evidence is sufficient to justify changing patient care protocols.

61. When gathering data for a research project that involves subjects in various age groups, standard deviation outlines: A) how close the scores in each set will be to the median. B) how much the scores in each set will differ from the mean. C) the most frequent age of the subject or subjects being used. D) the average age of the subjects used in the research project.

B) how much the scores in each set will differ from the mean.

Indications for propranolol hydrochloride (Inderal) may include: A) bradycardia. B) hypertension. C) bronchial asthma. D) pulmonary edema.

B) hypertension.

Risk factors that increase a person's chances of intentionally injuring another person include all of the following, EXCEPT: A) male sex. B) hypoglycemia. C) alcohol abuse. D) mental illness.

B) hypoglycemia.

Glucagon can be classified as all of the following, EXCEPT as a(n): A) pancreatic hormone. B) hypoglycemic agent. C) insulin antagonist. D) hyperglycemic agent.

B) hypoglycemic agent.

Haloperidol (Haldol) should NOT be given to patients with: A) associated hypertension. B) hypoxia-induced agitation. C) a history of acute psychosis. D) a shortened QT interval.

B) hypoxia-induced agitation.

47. A CQI program should primarily focus on: A) modifying protocols as needed. B) improving patient care delivery. C) identifying incompetent medics. D) reviewing all patient care reports.

B) improving patient care delivery.

33. You should prioritize the needs of your patient based on the: A) distance from the scene to the closest medical facility. B) injury or illness that requires the most urgent treatment. C) patient's interpretation of the seriousness of the situation. D) patient's age and the results of his or her initial vital signs.

B) injury or illness that requires the most urgent treatment.

68. While you and your partner are en route to the scene of a patient in cardiac arrest, you should expect the emergency medical dispatcher to: A) obtain your permission to give simple medical directions to the caller. B) instruct the caller on how to perform CPR until you arrive at the scene. C) advise you of the patient's medical history so you can be better prepared. D) tell the caller to place the patient in the recovery position and then reassess.

B) instruct the caller on how to perform CPR until you arrive at the scene.

39. When educating the public regarding your EMS system, you should do all of the following, EXCEPT: A) research the needs of your community. B) liken your job to EMS-related TV shows. C) advocate the importance of injury prevention. D) ensure that citizens know how to access EMS.

B) liken your job to EMS-related TV shows.

Succinylcholine (Anectine) is contraindicated for patients with: A) head trauma. B) major burns. C) tachycardia. D) blunt force trauma.

B) major burns.

62. Prior to conducting a research project in which people will be used as subjects, it is MOST important to: A) ensure that all the subjects are fully briefed on the perceived outcome. B) obtain consent from the subjects and ensure their safety and well-being. C) select subjects who are nonbiased and have no knowledge of the project. D) randomly select the subjects using the alternative time sampling method.

B) obtain consent from the subjects and ensure their safety and well-being.

71. You are moving from one state to another and plan to continue your career in EMS. The state to which you are moving will MOST likely require that you: A) become a registered paramedic with the National Registry of EMTs. B) obtain state certification and maintain adequate continuing education. C) show proof that you have worked as a paramedic for at least 10 years. D) repeat an entire paramedic training program and take a state examination.

B) obtain state certification and maintain adequate continuing education.

The statement, "The bicycle safety program will increase the rate of helmet use by children younger than 18 years of age from 30% to 50% within the next 18 months," is an example of a(n): A) process objective. B) outcome objective. C) short-term objective. D) proactive intervention.

B) outcome objective.

In doses less than 0.1 mg, atropine may cause: A) profound tachycardia. B) paradoxical bradycardia. C) severe urinary retention. D) flushed, hot, dry skin.

B) paradoxical bradycardia.

Prior to administering ipratropium (Atrovent), the paramedic should routinely ask the patient if he or she is allergic to: A) wheat. B) peanuts. C) aspirin. D) opiates.

B) peanuts.

With regard to injury prevention, effective educational techniques include all of the following, EXCEPT: A) incentives. B) penalties. C) modeling. D) behavioral feedback.

B) penalties.

75. You arrive at a convenience store to find a middle-aged male in cardiac arrest. Your protocols provide for standing orders in this type of scenario. This means that you should: A) contact medical control before providing advanced-level care. B) perform certain interventions prior to contacting medical control. C) begin CPR and then contact medical control for further direction. D) pronounce the patient dead if there is no response after 10 minutes.

B) perform certain interventions prior to contacting medical control.

42. The MAIN benefit to online medical control is that it: A) affords the paramedic better protection against a lawsuit. B) provides an immediate and specific patient care resource. C) allows the physician and paramedic to develop a rapport. D) facilitates a faster transport to the emergency department.

B) provides an immediate and specific patient care resource.

34. When faced with a situation that is not addressed in your EMS system's protocols, you should: A) contact the nurse at the receiving facility. B) radio your medical director to obtain orders. C) proceed with basic life support and transport. D) let experience guide further care of the patient.

B) radio your medical director to obtain orders.

From an injury prevention standpoint, the term "intervention" is defined as: A) any activity or measure that is performed following an injury and that is designed to decrease mortality. B) specific prevention measures or activities designed to increase positive health and safety outcomes. C) on-the-spot education of an injured person regarding how his or her injury could have been prevented. D) participating in a mortality/morbidity review following a series of major motor vehicle crashes.

B) specific prevention measures or activities designed to increase positive health and safety outcomes.

Metaproterenol sulfate (Alupent) is contraindicated in patients with: A) a systolic BP less than 120 mm Hg. B) tachycardia due to digitalis toxicity. C) bronchospasm secondary to bronchitis. D) chronic obstructive pulmonary disease.

B) tachycardia due to digitalis toxicity.

When defining an injury problem in your community, it is MOST important to determine: A) if you have support from local law enforcement. B) the most frequent causes of fatal and nonfatal injuries. C) how many trauma centers are located in your community. D) the socioeconomic status of those most commonly injured.

B) the most frequent causes of fatal and nonfatal injuries.

In hypovolemic shock, lactated Ringer's solution should be: A) mixed with normal saline solution. B) titrated to the patient's physiologic response. C) given until a systolic BP of 110 mm Hg is achieved. D) avoided if the patient's shock is caused by blood loss.

B) titrated to the patient's physiologic response.

Side effects of albuterol may include: A) wheezing, hypersalivation, and nausea. B) tremors, lightheadedness, and irritability. C) hypotension, bradycardia, and headache. D) dizziness, blurred vision, and dysphagia.

B) tremors, lightheadedness, and irritability.

Activated charcoal is contraindicated in patients: A) who are pregnant or may become pregnant. B) who ingested a corrosive substance. C) who are younger than 16 years of age. D) with abdominal pain of unknown origin.

B) who ingested a corrosive substance.

Many veteran EMS providers have embraced a leadership role in primary injury prevention after: A) being requested to do so by their captain or chief. B) witnessing too many episodes of needless suffering. C) experiencing a personal loss due to a traumatic injury. D) suffering burnout from caring for severely injured patients.

B) witnessing too many episodes of needless suffering.

Which of the following questions would MOST likely reveal a hidden medical condition when communicating with a patient who has a severe headache? A: "Are you having difficulty seeing objects?" B: "What happened the last time you felt this way?" C: "Have you recently experienced any head trauma?" D: "Do you have a family history of severe headaches?"

B: "What happened the last time you felt this way?"

Notification of EMS usually occurs when: A: EMTs contact an emergency medical dispatcher B: A bystander notifies the dispatcher via telephone C: A sick or injured patient presents to your EMS station D: Law enforcement requests assistance via two-way radio

B: A bystander notifies the dispatcher via telephone

Which of the following situations is an example of an act of commission? A: The paramedic charges for his or her services B: A paramedic sutures a patient's lacerated arm C: An EMT fails to splint a possible leg fracture D: A physician transfers patient care to a paramedic

B: A paramedic sutures a patient's lacerated arm

While caring for a critically injured patient at the scene of a motor vehicle crash, an emergency physician bystander stops at the scene to assist. Which of the following procedures performed by the physician would require the physician to accompany the patient to the hospital in the ambulance? A: ECG interpretation B: A pericardiocentesis C: Orotracheal intubation D: Intraosseous cannulation

B: A pericardiocentesis

Repeating the key parts of a patient's responses to your questions demonstrates: A: Sympathy B: Active listening C: Passive communication D: An exchange of information

B: Active listening

Which of the following statements regarding emergency vehicle laws is correct? A: The Star of Life insignia permits an ambulance to run a red light or stop sign if it is safe B: All state statutes require emergency vehicles to be operated in a safe and prudent manner C: An ambulance must use its lights and siren when transporting any acutely ill or injured patient D: Most states allow an emergency vehicle to exceed the speed limit by 20 MPH if it is safe to do so

B: All state statutes require emergency vehicles to be operated in a safe and prudent manner

Most lawsuits against EMS providers result from: A: Unethical acts B: Ambulance collisions C: Substandard patient care D: Gross infractions of the law

B: Ambulance collisions

When attempting to interview a patient with a behavioral crisis, you should: A: Use closed-ended questions to obtain his or her medical history B: Approach the patient cautiously, while maintaining eye contact C: Avoid eye contact with the patient, as this may agitate him or her D: Set "ground rules" regarding what you expect from him or her

B: Approach the patient cautiously, while maintaining eye contact

Interventions that have been proven by studies to be of no benefit to the patient in cardiac arrest: A: Are illegal for the paramedic to perform B: Are not medically or ethically indicated C: Are commonly authorized by medical control D: Should be performed unless the family objects

B: Are not medically or ethically indicated

Low-band frequencies: A: Have a range of up to 500 miles and are not associated with skip interference B: Are unpredictable because changes in ionospheric conditions may cause losses in communication C: Function at 150 to 175 MHz and have a range that is nearly triple that of high-band frequencies D: Have a longer range than high-band frequencies, but are more readily absorbed by rain, trees, and brush

B: Are unpredictable because changes in ionospheric conditions may cause losses in communication

Many _____ believe that touching the head may put their soul in jeopardy A: Thais B: Asians C: Muslims D: Somalis

B: Asians

Islamic and Hindu cultures avoid: A: Touching the head B: Touching with the left hand C: Clapping their hands together D: Sitting with their legs crossed

B: Touching with their left hand

If a parent insists on monitoring your conversation with his or her adolescent son or daughter, you should: A: Suspect that the adolescent has been physically or emotionally abused and confront the parent B: Communicate the situation to the emergency department physician and document it accurately C: Refuse the parent's prerogative and move the patient to the ambulance to continue your conversation D: Explain to the adolescent that he or she is a minor and that you cannot converse without parental presence

B: Communicate the situation to the emergency department physician and document it accurately

You have been attempting resuscitation of a middle-aged woman for approximately 15 minutes; however, she has not responded to any of your treatment. There is no evidence of hypothermia or drug ingestion, and the cardiac monitor shows asystole. You should: A: Determine if she has an advance directive B: Consider terminating your resuscitative efforts C: Perform CPR only and try to contact her family D: Pronounce the patient dead and call the coroner

B: Consider terminating your resuscitative efforts

Without obtaining her consent, you transport a mentally competent young woman to the hospital because you suspect she is experiencing internal bleeding. This action: A: Is defensible in a court a law B: Constitutes false imprisonment C: Reflects an act of gross negligence D: Is justifiable because of your suspicions

B: Constitutes false imprisonment

Prior to administering nitroglycerin to a patient with chest pain, the patient denies the use of erectile dysfunction (ED) drugs when asked, even though he took an ED drug a few hours earlier. After being given the nitroglycerin, the patient experiences severe hypotension and almost dies. Which of the following could the paramedic use as a potential defense if the patient attempts to sue? A: Patient incompetence B: Contributory negligence C: Plausible deniability D: Qualified immunity

B: Contributory negligence

During the course of your interview, your patient begins making sexual innuendos to you. You should: A: Defer further questioning and simply transport your patient B: Ensure that another paramedic or EMT is present at all times C: Stop the interview until the patient's behavior is less aggressive D: Ask a paramedic of the opposite sex to interview the patient

B: Ensure that another paramedic or EMT is present at all times

Informed consent involves: A: Carefully explaining the potential ramifications of refusing emergency medical treatment B: Ensuring that a patient understands the potential risks involved in performing a particular procedure C: A patient verbally expressing his or her wishes for you to proceed with emergency medical treatment D: Explaining the rationale for an invasive procedure to the patient after you have already performed it

B: Ensuring that a patient understands the potential risks involved in performing a particular procedure

Interpersonal communication is MOST accurately defined as the: A: Ability to communicate while under extreme stress B: Exchange of information between two or more persons C: Dialogue that occurs between a paramedic and a patient D: Removal of an emotional barrier while communicating

B: Exchange of information between two or more persons

What is the main legal risk of providing a tiered-response EMS system? A: Ambulance crashes at intersections as ALS and BLS providers simultaneously respond to the scene B: Exposure to liability if the BLS crew makes an improper determination that the patient does not need ALS care C: Lengthy response times for the BLS crew if ALS providers wait too long before determining that they need help D: Premature canceling of a BLS crew by an on-scene paramedic who performs an improper assessment of the patient

B: Exposure to liability if the BLS crew makes an improper determination that the patient does not need ALS care

If the EMD suspects that your patient has a life-threatening emergency, the EMD should make you aware of the situation and then: A: Dispatch law enforcement to the scene B: Give prearrival instructions to the caller C: Ask the caller to put the patient on the phone D Obtain the caller's name and physical address

B: Give prearrival instructions to the caller

Patients with decision-making capacity: A: Cannot refuse EMS treatment and transport after they have given consent for it B: Have the right to refuse all or part of the emergency medical care offered to them C: Must agree to EMS transport if they give consent for emergency medical treatment D: Cannot withdraw consent unless their conditions are deemed to be non-life threatening

B: Have the right to refuse all or part of the emergency medical care offered to them

If a conscious patient with decision-making capacity refuses care for a potentially life-threatening condition: A: You must begin lifesaving treatment at once B: He or she cannot be treated without a court order C: Implied consent will allow you to treat the patient D: Medical direction can overrule the patient's decision

B: He or she cannot be treated without a court order

Which of the following statements regarding a psychiatric patient who is refusing transport is MOST correct? A: Medical control has the authority to order paramedics to forcibly restrain and transport any psychiatric patient B: If the patient's life is not in danger, only a police officer can authorize paramedics to restrain and transport the patient C: It is generally agreed that any psychiatric patient should be transported against his or her will for evaluation by a psychiatrist D: Family members can authorize involuntary commitment, including forcibly transporting the patient against his or her will

B: If the patient's life is not in danger, only a police officer can authorize paramedics to restrain and transport the patient

Cellular telephones are more advantageous than regular two-way radios in that cellular telephones: A: Enable laypeople to call 911 for a minimal service charge B: Incorporate GPS technology to help rescuers find the patient C: Can transmit long distances with the use of a mobile antenna D: Do not utilize computer technology and are less likely to fail

B: Incorporate GPS technology to help rescuers find the patient

The surrogate decision maker: A: Must be an immediate family member of the patient B: Is legally obligated to make decisions as the patient would want C: Must recertify his or her decision-making status every 10 years D: Can make decisions for a patient who has decision-making capacity

B: Is legally obligated to make decisions as the patient would want

The ability of multiple agencies or systems to share the same radio frequency is called: A: A duplex B: Trunking C: Patching D: Telemetry

B: Trunking

While on duty, a paramedic unit stops at the scene of a traffic accident to which it has not been dispatched. During the course of providing patient care, one of the paramedics purposely manipulates the patient's neck to elicit a painful response. This paramedic: A: Is protected by the Good Samaritan law because he was not officially dispatched to the scene of the accident B: Is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed C: Is not protected by the Good Samaritan law but provided treatment that is consistent with the accepted standard of care D: Cared for the patient in a manner consistent with his scope of practice and is not liable for the patient's injury or injuries

B: Is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed

The use of ten-codes over the radio: A: Should be carried out whenever possible to ensure effective communication B: Is not recommended by the National Incident Management System (NIMS) C: Increases the likelihood of miscommunication during the radio transmission D: Is prohibited by the Federal Communications Commission and should be avoided

B: Is not recommended by the National Incident Management System (NIMS)

Most civil cases are resolved during a settlement process because: A: The plaintiff is typically awarded a larger amount of money B: It is expensive and time-consuming to take the case to trial C: The paramedic is found responsible during the discovery phase D: Trial juries can be very unpredictable and are often misinformed

B: It is expensive and time-consuming to take a case to trial

Before you begin to transmit over the radio, you should check the volume and then: A: Press the transmit key for 1 second before talking B: Listen to make sure that the channel is clear of traffic C: Turn the squelch setting to zero to ensure good signal D: Key the microphone two or three times to reach the repeater

B: Listen to make sure that the channel is clear of traffic

If you want reliable answers to personal questions, you should: A: Tell the patient that his or her responses to your questions are confidential B: Manage the scene so you can ask such questions quietly and privately C: Request law enforcement presence when asking a personal question D: Tell the patient that personal questions are a routine part of your exam

B: Manage the scene so you can ask such questions quietly and privately

While off duty and outside of your jurisdiction, you encounter a motor vehicle crash. You can see one patient lying motionless on the ground near her overturned vehicle. As an off-duty paramedic, you: A: Should call 911 but not stop to provide care B: May feel an ethical obligation to stop and assist C: May have a legal responsibility to stop and render aid D Should stop if you have an EMS decal on your car

B: May feel an ethical obligation to stop and assist

The initial complaint field against a paramedic or EMS system by a dissatisfied patient: A: Is typically detailed and contains specific information about what went wrong B: May not contain specific information about what the patient thinks went wrong C: Does not include the name of the paramedic or EMS system who is being sued D: Must be reviewed by a judge in order to determine if the complaint is justified

B: May not contain specific information about what the patient thinks went wrong

If your EMS system receives a subpoena for the patient's protected health information, it would be MOST appropriate to: A: Disclose the information requests by the subpoena B: Notify legal counsel before releasing any information C: Refuse to disclose any of the patient's protected information D: Obtain the patient's consent before releasing any information

B: Notify legal counsel before releasing any information

Which of the following statements regarding ethics in the workplace is correct? A: Acknowledging a patient's cultural beliefs is a low priority if he or she is critically ill or injured B: Off-duty misconduct on the part of the paramedic may lesson the public's confidence in EMS in general C: EMS has long been recognized and funded in the same manner as the other health care professions D: Paramedics are accountable only to the EMS systems medical director and to the director of EMS operation

B: Off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS in general

Radio transmission distances from a mobile transceiver are reduced: A: By fog or light rain B: Over mountainous areas C: Over water or flat terrain D: With greater than 7.5 W of power

B: Over mountainous areas

Patient autonomy is MOST accurately defined as the: A: Court's support and upholding of the rights of a patient with regard to health care decisions B: Patient's right to direct his or her own care and to decide how end-of-life care should be provided C: Inability of the patient to refuse medical treatment once he or she has given appropriate consent D: Right of the patient to determine which medications the paramedic should administer for a given situation

B: Patient's right to direct his or her own care and decide how end-of-life care should be provided

If a patient mentions something in passing or avoids answering a specific question, you should: A: Assume that he or she is intentionally hiding something B: Politely redirect his or her attention to that question C: Ask the patient why he or she did not provide an answer D: Defer the question and continue your interview

B: Politely redirect his or her attention to that question

The BEST protections for the paramedic is to: A: Always transport the patient to the hospital of the patient's choice, regardless of the patient's clinical condition B: Provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation C: Routinely obtain more than the minimum number of continuing education credits required by the state department of health D: Treat all patients wish respect and remain aware that patient's cultural beliefs may differ from those of the paramedic

B: Provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation

When transmitting information via radio, you should: A: Break long messages into 60-second segments B: Use a normal conversational tone of voice C: Speak with your voice slightly elevated D: Keep your mouth 1" from the microphone

B: Use a normal conversational tone of voice

115. If nonencapsulated bacteria enter the body: A) exogenous antibiotic therapy is not effective. B) antibodies coat them so phagocytosis can occur. C) macrophages begin to destroy them immediately. D) antibodies are not produced and released into the blood.

You are called to a community center for a 40-year old woman who is "acting strange." Upon your arrival, you assess the patient and determine that she is conscious, alert, and oriented to person, place, time, and event. She does not appear to be mentally impaired. Her oxygen saturation is 99% on room air and her blood glucose level is 112 mg/dL. The patient's husband tells you that his wife has bipolar disorder and takes medication for it. The patient tells you that she is fine and does not want to go to the hospital. You should: A: Contact online medical control and request permission to transport the patient against her will because of her bipolar disorder B: Recognize that this patient has decision making capacity at the present time and that you cannot force her to go to the hospital C: Transport the patient against her will, but only if it can be established that she has been noncompliant with her bipolar medication D: Advise the patient that, because of her history of bipolar disorder, she does not have the legal capacity to refuse EMS treatment and transport

B: Recognize that this patient has decision making capacity at the present time and that you cannot force her to go to the hospital

If a patient avoids answering a specific question, you should: A: Conclude that the patient is trying to hide something B: Redirect him or her to the question to elicit a response C: Document that the patient did not answer the question D: Avoid repeating the question as this may upset the patient

B: Redirect him or her to the question to elicit a response

A patient states, "I can't catch my breath," and the paramedic responds, "you say you can't catch your breath, ma'am?" This is an example of: A: Facilitation B: Reflection C: Confrontation D: Interpretation

B: Reflection

You are caring for a 66-year old man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating, "Just let me die with dignity!" You should: A: Tell him that the oxygen is crucial in preventing him from experiencing cardiac arrest B: Respect the patient's wishes and ask him if he wants to be transported to the hospital C: Contact medical control and request permission to treat without the patient's consent D: Recognize that patients with terminal illnesses do not have decision-making capacity

B: Respect the patient's wishes and ask him if he wants to be transported to the hospital

A reasonable paramedic should follow the same _____ that another paramedic in a similar situation would. A: Scope of practice B: Standard of care C: Wishes of the family D: Medical practice act

B: Standard of care

Which of the following is an example of a protocol? A: Radio orders B: Standing orders C: Online medical control D: Verbal order by a physician

B: Standing orders

When determining whether a paramedic's actions were consistent with the standard of care, the court would be LEAST likely to: A: Speak with other paramedics who have done the same training B: Talk to patients to whom the paramedic has provided care in the past C: Subpoena the paramedics' instructor and the text he or she used D: Request a copy of the paramedic's standard operating procedures

B: Talk to patients to whom the paramedic has provided care in the past

The BEST way for the paramedic to evaluate a patient's decision-making capacity is to: A: Determine if the patient knows what care is appropriate for the situation B: Talk to the patient to determine if he or she understands what is happening C: Confirm that the patient is at least 18 years of age or otherwise emancipated D: Ensure that pulse oximetry and blood glucose readings are within normal limits

B: Talk to the patient to determine if he or she understands what is happening

Which of the following is an example of slander? A: Asking a family member if the patient uses drugs B: Telling the receiving facility that a patient is drunk C: Asking a patient if he or she is under psychiatric care D: Documenting that you noted the possible smell of alcohol

B: Telling the receiving facility that a patient is drunk

If an EMS agency's call volume is too heavy to allow response within an appropriate time frame: A: The agency no longer has a legal duty to respond B: The agency is obligated to use mutual aid resources C: Off-duty personnel are legally obligated to respond D: All area hospitals must be made aware of the situation

B: The agency is obligated to use mutual aid resources

When an ambulance collides with a citizen's vehicle at an intersection: A: It is because the citizen failed to yield the right of way B: The driver of the ambulance may be charged criminally C: Most state laws provide immunity to the EMS vehicle D: EMS providers are rarely found at fault in civil lawsuits

B: The driver of the ambulance may be charged criminally

Which of the following is NOT a required element needed to prove negligence? A: The paramedic committed a breach of duty B: The patient's condition was life threatening C: The paramedic or EMS system had a duty to act D: An act of omission was the cause of the patient's injury

B: The patient's condition was life threatening

It is important to remember that if a patient is not personally sensitive to modesty because of an impaired mental state: A: This will not influence your care B: The patient's family likely will be C: Then he or she will not care about your treatment D: Protecting his or her privacy is of lesser concern

B: The patient's family likely will be

When communicating with older patients, it is MOST important to remember that: A: Many older patients lose the ability to understand simple terminology, thus requiring the paramedic to gear his or her questions accordingly B: Their illnesses may be more complex because they may have more than one disease process and may be taking several medications concurrently C: The ability to hear and see is naturally impaired due to the process of aging, and the paramedic must accommodate these disabilities appropriately D: Older patients are generally poor historians regarding their medical history, and the paramedic should interview a family member or friend instead

B: Their illnesses may be more complex because they may have more than one disease process and may be taking several medications concurrently

Which of the following statements regarding ten-does is correct? A: All EMS agencies utilize a universal ten-code system B: They should be avoided during a mass-casualty situation C: The purpose of ten-codes is to ensure transmission clarity D: Most services use ten-codes for regular day-to-day operations

B: They should be avoided during a mass-casualty situation

While en route to a call for an emotionally disturbed patient, law enforcement notifies you by radio that the patient has become extremely violent. You should: A: Continue to the scene and assist law enforcement in restraining the patient B: Wait for law enforcement to advise you that they have the patient under control C: Carefully enter the scene and administer a benzodiazepine to sedate the patient D: Advise law enforcement to handcuff the patient and transport him to the hospital

B: Wait for law enforcement to advise you that they have the patient under control

A patient's wife called 911 because the patient was complaining of a severe headache and nausea. The patient is conscious and alert, but obviously upset that his wife called 911 without consulting him first. As you present the blood pressure cuff, the patient folds his arms and turns away from you. From this patient's actions, you should conclude that: A: He is not mentally competent B: You do not have consent to treat him C: Consent to treat this patient is implied D: He will only consent to EMS transport

B: You do not have consent to treat him

1. The study of the functioning of an organism in the presence of disease is called: A) biology. B) physiology. C) pathophysiology D) biochemistry.

101. In decompensated shock, systolic blood pressure is: A) less than 90 mm Hg in adult males. B) less than 80 mm Hg in adult females. C) less than the fifth percentile for the age. D) usually undetectable due to vasodilation.

106. Red bone marrow is essential for the formation of: A) calcium. B) interstitial fluid. C) mature blood cells. D) granular leukocytes.

137. The resistance stage of the stress reaction is characterized by: A) an immediate release of the catecholamines epinephrine and norepinephrine, which causes the fight-or-flight response B) a reduction of cortisol in the body, which predisposes the person to acute inflammatory processes. C) stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure. D) adrenal gland depletion, which leads to decreased blood glucose levels, physical exhaustion, and immunocompromise.

138. Severe, prolonged stress: A) is frequently a direct cause of death. B) results in the destruction of cholesterol and fat. C) causes the body to lose its ability to fight disease. D) results in chronically low levels of cortisol.

16. Which of the following is an example of homeostatic failure? A) A pH balance of 7.37 with a respiratory rate of 28 breaths/min B) Severe vomiting and diarrhea and a heart rate of 120 beats/min C) Salt and water retention and a blood pressure of 170/98 mm Hg D) Core body temperature of 98.2°F and an ambient temperature of 28°F

22. An alteration in the size, shape, and organization of cells is called: A) atrophy. B) metaplasia. C) dysplasia. D) hypertrophy.

28. When comparing two solutions, the solution that has a higher solute concentration and a higher osmotic pressure is referred to as a(n) __________ solution. A) isotonic B) hypotonic C) hypertonic D) crystalloid

32. What type of pressure is generated by dissolved proteins in the plasma that are too large to penetrate the capillary membrane? A) Capillary hydrostatic pressure B) Tissue hydrostatic pressure C) Capillary colloidal osmotic pressure D) Tissue colloidal osmotic pressure

37. When blood osmolarity increases: A) the kidneys excrete more water from the body through diuresis in an attempt to normalize the blood's osmolarity. B) osmoreceptors located in the hypothalamus stimulate the release of vasopressin, which causes the body to retain water. C) the pituitary gland releases antidiuretic hormone (ADH), which stimulates the kidneys to resorb water and decrease the blood's osmolarity. D) volume-sensitive receptors in the atria stretch, causing the release of natriuretic proteins that normalize the blood's osmolarity.

42. Aldosterone acts on the kidneys by: A) increasing potassium reabsorption into the blood and enhancing sodium elimination in the urine. B) dilating the renal vasculature, thus enhancing renal blood flow and facilitating sodium excretion. C) increasing sodium reabsorption into the blood and enhancing potassium elimination in the urine. D) constricting the renal vasculature, thus slowing renal blood flow and decreasing the glomerular filtration rate.

47. Hyperkalemia is defined as: A) excess potassium in the cells. B) a relative deficit of sodium. C) an elevated serum potassium level. D) a critically low magnesium level.

48. All of the following factors would cause potassium to shift into the cell, EXCEPT: A) alkalosis. B) epinephrine release. C) increased vagal tone. D) insulin administration

53. A patient with chronic renal insufficiency who has been taking laxatives and presents with confusion, muscle weakness, and decreased deep tendon reflexes MOST likely has: A) decreased serum sodium levels. B) an overall decrease in serum potassium. C) an increased serum level of magnesium. D) increased intracellular magnesium levels

58. A person who ingests an excessive amount of salicylate would MOST likely experience: A) alkalosis. B) bradycardia. C) a fall in pH. D) hypoventilation.

63. What chemical induces hypoxia by blocking oxidative phosphorylation in the mitochondria and preventing oxygen metabolism? A) Lead B) Ethanol C) Cyanide D) Carbon monoxide

70. Which of the following disease processes is more common in women? A) Gout B) Lung cancer C) Osteoporosis D) Parkinson's disease

71. The prevalence of a particular disease refers to: A) the frequency with which the disease occurs. B) how acutely the disease negatively affects a person. C) the number of cases in a particular population over time. D) the number of deaths from the disease in a given population.

76. Major risk factors for lung cancer include: A) female sex and age over 40 years. B) frequent respiratory infections and asthma. C) cigarette smoking and exposure to asbestos. D) chewing tobacco use and a history of allergies.

8. What type of tissue lines the intestines, blood vessels, and bronchiole tubes? A) Muscle B) Nervous C) Epithelial D) Connective

82. Syncope is probably NOT caused by a life-threatening dysrhythmia if it occurs: A) immediately after a person is startled. B) following exercise or heavy exertion. C) in a person whose cousin has syncope. D) in conjunction with chest pain or pressure

87. Common signs and symptoms of ulcerative colitis include all of the following, EXCEPT: A) pus or blood in the stools. B) recurrent abdominal pain. C) bloating after milk ingestion. D) fever, chills, and diarrhea.

89. Common health risks associated with obesity include all of the following, EXCEPT: A) diabetes. B) infertility. C) hypolipidemia. D) insulin resistance.

9. Endothelial cells that line the inside of blood vessels: A) are nonliving cells made of protein. B) are made of epithelial squamous cells. C) regulate blood flow and coagulation. D) are composed of specialized nervous tissue.

95. The MOST common cause of cardiogenic shock is: A) untreated hypertension. B) blunt force chest trauma. C) acute myocardial infarction. D) sustained pulmonary hypertension.

A "runaway" pacemaker is characterized by: A) an absence of pacemaker spikes. B) profound slowing of the heart rate. C) a tachycardic pacemaker rhythm. D) a narrowing of the QRS complexes.

A 2-year-old child has experienced a proximal humeral fracture involving the growth plate. This plate is also called the: A) diaphyseal plate. B) metaphyseal plate. C) epiphyseal plate. D) endosteum plate

A 70-year-old man called 9-1-1 because of generalized weakness. When you arrive at the scene, you find the patient seated in his recliner. He is conscious and alert and is breathing without difficulty. Your physical exam reveals tenderness to his right upper abdominal quadrant, edema to his ankles, and distended jugular veins. The patient tells you that he takes Vasotec for hypertension and Maxide for his swollen ankles. His vital signs are stable. The MOST appropriate treatment for this patient includes: A) an IV of D5W, 0.4 mg of sublingual nitroglycerin, ECG, and transport. B) high-flow oxygen, vascular access, 1 mg/kg of furosemide, and transport. C) oxygen, cardiac monitoring, an IV line at a keep-open rate, and transport. D) 12-lead ECG acquisition, vascular access, 4 mg of morphine, and transport.

A 70-year-old woman remains in asystole following 10 minutes of well-coordinated CPR, successful intubation, IV therapy, and three doses of epinephrine. There are no obvious underlying causes that would explain her cardiac arrest. At this point, it would be appropriate to: A) attempt transcutaneous cardiac pacing. B) defibrillate one time in case she is in V-Fib. C) seriously consider ceasing resuscitative efforts. D) transport at once with CPR continuing en route.

A bruit differs from a murmur in that a bruit: A) represents widespread arteriosclerosis. B) is a benign physiologic abnormality. C) is auscultated over a main blood vessel. D) indicates turbulent blood flow in the heart.

A delta wave is identified on a cardiac rhythm strip as a(n): A) apparent P wave that occurs at the end of the QRS complex. B) acute widening of the QRS complex immediately after the R wave. C) rapid upslope to the R wave immediately after the end of the P wave. D) delay between the end of the P wave and the beginning of the R wave.

A key to interpreting a Mobitz type II second-degree heart block is to remember that: A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular. B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted. C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant. D) most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.

A loud S3 heart sound, when heard in older adults, often signifies: A) emphysema. B) valve rupture. C) heart failure. D) pulmonary hypertension.

A normal QT interval lasts: A) 0.15 to 0.25 seconds. B) 0.30 to 0.40 seconds. C) 0.36 to 0.44 seconds. D) 0.38 to 0.48 seconds.

A pathologic Q wave: A) generally indicates that an acute myocardial infarction has occurred within the past hour. B) is deeper than one quarter of the height of the R wave and indicates injury. C) is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. D) can only be substantiated by viewing at least two previous 12-lead ECGs.

A patient experiencing an acute coronary syndrome should receive morphine sulfate in an initial dose of: A) 0.5 mg/kg. B) 1 to 2 mg. C) 2 to 4 mg. D) 5 to 10 mg.

A patient is found to have a high blood sugar level (hyperglycemia). What is a cause of this? A) Excessive insulin levels in the blood B) Decreased production of glucagon C) Deficient insulin levels in the blood D) Hyperactivity of the pancreatic beta cells

A patient with orthopnea: A) experiences dyspnea during periods of exertion. B) prefers a semisitting position to facilitate breathing. C) experiences worsened dyspnea while lying down. D) sleeps in a recliner due to severe right heart failure.

A projection of the second cervical vertebra (C2) that fits into the vertebral foramen of the first cervical vertebra (C1) is called the: A) vertebra prominens. B) foramen magnum. C) odontoid process. D) spinous process.

A prolonged PR interval: A) is greater than 120 milliseconds. B) indicates that the AV node was bypassed. C) indicates an abnormal delay at the AV node. D) is a sign of rapid atrial depolarization.

A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a PR interval of 0.14 seconds, and QRS complexes that measure 0.10 seconds should be interpreted as: A) supraventricular tachycardia. B) normal sinus rhythm. C) sinus tachycardia. D) junctional tachycardia.

A wandering atrial pacemaker: A) has consistent P-wave shapes. B) is generally faster than 100 beats/min. C) may have variable PR intervals. D) is generally treated with atropine.

Acute coronary syndrome is a term used to describe: A) acute chest pressure or discomfort that subsides with rest or nitroglycerin. B) a clinical condition in which patients experience chest pain during exertion. C) any group of clinical symptoms consistent with acute myocardial ischemia. D) a sudden cardiac rhythm disturbance that causes a decrease in cardiac output.

Afterload is defined as the: A) volume of blood returned to the left and right atrium. B) amount of blood pumped from the heart per contraction. C) degree of pressure against which the left ventricle pumps. D) volume of blood pumped ejected from the heart per minute.

All of the following are endocrine glands, EXCEPT the: A) adrenal glands. B) thymus gland. C) sweat glands. D) pituitary gland.

All of the following are functions of the parasympathetic nervous system, EXCEPT: A) constriction of the pupils. B) lowering of the blood pressure. C) decreased gastrointestinal function. D) mediating arousal in males and females.

All of the following are strategies for decreasing the risk for cardiovascular disease, EXCEPT: A) smoking cessation. B) lipid management. C) anaerobic exercise. D) behavior modification.

An ST segment that is more than 1 mm above the isoelectric line: A) indicates myocardial ischemia. B) is clinically insignificant in lead II. C) must be substantiated by a 12-lead ECG. D) is a definitive sign of myocardial injury.

Anatomically contiguous leads view: A) opposite walls of the heart. B) only the lateral wall of the heart. C) the same general area of the heart. D) only the anterior wall of the heart.

In a patient with left heart failure and pulmonary edema: A) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood. B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart. C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli. D) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.

In contrast to arteries, veins: A) do not contain valves that prevent backflow of blood. B) have less capacity to increase the size of their diameter. C) are more likely to distend when exposed to backpressure. D) operate on the high-pressure side of the circulatory system.

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm: A) often waxes and wanes. B) gradually becomes severe. C) is maximal from the onset. D) is preceded by other symptoms.

In contrast to treatment for supraventricular tachycardia, treatment for multifocal atrial tachycardia in the prehospital setting: A) is often more effective. B) involves atropine sulfate. C) is generally not effective. D) includes synchronized cardioversion.

Infarctions of the inferior myocardial wall are MOST often caused by: A) blockage of the left coronary artery. B) acute spasm of the circumflex artery. C) occlusion of the right coronary artery. D) a blocked left anterior descending artery.

It is MOST important to evaluate a cardiac arrhythmia in the context of the: A) patient's heart rate. B) patient's medical history. C) patient's overall condition. D) width of the QRS complex.

Leakage of cerebrospinal fluid from the nose following severe head trauma suggests: A) fracture of the basilar skull. B) damage to the nasal sinuses. C) fracture of the cribriform plate. D) damage to the auditory canal.

Molecules that bind to a receptor's cells and trigger a response by that cell, thereby resulting in some kind of action or biologic effect, are called: A) steroids. B) proteins. C) agonists. D) hormones.

Movement of an extremity toward the midline of the body is called: A) supination. B) pronation. C) adduction. D) abduction.

Normal inhalation is the result of: A) diaphragmatic relaxation. B) air passively entering the lungs. C) negative pressure in the thoracic cavity. D) positive pressure in the thoracic cavity.

On the ECG strip, a third-degree AV block usually appears as a: A) wide QRS complex rhythm with a rate between 50 and 70 beats/min. B) slow, narrow QRS complex rhythm with irregular P-P intervals. C) slow, wide QRS complex rhythm with inconsistent PR intervals. D) narrow QRS complex rhythm with a rate less than 60 beats/min.

Patients with Wolff-Parkinson-White syndrome: A) have a diseased SA node, resulting in ectopic atrial pacemakers and abnormal AV nodal conduction. B) are highly susceptible to a variety of bradycardic rhythms due to an abnormal delay at the AV node. C) have an accessory pathway that bypasses the AV node and causes early ventricular depolarization. D) experience independent atrial depolarization due to failure of the Bachmann bundle between the atria.

Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of: A) jugular venous distention. B) a narrowing pulse pressure. C) clear and equal breath sounds. D) alterations in the QRS amplitude.

Phagocytosis is the process by which: A) phagocytes are produced. B) phagocytes are destroyed. C) monocytes digest microbes. D) microbes destroy monocytes.

Relative to the wrist, the elbow is: A) anterior. B) posterior. C) proximal. D) distal.

Severe injuries to the liver are life-threatening because it is: A) avascular and relatively small. B) poorly protected by the rib cage. C) highly vascular and very fragile. D) normally enlarged in most people.

Spironolactone is a(n): A) beta blocker. B) vasodilator. C) diuretic. D) antiarrhythmic.

Stimulation of the parasympathetic nervous system causes all of the following effects, EXCEPT: A) negative inotropy. B) increased salivation. C) dilation of the pupils. D) negative chronotropy.

The Levine sign is defined as: A) pushing on the sternum with the fingertips. B) rubbing the arm to which pain is radiating. C) a subconsciously clenched fist over the chest. D) a state of denial in patients with an acute myocardial infarction.

The MOST common cause of cardiac arrest in adult patients is: A) acute myocardial infarction. B) electrocution. C) a dysrhythmia. D) respiratory failure.

The MOST effective drug for the treatment of non-vagal-induced bradycardia is: A) atropine. B) dopamine. C) epinephrine. D) metoprolol.

The base of the epidermis, which continuously produces new cells that rise to the skin's surface, is called the: A) corneal layer. B) sebaceous layer. C) germinal layer. D) melanin layer.

The layer of tissue that lines the inside of the chest cavity is called the: A) visceral pleura. B) pulmonary pleura. C) parietal pleura. D) thoracic pleura.

The main pacemaker for breathing that is responsible for initiating respiration is called the: A) apneustic center. B) pneumotaxic center. C) dorsal respiratory group. D) ventral respiratory group.

The movement of a substance against a concentration or gradient that requires energy is called: A) endocytosis. B) osmotic pressure. C) active transport. D) facilitated diffusion.

The numerous connections among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery begins to narrow, are called: A) cardiac myocytes. B) the coronary sinus. C) collateral circulation. D) coronary microcirculation.

Ventricular fibrillation occurs when: A) the ventricles quiver rather than contract normally, while organized atrial contractions continue as normal. B) the ventricles become the primary pacemaker for the heart, resulting in a rapid and irregular ventricular rhythm. C) many different cells in the heart depolarize independently rather than in response to an impulse from the SA node. D) cardiac cells in the ventricles fail to completely repolarize, resulting in a decrease in ventricular automaticity.

What physiologic reaction occurs when a person's blood sugar level falls? A) The pancreas secretes more insulin. B) More glycogen is stored in the liver. C) Glucagon production is increased. D) The pancreatic beta cells become hyperactive

What type of tissue covers and lines internal organs? A) Connective B) Muscle C) Epithelial D) Striated

What type of valves are the aortic and pulmonic valves? A) Papillary B) Chordis C) Semilunar D) Atrioventricular

When administering aspirin to a patient with an acute coronary syndrome, you should: A) first check to make sure the patient is not severely hypertensive. B) administer half the usual dose if the patient has a history of stroke. C) have him or her chew and swallow 160 to 325 mg of baby aspirin. D) give up to 325 mg of enteric-coated aspirin for the patient to swallow.

When analyzing a cardiac rhythm strip in lead II, you should routinely evaluate all of the following components, EXCEPT the: A) QRS width. B) PR interval. C) ST segment. D) R-R interval.

When applying the limb leads, the negative lead should be placed on the: A) left arm. B) left leg. C) right arm. D) right leg.

When monitoring a patient's cardiac rhythm, it is MOST important to remember that: A) a heart rate below 60 beats per minute must be treated immediately. B) many patients with acute myocardial infarction experience asystole. C) the ECG does not provide data regarding the patient's cardiac output. D) the presence of a QRS complex correlates with the patient's pulse.

When viewing leads V3 and V4, you are looking at the _________ wall of the _________. A) septal, heart. B) lateral, left ventricle. C) anterior, left ventricle. D) inferior, right ventricle.

Which layer of the heart would be penetrated during an emergent medical procedure in order to remove fluid? A) Myocardium B) Epicardium C) Pericardium D) Endocardium

Which of the following ECG waveforms represents ventricular depolarization? A) T wave B) ST segment C) QRS complex D) U wave

Which of the following blood pressure readings is MOST suggestive of a patient who has arteriosclerosis? A) 140/90 mm Hg B) 150/80 mm Hg C) 160/70 mm Hg D) 180/110 mm Hg

Which of the following drugs possesses beta-2-specific properties? A) Dopamine B) Levophed C) Proventil D) Epinephrine

Which of the following interventions should be performed en route to the hospital during a lengthy transport of a patient with a suspected myocardial infarction? A) Supplemental oxygen B) Aspirin administration C) IV therapy and analgesia D) 12-lead electrocardiography

Which of the following mechanisms causes hypertension? A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity. B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion. C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart. D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.

Which of the following organs contain(s) the greatest number of lymphocytes? A) Liver B) Pancreas C) Spleen D) Kidneys

Which of the following organs/structures lie(s) in the retroperitoneal space of the abdomen? A) Liver B) Spleen C) Kidneys D) Superior vena cava

Which of the following physiologic responses would you expect to see in a patient with a pH of 7.50? A) Bicarbonate retention B) Increased respirations C) Decreased respirations D) Hydrogen ion excretion

Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take? A) Plavix and Vasotec B) Lisinopril and aspirin C) Digitalis and Coumadin D) Cordarone and furosemide

Which of the following pulseless rhythms is NOT treated as pulseless electrical activity? A) Sinus bradycardia B) Idioventricular rhythm C) Ventricular tachycardia D) Junctional escape rhythm

Which of the following situations would contraindicate the administration of nitroglycerin? A) Hypersensitivity to salicylates B) Systolic BP less than 110 mm Hg C) Tadalafil use within the last 24 hours D) Use of Plavix within the last 12 hours

Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct? A) Evidence has shown that high (greater than 90%) concentrations of oxygen reduce mortality. B) In order to prevent hypoxic injury, do not give any patient with an acute myocardial infarction more than 2 L/min of oxygen. C) Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%. D) Any patient experiencing an acute myocardial infarction should receive high-flow oxygen.

Which type of nerve cells conduct electrical impulses away from the cell body? A) Axons B) Neurons C) Dendrites D) Neurocytes

With regard to the heart, ejection fraction is defined as the: A) volume of blood that enters the lungs. B) volume of blood ejected from both atria. C) percentage of blood ejected from the heart. D) percentage of blood returned to the heart.

84. Generally, the only physical finding in a patient with a prolapsed mitral valve is: A) a chronically irregular heart rate. B) sharp chest pain following strenuous exertion. C) dyspnea and palpitations while in a sitting position. D) a clicking sound heard during cardiac auscultation.

48. Peer review can be a good learning experience if: A) the EMS system's medical director and administrative staff take part in the process. B) the person or persons conducting the review have at least 10 years of EMS experience. C) those conducting the review have good guidelines to follow and the person being evaluated keeps an open mind. D) the information gained from the review is shared with other personnel within the EMS system.

C) those conducting the review have good guidelines to follow and the person being evaluated keeps an open mind.

43. A protocol is MOST accurately defined as a(n): A) nationally accepted standard of care. B) verbal order given by the medical director. C) treatment plan for a specific illness or injury. D) agreement between the paramedic and physician.

C) treatment plan for a specific illness or injury.

The correct dose of aspirin for a patient with cardiac-related chest pain is: A) 81 to 162 mg, enteric. B) 81 to 324 mg, enteric. C) up to 325 mg, chewable. D) up to 160 mg, chewable.

C) up to 325 mg, chewable.

Ketorolac tromethamine (Toradol) should NOT be given to patients: A) taking a narcotic analgesic. B) older than 55 years of age. C) with a bleeding disorder. D) with an orthopaedic injury.

C) with a bleeding disorder.

Pancuronium bromide (Pavulon) is contraindicated if: A) the patient has a severe head injury and is hypertensive. B) you have reason to believe that the patient is hypovolemic. C) you cannot provide adequate ventilation and oxygenation. D) the patient has had his or her spleen surgically removed.

C) you cannot provide adequate ventilation and oxygenation.

Which of the following questions is the MOST effective when inquiring about a patient's chest pain? A: "Is the pain sharp or dull?" B: "Does the pain feel more like pressure?" C: "Can you describe the pain to me?" D: "Does the pain radiate to your arm?"

C: "Can you describe the pain to me?"

An elderly man states that he is sad and depressed because his wife recently died of cancer. Which of the following statements from the paramedic demonstrates empathy? A: "I understand why you are sad, and I am sad for you. Is there anything I can do to make you feel better?" B: "I'm sorry to hear about your wife, but you should take comfort in the fact that she is in a better place." C: "I'm sorry, sir. I don't know how I would feel in your situation, but I am sure it would be similar." D: "Your wife's death is very tragic, but perhaps going to the hospital will provide you with some relief."

C: "I'm sorry, sit. I don't know how I would feel in your situation, but I'm sure it would be similar."

Which of the following statements is an example of providing false reassurance? A: "Your condition does not appear to be life-threatening at the present time, but that could change." B: "I can see that you are obviously upset, but I will provide the best care possible to you." C: "I'm sure that you will be fine, but let us take you to the hospital just to be on the safe side." D: "I don't see any abnormalities on your ECG, but you should be evaluated by a physician."

C: "I'm sure that you will be fine, but let us take you to the hospital just to be on the safe side."

When a patient repeatedly apologizes to you because he or she is incontinent, you should say: A: "I understand your embarrassment, but it is okay." B: "Don't worry about it because we see this all the time." C: "You don't have to apologize; that's what we're here for." D: "Given the situation, your incontinence is understandable."

C: "You don't have to apologize; that's what we're here for."

Which of the following patients is NOT an emancipated minor? A: 17-year old man who is a member of the U.S. armed forces B: 16-year old woman who is pregnant and lives with her boyfriend C: 17-year old woman who goes to college and lives with her parents D: 18-year old woman who is pregnant and lives with her grandmother

C: 17-year old woman who goes to college and lives with her parents

Which of the following scenarios reflects a violation of EMTALA? A: A registration clerk asks you if a patient has insurance B: An emergency department provides stabilization care only C: A hospital transfers an unstable patient to another facility D: Paramedics transport a woman in labor to the closest hospital

C: A hospital transfers an unstable patient to another facility

Which of the following statements regarding the harm element of a negligence lawsuit is MOST correct? A: The burden of proof for establishing harm rests with the defendant B: Serious injury must have occurred in order for harm to be established C: A loss of earning capacity is a form of harm that the patient may claim D: Loss of income is the most common form of harm proven in a lawsuit

C: A loss of earning capacity is a form of harm that the patient may claim

Conducting EMS research studies on critically ill or injured patients without their informed consent is: A: Inappropriate B: Ethically acceptable C: A true ethical dilemma D: Legal under the law of implied consent

C: A true ethical dilemma

You deliver a 61-year old man with abdominal pain to a busy emergency department. A staff nurse instructs you to take the patient to the triage area where he will be tender to later. She further tells you that after you leave a copy of your patient care report with the clerk, you are free to leave. You should: A: Do as the nurse instructs you and thoroughly document the incident to ensure you are not accused of abandonment B: Leave the patient in the triage area, give your patient care report to the clerk and tell the clerk to keep an eye on the patient C: Advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient D: Transfer the patient to a gurney in a highly visible area, advise the nurse of what you did, and give the nurse a copy of your patient care report

C: Advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient

Although the technicalities of EMS DNR orders vary from state to state, they all: A: Are completely irrevocable by the patient's immediate family members B: Require the patient to wear a DNR insignia such as a bracelet or necklace C: Are designed to tell EMS providers when resuscitation is or is not appropriate D: Must be renewed every 5 years or they will expire and become null and void

C: Are designed to tell EMS providers when resuscitation is or is not appropriate

You arrive at the scene of a motor-vehicle versus pedestrian accident. The patient is a 12-year old girl who was struck by a car while riding her bike. She is conscious but combative. She has a large hematoma on her leg and several hematoma to her forehead. As a police officer attempts to contact the child's parents, you should: A: Provide supportive care only but do not transport the child until the parents arrive and give consent Closely monitor the child's condition and begin emergency treatment after obtaining consent from both parents C: Assume that her parents would consent to emergency treatment and initiate the appropriate care for the child D: Withhold all emergency care until you have obtained consent from at least one of her parents via telephone

C: Assume that her parents would consent to emergency treatment and initiate the appropriate care for the child

You arrive at the scene of a shooting. The patient, a 19-year old man, has a gunshot wound to the side of his head with a large amount of exposed brain matter. Further assessment reveals that the patient is apnec and pulseless. Law enforcement personnel advise you that the person who shot the patient is in their custody. You should: A: Begin resuscitative measures at once and contact the patient's family to determine if he is an organ donor B: Begin CPR immediately, cover the wound with a bulky dressing, and prepare to transport the patient C: Avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene D: Place plastic bags over the patient's hands, apply a cardiac monitor to confirm asystole, and notify the coroner's office

C: Avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene

While caring for a conscious and alert 49-year old man with a suspected myocardial infarction, you start an IV prior to obtaining the patient's consent. This action constitutes: A: Appropriate care B: Assault C: Battery D: Gross negligence

C: Battery

You arrive at the scene of a major motor vehicle crash. The patient, a 29-year old man, is in cardiac arrest from a severe head injury and has been receiving bystander CPR for approximately 10 minutes. A law enforcement official advises you that the patient's driver's license identifies him as an organ donor. You should: A: Recognize that none of the patient's vital organs are appropriate for donation and ask the bystanders to stop CPR B: Continue to attempt resuscitation of the patient because his liver, kidneys, and heart are likely viable for harvesting C: Begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting D: Continue basic life support only until law enforcement can notify a family member of the patient and obtain consent for organ donation

C: Begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting

Which of the following general statements regarding violent patients is correct? A: You must rule out hypoglycemia before restraining a violent patient B: Ideally, violent patients should be restrained in a face-down position C: Benzodiazepines are acceptable to use as a means of chemical restraint D: Most patients become violent because of a severe psychiatric condition

C: Benzodiazepines are acceptable to use as a means of chemical restraint

Abandonment occurs when: A: A patient is released and did not require further medical care B: An emergency nurse takes a verbal report from a paramedic C: Care of a patient was terminated without his or her consent D: A patient refuses care and subsequently dies of his condition

C: Care of a patient was terminated without his or her consent

Current bioethical guidelines regarding the decision not to initiate resuscitation efforts rely mainly on the use of: A: Flexible algorithms and protocols B: The personal beliefs of the paramedic C: Common sense and reasonable judgement D: Criteria established by the local coroner

C: Common sense and reasonable judgement

If a conflict arises between a paramedic and a physician bystander in the field, the paramedic should: A: Become subordinate to the physician B: Involve law enforcement in the incident C: Contact medical control to seek resolution D: Politely ask the physician to leave the scene

C: Contact medical control to seek resolution

A hospital that is in violation of EMTALA: A: Is fined by the health insurance company B: Is responsible to the state board of health C: Could forfeit all of its Medicare funding D: Must pay a monetary settlement to the patient

C: Could forfeit all of is Medicare funding

The Good Samaritan law was originally passed in order to A: Encourage paramedics to respond while on duty B: Discourage EMS systems from billing the patient C: Encourage the public to help at emergency scenes D: Provide immunity from liability to the paramedic

C: Encourage the public to help at emergency scenes

Before asking a patient to sign a refusal form, the paramedic must: A: Ask an impartial observer to sign the refusal form first B: Tell the patient that he or she will die without treatment C: Ensure the patient is aware of the risks of his or her refusal D: Ask a police officer to determine if the patient is competent

C: Ensure the patient is aware of the risks of his or her refusal

Which aspect of the HIPAA is MOST pertinent to the paramedic? A: Documenting a thorough patient assessment B: Recovering funds from insurance companies C: Ensuring that the patient's privacy is protected D: Disclosing patient information to the media

C: Ensuring that the patient's privacy is protected

Transporting a competent adult patient without his or her consent would MOST likely result in allegations of: A: Assault B: Battery C: False imprisonment D: Criminal trespassing

C: False imprisonment

When transmitting data over the radio, you should NOT disclose the patient's: A: Vital signs B: Chief complaint C: HIV status D: Age and sex

C: HIV status

If an off-duty paramedic stops at the scene of a motor vehicle crash, the paramedic: A: Does not have a legal duty to provide care B: Must accompany the patient to the hospital C: Has a legal obligation to provide patient care D: Is legally protected by the Good Samaritan law

C: Has a legal obligation to provide patient care

If a patient provides an inappropriate response to a paramedic's question, it should be assumed that the patient: A: Is frightened by the situation B: Does not wish to communicate C: Has impaired cerebral function D: Is not willing to cooperate

C: Has impaired cerebral function

10. Which of the following statements regarding connective tissue is MOST correct? A) Connective tissue is enclosed by fascia. B) Connective tissue can transmit electrical impulses. C) Skeletal muscle is a type of connective tissue. D) Connective tissue binds other types of tissue together.

Cardiac output is equal to: A) systole minus diastole. B) blood pressure multiplied by heart rate. C) heart rate minus systolic blood pressure. D) stroke volume multiplied by heart rate.

103. Which of the following statements regarding multiple organ dysfunction syndrome (MODS) is correct? A) MODS typically develops within 20 to 30 minutes following resuscitation from cardiac arrest. B) At the cellular level, MODS results in aerobic metabolism, metabolic alkalosis, and impaired cellular function. C) Signs and symptoms of MODS include compensatory hypertension, bradycardia, and a fever greater than 105°F. D) MODS occurs when injury or infection triggers a massive systemic immune, inflammatory, and coagulation response

109. Which of the following statements regarding basophils is correct? A) Basophils release chemicals that destroy parasitic invaders. B) Basophils account for approximately 70% of the leukocytes. C) Basophils travel to the tissues, where they become macrophages. D) Basophils release histamine and other chemicals that dilate blood vessels.

114. Opsonization is a process in which: A) antibodies bind to and inactivate toxins produced by bacteria. B) antibodies cause antigens to clump together to facilitate phagocytosis. C) a mother passes IgG and IgM antibodies to the fetus via breast milk. D) an antibody coats an antigen to facilitate its recognition by immune cells.

119. Slow-reacting substances of anaphylaxis are also known as: A) histamine. B) mast cells. C) eosinophils. D) leukotrienes.

12. Unlike skeletal muscle, cardiac muscle is: A) striated voluntary. B) nonstriated voluntary. C) nonstriated involuntary. D) striated involuntary.

124. Interleukins function by: A) releasing prothrombin from the liver and converting it to thrombin. B) stimulating macrophages to help engulf and destroy foreign substances. C) keeping leukocytes at the infection site until they can perform their task. D) attracting white blood cells to the sites of injury and bacterial invasion.

125. When nerve cells and cardiac myocytes are injured: A) they are replaced by regeneration from remaining cells. B) their cells divide completely and thus heal completely. C) a slow influx of blood flow causes progressive repair. D) scar tissue forms because these cells cannot be replaced.

13. ___________ nerves exit from between the spinal vertebrae and extend to various parts of the body. A) Cranial B) Connecting C) Somatic D) Peripheral

130. The body's rejection of an organ following transplantation is MOST likely the result of: A) autoimmunity. B) hypersensitivity. C) an infection. D) isoimmunity.

136. If an Rh-negative person receives Rh-positive blood: A) thrombocytopenia will occur. B) antibodies will not be released. C) a transfusion reaction will not occur. D) hemolysis and anemia can result.

17. In healthy adults, a loss of more than ____% of total body fluid is required to alter homeostasis and cause illness. A) 10 B) 15 C) 20 D) 30

21. Enlargement of the left ventricle due to chronically elevated blood pressure is called: A) atrophy. B) dysplasia. C) hyperplasia. D) hypertrophy.

26. The net effect of osmosis is to: A) equalize the amount of water on both sides of the cell membrane. B) shift extracellular fluid to the intracellular and intravascular fluids. C) passively transport a solution to an area of lower solute concentration. D) equalize the concentrations of a solute on both sides of the cell membrane.

31. Plasma comprises approximately ___% of the blood. A) 25 B) 35 C) 45 D) 55

35. Acute pulmonary edema: A) commonly results from right-sided heart failure. B) results in excess elimination of carbon dioxide. C) is characterized by progressively worsening dyspnea. D) impairs oxygen diffusion into the pulmonary capillaries.

4. An organ is composed of: A) a group of cells. B) multiple organisms. C) identical cells and tissues. D) various types of tissues

41. When renin is released: A) the conversion of angiotensin I to angiotensin II is inhibited, which facilitates excretion of sodium via the kidneys. B) the lungs convert the plasma protein angiotensinogen to angiotensin I, which dilates the renal blood vessels and increases kidney function. C) the pancreatic alpha cells secrete the hormone glucagon, which facilitates the conversion of glycogen to glucose in the liver. D) the angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates sodium resorption by the renal tubules.

46. Which of the following factors would MOST likely cause hyponatremia? A) Mild fever B) A seizure C) Acute nausea D) Diuretic use

50. Which of the following medications does NOT shift potassium into the cells? A) Insulin B) Albuterol C) Bicarbonate D) 50% dextrose

55. The MOST major challenge to pH homeostasis is: A) hyperventilation. B) CO2 elimination. C) acute fluid loss. D) acid production.

61. Which of the following conditions would be the LEAST likely to cause hyperventilation? A) Ketoacidosis B) Severe infection C) Aspirin overdose D) Metabolic alkalosis

67. Unlike bacteria, viruses: A) are unable to replicate. B) are treated effectively with antibiotics. C) do not produce an immune response. D) do not produce exotoxins or endotoxins.

69. If an injury leading to cell degeneration is of sufficient intensity and duration: A) ischemia will result in simple necrosis. B) the cell will undergo coagulation necrosis. C) the cell will become inflamed and may burst. D) irreversible cell injury will lead to cell death

74. Recurrent episodes of rheumatic fever would MOST likely cause: A) metastatic brain cancer. B) frequent streptococcal infections. C) progressive failure of the liver. D) permanent damage to the heart valves.

79. Hemolytic anemia is a disease characterized by: A) decreased production of red blood cells. B) premature death of white blood cells. C) an overproduction of red blood cells. D) increased destruction of red blood cells.

Common causes of bradycardia include: A) exercise. B) hyperthermia. C) amphetamines. D) beta blocker use.

A 33-year-old woman presents with an acute onset of "fluttering" in her chest. She is conscious and alert but is somewhat anxious. She denies any significant medical problems but states that she has been under a lot of stress at work. You apply the cardiac monitor, which reveals a narrow QRS complex tachycardia at a rate of 170 beats/min. The patient's blood pressure is 140/90 mm Hg, and she is breathing without difficulty. The MOST appropriate treatment for this patient involves: A) oxygen, vagal maneuvers, and emotional support. B) vagal maneuvers, IV access, and 0.25 mg/kg of diltiazem. C) oxygen, emotional support, and 2.5 mg of midazolam IM. D) oxygen, IV access, vagal maneuvers, and 6 mg of adenosine.

A 68-year-old woman presents with an acute onset of confusion, shortness of breath, and diaphoresis. Her blood pressure is 72/50 mm Hg, her heart rate is slow and weak, and her respirations are increased and shallow. The ECG reveals a third-degree heart block at a rate of 38 beats/min. After placing the patient on high-flow oxygen, you should: A) start an IV and administer 0.5 mg atropine. B) obtain a 12-lead ECG to detect an acute myocardial infarction. C) obtain vascular access and give a fluid bolus. D) immediately attempt transcutaneous pacing.

A hypertensive emergency is MOST accurately defined as: A) an increase in the blood pressure due to medication noncompliance. B) an elevated blood pressure that is accompanied by a frontal headache. C) a blood pressure greater than 170/90 mm Hg with a severe nosebleed. D) an acute elevation in blood pressure with signs of end-organ damage.

A newborn's total body water content is approximately: A) 40% of total body weight. B) 50% of total body weight. C) 60% of total body weight. D) 80% of total body weight.

A pH of 7.30 indicates: A) a neutral pH. B) a basic pH. C) alkalosis. D) acidosis.

A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from: A) supplemental oxygen. B) a high-dose vasopressor infusion. C) a 250-mL bolus of a crystalloid solution. D) rapid transport to an appropriate hospital.

A patient with a medical condition that requires antiplatelet therapy would MOST likely be taking: A) Coreg. B) Altace. C) Zocor. D) Plavix.

A protein of the immune system that recognizes foreign substances is called a(n): A) bilirubin. B) antigen. C) pathogen. D) antibody.

A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 beats/min, narrow QRS complexes, and a PR interval of 0.16 seconds should be interpreted as a(n): A) ectopic atrial rhythm. B) junctional escape rhythm. C) supraventricular tachycardia. D) accelerated junctional rhythm.

A slight dilation at the carotid bifurcation, called the ________________, contains structures that are important in regulating blood pressure. A) foramen ovale B) circle of Willis C) fossa ovalis D) carotid sinus

A specialized part of the venous system that filters the blood and metabolizes various drugs is called the: A) duodenal portal system. B) splenic portal system. C) renal portal system. D) hepatic portal system.

A wide QRS complex that is preceded by a normal P wave indicates: A) that the rhythm is ventricular in origin. B) rapid conduction through the ventricles. C) a delay in conduction at the AV junction. D) an abnormality in ventricular conduction.

Abnormal neurologic signs that accompany hypertensive encephalopathy occur when: A) pressure in the brain causes transient dysfunction of the parietal lobe and cerebral vasodilation. B) the mean arterial pressure exceeds 100 mm Hg and blood is forced from the brain and into the spinal cord. C) neurons sustain permanent damage secondary to a single increase in blood pressure above 200/130 mm Hg. D) pressure causes a breach in the blood-brain barrier and fluid leaks out, causing an increase in intracranial pressure.

According to the Einthoven triangle, lead II is assessed by placing the: A) negative lead on the left arm and the positive lead on the left leg. B) positive lead on the left leg and the negative lead on the right arm. C) positive lead on the left arm and the negative lead on the right arm. D) negative lead on the right arm and the positive lead on the left leg.

Administering a drug that possesses a positive chronotropic effect will have a direct effect on: A) stroke volume. B) blood pressure. C) cardiac output. D) the heart rate.

An early complex that breaks the regularity of the underlying rhythm and that is characterized by a narrow QRS complex and an upright P wave that differs in shape and size from the P waves of the other complexes MOST accurately describes a(n): A) atrial escape complex. B) wandering atrial pacemaker. C) junctional escape complex. D) premature atrial complex.

An electrical impulse is slightly delayed at the AV node so that the: A) bundle of His can depolarize fully. B) ventricles can contract completely. C) primary cardiac pacemaker can reset. D) atria can empty into the ventricles.

An organism will be biologically male if the 23rd chromosome pair in the zygote is: A) X. B) Y. C) XX. D) XY.

An unconscious, adequately breathing patient should be placed in the recovery position, which is: A) supine. B) prone. C) semi-sitting. D) laterally recumbent.

Antibodies made by the liver that make up about 36% of the plasma proteins are called: A) albumins. B) neutrophils. C) lysosomes. D) globulins.

As electricity travels down the left and right bundle branches, it first stimulates the: A) Purkinje fibers. B) interatrial pathways. C) ventricular myocardium. D) intraventricular septum.

Atrial kick is defined as: A) the blood that flows passively into the ventricles. B) pressure on the AV valves during ventricular contraction. C) an attempt of the atria to contract against closed valves. D) increased preload pressure as a result of atrial contraction.

Blood enters the right atrium of the heart from the: A) vena cava and aorta. B) aorta and coronary sinus. C) pulmonary vein and aorta. D) vena cavae and coronary sinus.

Which of the following statements regarding the use of vasopressin when managing cardiac arrest is correct? A) If the initial drug you give is epinephrine, vasopressin should not be administered to the patient. B) Vasopressin and epinephrine should be given together to achieve a more potent vasopressor effect. C) Unlike epinephrine, vasopressin provides greater alpha and beta adrenergic stimulation. D) A one-time dose of 40 units of vasopressin may be given to replace the first or second dose of epinephrine.

You are assessing a conscious and alert middle-aged male who complains of chest discomfort and nausea. His blood pressure is 112/70 mm Hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patient's past medical history is significant for hypothyroidism and hyperlipidemia. His medications include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer? A) Aspirin B) Fentanyl C) Morphine D) Nitroglycerin

You are assessing the 12-lead tracing of a 40-year-old man with chest pain and note ST-segment elevation in leads II, III, and aVF. Lead V4R shows 2-mm ST-segment elevation. The patient's blood pressure is 88/58 mm Hg, and his heart rate is 72 beats/min and regular. He denies any significant past medical history but is allergic to salicylates. After placing the patient on oxygen and starting an IV line of normal saline, you should: A) administer up to 325 mg of baby aspirin. B) give 2-mg increments of morphine sulfate. C) start a dopamine infusion at 2 µg/kg/min. D) give crystalloid boluses to increase preload.

You are dispatched to a residence at 2:00 AM for an elderly man with shortness of breath. The patient tells you that he was suddenly awakened with the feeling that he was smothering. You note dried blood on his lips. The patient tells you that he has some type of "breathing problem," for which he uses a prescribed inhaler and takes a "heart pill." You should suspect: A) right ventricular failure. B) reactive airway disease. C) acute COPD exacerbation. D) left-sided heart failure.

You are performing CPR on an 80-year-old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 beats/min. According to the patient's husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to: A) administer 1 mg of atropine while CPR is ongoing. B) assess the rhythm and pulse after 3 minutes of CPR. C) administer 50% dextrose for presumed hypoglycemia. D) continue CPR and administer crystalloid fluid boluses.

You have applied the cardiac monitor to your 66-year-old male cardiac arrest patient and see what appears to be asystole. You should: A) check for a pulse for a maximum of 10 seconds. B) resume CPR and place an advanced airway device. C) continue CPR and reassess the rhythm in 2 minutes. D) assess another lead or increase the gain sensitivity.

You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to: A) attempt cardiac pacing. B) check the carotid pulse. C) assess breathing effort. D) resume CPR at once.

Dr. Eugene Nagel advanced emergency medical treatment in 1969 by: A) training paramedics to administer certain medications directly through the chest wall and into the left ventricle. B) developing and implementing closed-chest cardiac massage (CPR) in order to pump blood in a patient without a pulse. C) implementing the "golden hour," which dramatically increased survival rates of patients who experienced severe trauma. D) developing a telemetry system that enabled fire fighters to transmit a patient's electrocardiogram to the physician at the hospital.

If an initial dose of diltiazem is ineffective, a second dose of ____ can be given. A) 5 to 10 mg B) 10 to 20 mg C) 0.25 mg/kg D) 0.35 mg/kg

D) 0.35 mg/kg

The correct adult IV/IO dose and concentration of epinephrine for cardiac arrest is: A) 1 mg, 1:1,000 every 3 to 5 minutes. B) 0.1 mL/kg, 1:1,000 every 5 minutes. C) 0.01 mg/kg, 1:10,000 every 3 minutes. D) 1 mg, 1:10,000 every 3 to 5 minutes.

D) 1 mg, 1:10,000 every 3 to 5 minutes.

When given during cardiac arrest due to torsade de pointes, the dose for magnesium sulfate is: A) 1 to 4 g of a 10% solution over 3 minutes. B) 1 to 2 g of a 10% solution over 5 to 60 minutes. C) 25 to 50 mg/kg of a 10% solution over 3 minutes. D) 1 to 2 g of a 10% solution over 5 to 20 minutes.

D) 1 to 2 g of a 10% solution over 5 to 20 minutes.

What is the initial dose of sodium bicarbonate for a 240-pound man? A) 37 mEq B) 55 mEq C) 70 mEq D) 110 mEq

D) 110 mEq

The correct dose of IV dextrose for an adult is: A) 100 mL of a 50% solution. B) 2 to 4 g/kg of a 50% solution. C) 500 mg/kg of a 25% solution. D) 12.5 to 25 g of a 50% solution.

D) 12.5 to 25 g of a 50% solution.

Atenolol is indicated for all of the following conditions, EXCEPT: A) hypertension. B) paroxysmal SVT. C) atrial flutter. D) AV heart block.

D) AV heart block.

Which of the following is the BEST example of a teachable moment? A) Lecturing the parent of a small child in cardiac arrest that the parent should have placed a fence around the swimming pool B) Telling a babysitter that the child for whom she was caring would not have been injured had the babysitter practiced safer babysitting habits C) Being stern with a man in front of his family when telling him that he would not have fallen from the roof if his son had been helping him D) Advising the unrestrained passenger with minor injuries following a motor vehicle accident that she easily could have been killed

D) Advising the unrestrained passenger with minor injuries following a motor vehicle accident that she easily could have been killed

69. Upon arriving at the scene of a motorcycle crash, you are approached by an EMR. What is the MOST important information the EMR should provide to you? A) The patient's vital signs and the presence of any underlying medical conditions B) How the crash occurred and approximately when he or she first arrived at the scene C) His or her perception of the criticality of the patient's condition and suspicion for internal bleeding D) Initial scene and patient assessment findings and any basic care that was provided to the patient

D) Initial scene and patient assessment findings and any basic care that was provided to the patient

Which of the following statements regarding Phenergan is correct? A) Phenergan possesses sedative and anticholinergic activity. B) Phenergan should only be given by the intravenous route. C) Phenergan antagonizes the effects of narcotic analgesics. D) Phenergan is contraindicated for patients with asthma.

D) Phenergan is contraindicated for patients with asthma.

Which of the following would MOST likely encourage manufacturers to remove dangerous products from the market or make them safer? A) Product education B) Economic incentives C) Increased morbidity rates D) Product liability litigation

D) Product liability litigation

Phenobarbital is classified as a: A) Schedule II narcotic. B) Schedule III benzodiazepine. C) Schedule V sedative-hypnotic. D) Schedule IV barbiturate.

D) Schedule IV barbiturate.

Which of the following statements regarding fentanyl (Sublimaze) is correct? A) The adult dose of fentanyl is 25 to 50 μg. B) Fentanyl has a duration of action of 10 minutes. C) Fentanyl should be given over 10 to 20 seconds. D) The peak effect of fentanyl is 3 to 5 minutes.

D) The peak effect of fentanyl is 3 to 5 minutes.

Which of the following results in the MOST years of potential life lost? A) Cancer B) Suicide C) Heart disease D) Unintentional injury

D) Unintentional injury

Diazepam may be indicated for patients with: A) myasthenia gravis. B) coma of unknown cause. C) increased intracranial pressure. D) acute alcohol withdrawal.

D) acute alcohol withdrawal.

Morphine sulfate is contraindicated for patients with: A) severe pain that is chronic. B) cardiogenic pulmonary edema. C) a systolic BP less than 120 mm Hg. D) acute exacerbation of COPD.

D) acute exacerbation of COPD.

64. An unblinded research study is one in which: A) some of the participants are aware of all aspects of the project. B) nobody is aware of any of the aspects of the research project. C) only the principal researcher is aware of all aspects of the project. D) all research participants are advised of all aspects of the project.

D) all research participants are advised of all aspects of the project.

Haloperidol (Haldol) would be expected to antagonize the effects of: A) opiates. B) barbiturates. C) benzodiazepines. D) amphetamines.

D) amphetamines.

46. The main goal of any CQI program is to: A) promptly correct any problems once they are identified. B) identify and remove paramedics who are not competent. C) revamp protocols based on the current standards of care. D) assess for ongoing improvement before a problem arises.

D) assess for ongoing improvement before a problem arises.

As a paramedic, your priority is to: A) teach the public why injuries tend to reoccur in the same place. B) provide definitive emergency care for severely injured patients. C) prevent an injury from occurring through education of the public. D) be prepared to respond to and treat injuries that inevitably will occur

D) be prepared to respond to and treat injuries that inevitably will occur

74. Prior to transporting a 66-year-old woman with chest pain to the hospital, she expresses the need to retrieve her bible and say a prayer. You should: A) advise the patient that a minister will talk with her at the hospital. B) tactfully explain to the patient that her condition will not allow it. C) leave the room if your religious beliefs are not consistent with hers. D) be respectful of the patient's wishes and give her the time she needs.

D) be respectful of the patient's wishes and give her the time she needs.

Verapamil hydrochloride (Isoptin, Calan) is classified as a(n): A) beta adrenergic blocker. B) alpha adrenergic agonist. C) selective beta antagonist. D) calcium channel blocker.

D) calcium channel blocker.

Calcium chloride is NOT routinely given to patients with: A) hypermagnesemia. B) beta-blocker overdose. C) hyperkalemia. D) cardiopulmonary arrest.

D) cardiopulmonary arrest.

40. A major distinction between a paramedic and an EMT is that the paramedic: A) is more likely to be sued for negligence. B) is held to a higher professional standard. C) can function independently of a physician. D) carries out advanced pharmacologic skills.

D) carries out advanced pharmacologic skills.

Naloxone (Narcan) reverses the central nervous system depressant effects of drugs such as morphine and fentanyl by: A) stimulating narcotic receptor sites. B) facilitating excretion by the renal system. C) agonizing opiate receptor sites. D) competitively inhibiting opiate receptor sites.

D) competitively inhibiting opiate receptor sites.

The amount of medication, expressed in milligrams, grams, or grains, that is present in an ampule or vial is called the: A) yield. B) volume. C) desired dose. D) concentration.

D) concentration.

The FIRST step in developing an injury prevention program is to: A) define the injury problem. B) plan and test interventions. C) establish goals and objectives. D) conduct a community assessment.

D) conduct a community assessment.

If a paramedic receives an order from a physician that he or she feels is detrimental to the patient's best interests, the paramedic should: A: Carry out the order, but factually and carefully document the event B: Not carry out the order and discuss the issue with the physician later C: Tell the patent that the physician's order is appropriate for him or her D: Immediately discuss with the physician why the paramedic feels that way

D: Immediately discuss with the physician why the paramedic feels that way

Criminal laws most likely to apply to paramedics include all of the following, EXCEPT: A: Assault B: Battery C: False imprisonment D: Inadequate patient care

D: Inadequate patient care

Assault on a patient occurs when the EMS provider: A: Defames a patient's character in his or her report B: Touches another person without obtaining consent C: Carries out a harmful physical act against a patient D: Instills the fear of immediate bodily harm in a patient

D: Instills the fear of immediate bodily harm in a patient

Because a lawsuit may not begin until several years after the paramedic cares for a patient: A: The paramedic should place an attorney on retainer B: All paramedics should carry malpractice insurance C: The paramedic should follow up with the patient regularly D: It is essential to maintain good documentation on any call

D: It is essential to maintain good documentation on any call

If a patient experiences prolonged hypotension or requires prolonged CPR, his or her _____ would be inappropriate for organ or tissue donation. A: Skin B: Corneas C: Bones D: Kidneys

D: Kidneys

You respond to a skilled nursing facility for a patient who is not breathing. When you arrive, you assess the patient, a 78-year old man, and confirm apnea. However, the patient has a rapid carotid pulse. The charge nurse advises you that, according to the patient's family, the patient is not to be resuscitated. You should: A: Not attempt any form of resuscitation and ask the charge nurse to notify the patient's family immediately B: Remain on scene, begin artificial ventilation, but discontinue if the family arrives and presents a valid DNR order C: Contact medical control and request authorization to provide palliative care only and transport the patient to the hospital D: Maintain the patient's airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility

D: Maintain the patient's airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility

In order for the paramedic to talk and transmit an ECG simultaneously on one frequency, a _____ system is required. A: Duplex B: Simplex C: Low-band D: Multiplex

D: Multiplex

When transmitting your radio report to the hospital, you should: A: Use ten-codes whenever possible B: Allow the patient to hear the report C: Answer questions with the word "yes." D: Not be sitting right next to the patient

D: Not sitting right next to the patient

Under the instructions of a good EMD, a layperson should be able to: A: Obtain a good pressure B: Assess a patient's pupils C: Immobilize a person's spine D: Perform chest compressions

D: Perform chest compressions

Which of the following is addressed in the EMTALA? A: Discouraging private individuals from suing if a hospital has violated the law B: Allowing a woman who is in active labor to be transported to a distant hospital C: Requiring EMS to transport all patients to the closest medical treatment facility D: Preventing medical facilities from denying medical screening and stabilization

D: Preventing medical facilities from denying medical screening and stabilization

While en route to the scene of a patient in cardiac arrest, the driver of the vehicle in front of you does not hear your siren or see your lights. You should: A: Quickly merge to the right, pass the vehicle, and then obtain the vehicle's license plate number B: Turn your siren off and ask the driver of the vehicle to pull over using the public address radio C: Get as close to the rear of the vehicle as possible, change the tone of your siren, and flash your headlights D: Remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so

D: Remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so

A 40-year old man presents with bizarre behavior. His speech is slurred and he is very belligerent. His blood glucose level is 35 mg/dL. The patient tells you to get out of his house. You should: A: Administer oxygen only until you can obtain a court order to start an IV and administer dextrose B: Utilize law enforcement to help restrain the patient so that you can start an IV line and give him dextrose C: Monitor the patient's condition for 15 minutes and then begin emergency treatment if he does not improve D: Remain professional and advise the patient that he is not legally capable of refusing EMS treatment

D: Remain professional and advise the patient that he is not legally capable of refusing EMS treatment

If the paramedic is unable to defuse a hostile patient's anger, the paramedic should: A: restrain the patient and transport at once B: Administer Valium or Haldol for sedation C: Obtain a signed refusal and depart the scene D: Request law enforcement assistance if needed

D: Request law enforcement assistance if needed

The judicial branch at the state level is responsible for: A: Establishing and defining the law B: Carrying out and administering the laws C: Reporting to the governor in the state capitol D: Resolving disputes based on interpretation of law

D: Resolving disputes based on interpretation of law

If a patient makes a decision regarding his or her own health care and the paramedic does not agree with that decision, the paramedic should: A: Ensure that the EMS medical director agrees with the patient's decision B: Accept the patient's decision, but advise him or her that you do not agree C: Try to convince the patient that the decision is not in his or her best interest D: Respect the patient's wishes, assuming he or she has decision-making capacity

D: Respect the patient's wishes, assuming he or she has decision-making capacity

If a severely injured patient who will likely not survive is identified as being an organ donor, the paramedic: A: Must keep the patient warm to keep his or her organs viable B: Must determine whether or not the patient is legally brain dead C: Should recall that severe trauma disqualifies a patient as a donor D: Should contact medical control for guidance as to how to proceed

D: Should contact medical control for guidance as to how to proceed

Biotelemetry is MOST accurately defined as: A: Linking two frequencies together so that the paramedic and physician can converse directly B: A common radio frequency assigned to EMS by the Federal Communications Commission C: The ability of more than one public safety agency to share the same radio frequency during a crisis D: The capability of measuring vital signs and ECG tracings and transmitting them to a distant terminal

D: The capability of measuring vitals signs and ECG tracings and transmitting them to a distant terminal

If a paramedic is attacked by a violent patient: A: The paramedic is legally permitted to defend himself or herself with the use of deadly force B: The law allows the paramedic to use a knife or firearm as a means of self-defense against the attacker C: The paramedic will not be held legally accountable if the attack was a result of patient provocation D: The paramedic may respond with force that is equal to or slightly greater than the force offered by the patient

D: The paramedic may respond with force that is equal to or slightly greater than the force offered by the patient

Which of the following details is of LEAST importance for the EMD to obtain from the caller? A: The exact location of the patient B: An estimate of the situation's severity C: The caller's telephone number D: The patient's last known oral intake

D: The patient's last known oral intake

According to the qualified immunity doctrine, the paramedic can be held liable only if: A: He or she volunteers as a paramedic and receive no remuneration for his or her medical services B: The medical care that he or she provided was not consistent with what a physician would have provided C: He or she was not employed by a governmental entity at the time an incident or violation occurred D: The plaintiff proves that the paramedic violated a clearly established law about which he or she should have known

D: The plaintiff proves that the paramedic violated a clearly established law about which he or she should have known

What hand gesture is interpreted in many Arabic and some Latin American cultures as the equivalent of an extended middle finger? A: The OK sign B: A clenched fist C: Waving your hand D: The thumbs-up sign

D: The thumbs-up sign

Conveying calm, unmistakable, genuine concern for someone you have never met before is the MOST essential challenge as a(n): A: Sympathetic listener B: Competent paramedic C: Effective history taker D: Therapeutic communicator

D: Therapeutic communicator

The husband of a terminally ill woman called 911 because he thinks his wife is about to die. The patient has a valid living will and an out-of-hospital DNR order. You should: A: Ask the husband why he called EMS if his wife is not to be resuscitated B: Assume that the husband has revoked the DNR order and begin treatment C: Contact medical control and request permission to provide emergency care D: Treat the husband and his wife with respect and provide emotional support

D: Treat the husband and his wife with respect and provide emotional support

If a mentally competent adult refuses emergency medical treatment, your FIRST action should be to: A: Call medical control and seek further guidance B: Determine if his or her condition is life-threatening C: Assume the refusal is from fear and begin treatment D: Try to determine why he or she is refusing treatment

D: Try to determine why he or she is refusing treatment

A paramedic's actions are considered to be grossly negligent if he or she: A: Does not consult with online medical control first B: Only provides basic life support Ito a critical patient C: Makes a simple mistake that causes harm to the patient D: Willfully or wantonly deviates from the standard of care

D: Willfully or wantonly deviates from the standard of care

A Medical Order for Life-Sustaining Treatment (MOLST) would MOST likely apply to a patient: A: Who is in respiratory failure but has decision-making capacity B: Who has been in cardiac arrest for less than 10 minutes C: With a terminal illness whose cardiac arrest was witnessed D: With impending pulmonary failure but who is not in cardiac arrest

D: With impending pulmonary failure but who is not in cardiac arrest

When caring for any patient, it is important to remember that: A: A patient likely shares the same moral standards that you do B: Your moral standards should affect the way you treat the patient C: The patient's wishes and moral standards are often the same D: Your moral standards may conflict with the patient's best interests

D: Your moral standards may conflict with the patient's best interests

When providing patient care, it is MOST important that you maintain effective communication with: A: The dispatcher B: Bystanders C: Medical control D: Your partner

Paramedic final part 1.

Related study sets

Chapter 15 Learning Curve

Chemistry 101 - Chapter 5

Respiratory System

ECON 102 Exam 3: Chapter 9 2022

PSYCH

MACRO

MKT 350

Absence

Boiler Operation Principles Chp. 1

Testout Networking Chapter 15

Chapter 4 -Immigration (Set 3)

Preoperative Nursing Management

HLTH 236 Exam 1

A&P 1 - Chapter 12

CLEP Exam - Information Systems & Computer Applications

Midterm (Chapters: 1,3,4,18,5,6,7,8,9,10,11,12,13,14,15)

econ

Venous Disease

Modern world chapter 21

Pharmacology Ch. 46 Antianginal Agents