Paramedic Jb Learning All Chapter Exams

17 The diameter of a patients pupils and their reactivity to light provide information about the - status of cerebral perfusion. 18 When assessing a patient's conjunctivae you note they are injected. This means that the conjunctivae are - red. 3 Frank blood or clear watery fluid draining from the ear canal following head trauma is MOST suggestive of a (N) - basilar skull fracture. 4 Swollen lymph nodes in the anterior neck usually indicate - an infection. 5 Percussion of the chest produces _____ if the pleural space is full of blood - a dull sound. 6 You would NOT expect to encounter decreased breath sounds in a patient with - cardiac tamponade. 7 S1 the first heart sounds represents - closure of the mitral and tricuspid valve. 8 The fourth heart sound - indicates increased pressure in the atria. 9 When auscultating heart sounds, you should place your stethoscope at the - fifth intercoastal space, over the apex of the heart. 10 A bruit indicates _____ blood flow and is most significant in the ______ arteries - turbulent, carotid. 11 To appreciate the s2 sounds - ask the patient to breathe normally and hold his or her breath on inhalation. 12 Distention of the jugular veins indicates - increased venous capacitance. 13 Visceral abdominal pain is - often less localized on palpation and is poorly described by the patient. 14 A pathologic fracture occurs when - normal forces are applied to abnormal bone structures. 15 In general +3 pitting edema is characterized by indentation of the skin to a depth of - ½ in to 1 in. 16 At its worst, kyphosis can become a source of - restrictive lung disease. 17 The Babinski sign grasping, and sucking are - examples of primitive reflexes. 18 If a patient is able to sense smell, his or her ______ nerve is intact - olfactory 19 In contrast to dementia, delirium is - an acute change in mental status. 20 Proper documentation of your physical examination of a patient is MOST important because it - sures an accurate historical accounting of the patient's problems prior to entering the hospital. 21 After performing your primary assessment of a patient, your next action should be to - decide what care if needed at the scene versus en route to the hospital. 22 Tidal volume is MOST effectively assessed by - observing for rise and fall of the chest. 23 A patient with a blood pressure of 210/100 mm hg would be expected to have a pulse that is - bounding. 24 Stimulation of the sympathetic nervous system causes - diaphoresis. 25 A patient in shock due to internal bleeding will benefit MOST from - limited scene time and rapid transport. 26 The history of present illness is MOST accurately defines as - an elaboration of the chief complaint. 27 The presence of rhonchi during auscultation of the lungs is MOST suggestive of - pneumonia. 28 The presence of rales during auscultation the chest indicates all of the following conditions, EXCEPT - bronchospasm. 29 Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called ______ pain - visceral. 30 A patient is generally considered to have orthostatic vital signs when - the heart rate increases by 20 bpm or more when going from a supine to a standing position. 31 Which of the following is an example of a pertinent negative ? - atient with chest discomfort denies shortness of breath. 32 What are Korotkoff sounds ? - the sounds heard when taking a blood pressure. 33 The breath sounds found on the posterior chest in between the scapulae are called - bronchovesicular sounds. 34 Bruising in the periumbilical area is indicative of - intraperitoneal hemorrhage. CHAPTER 11 1 after gathering information from the patient, scene, and any bystanders, you must next - determine which information is valid and which may be invalid. 2 The care plan that you implement based on your working field diagnosis of a patient is almost always defined by - your ems systems patient care protocols or standing orders. 3 The main disadvantage of patient care algorithms is that they - only address classic patient presentations. 4 While treating a patient with chest pain you should administer fentanyl. Shortly after you ask him if his pain has improved. This is an example of - data interpretation. 5 Which of the following conditions or situations is the BEST example of a critical life threat that needs immediate care ? - acute presentation of a chronic condition. 6 In ems the process of concept formation involves - gathering information about your patient. 7 Which of the following actions has the LEAST impact on the paramedics ability to think under pressure ? - memorizing all patient care algorithms. 8 When reading the scene, the paramedic must remember that - scene information becomes unavailable once transport is initiated. 9 When you introduce yourself to your patient and ask why 911 was called, the patient looks at you, shakes your hand, and answers your questions appropriately. From these findings, you can gather that the patient - has a glascow coma scale score of 15. 10 When caring for a critically ill patient, three or more sets of vital signs will allow you to - assess trends and reassess whether the patient's condition is stabilizing, getting better, or getting worse. 11 Protocols or standing orders specify the paramedics performance parameters which - define what the paramedic can or cannot do without direct medical control. 12 Which of the following scenarios is the BEST example of independent decision making ? - controlling severe bleeding from an open wound, establishing an IV to maintain perfusion and contacting medical control en route to the hospital. 13 Once you determine that your patient is sick, you must next - quantify how sick he or she is. 14 Comments such as "I cant believe you called ems for this " - show a lack of compassion and interest in providing the best possible care. 15 A working diagnosis is MOST accurately defined as - what you feel is the cause of your patient's problems. 16 The MOST effective way for the paramedic to avoid tunnel vision is - keep an open mind to all of the possible causes of the patients problems. 17 Which of the following situations is MOST challenging with regard to your critical thinking and decision making skills ? - driver who passed out and then struck a tree. 18 After addressing any life threats in the order in which you find them you should next - consider the worst case scenario that could be causing the patient's symptoms and either rule it out or rule it in. 19 When caring for a trauma patient with multiple injuries it is MOST important for the paramedic to - ensure he or she does not overlook anything that can be treated in the field. 20 Excellence in prehospital care is - the gradual result of the provider constantly striving to improve his or her practice. 21 In order to be a competent and effective paramedic it is MOST important for you to - think and perform quickly and effectively under pressure. 22 Uncertainty regarding the specific cause of a patient's problem is called - medical ambiguity. 23 The hormonal effects associated with the fight or flight response can affect your performance as a paramedic by - diminishing your ability to concentrate. 24 Which of the following is NOT a typical element to evaluate when reading the scene of a motor vehicle crash ? - the person at fault. Module 3 MODULE 3 EXAM Chapter 16 1 _______ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea - Biot. 2 in which situation would Cheyne stokes respirations be considered an ominous finding ? - traumatic brain injury. 3 If a patients hemoglobin level is only 10g/dl, ___ % would have yo be desaturated before he or she would appear cyanotic - 50 4 A patent airway - does not equate to adequate ventilation. 5 Use of a spacer device in conjunction with a metered dose inhaler - collects medication as it is released from the canister allowing more to be delivered to the lungs and less to be lost to the environment. 6 A patient with quiet tachypnea suggests - shock. 7 An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dl typically will begin to exhibit cyanosis when - about 5 g/dl of hemoglobin is desaturated. 8 The most clinically significant finding when questioning a patient with a chronic respiratory disease is - prior intubation for the same problem. 9 Which of the following conditions would LEAST likely present with a rapid onset of dyspnea ? - pneumonia. 10 Hepatojugular reflux occurs when - mild pressure placed on the patients liver further engorges the jugular veins. 11 Hepatomegaly and jugular venous distention are MOST suggestive of - right sided heart failure. 12 Digital clubbing is MOST suggestive of - chronic hypoxia. 13 The diaphragm of the stethoscope is designed to auscultate - high pitched sounds. 14 Anbormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the - bases of the lungs. 15 ______ breath sounds are the MOST commonly heard breath sounds and have a much more onvious inspiratory component - vesicular. 16 Inspiratory and expiratory ______ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds - bronchial. 17 The presence of diffuse rhonchi (low pitched crackles) in the lungs indicates - thick secretions in the large airways. 18 A patient who is coughing up purulent sputum is MOST likely experiencing - an infection. 19 Frothy sputum that has a pink tinge to it is MOST suggestive of - congestive heart failure. 20 iF a patients hemoglobin level is 8 g/dl due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patients oxygen saturation would MOST likely read - above 95%. 21 A pulse oximetry reading would be LEAST accurate in a patient - with poor peripheral perfusion. 22 When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in - large changes in oxygen saturation when small changes in paO2 occur. 23 With regard to pulse oximetry, the more hypoxic a patient becomes- the faster he or she will desaturate. 24 COPD is characterized by - changes in pulmonary structure and function that are progressive and irreversible. 25 Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT - a decreased expiratory phase. 26 He primary treatment of bronchospasm is - bronchodilator therapy. 27 A patient with status asthmaticus commonly presents with - physical exhaustion and inaudible breath sounds. 28 A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she - was previously intubated for his or her condition. 29 The classic presentation of chronic bronchitis is - excessive mucus production and a chronic or recurrent productive cough. 30 Patients with COPD typically experience and acute exacerbation of their condition because of - environmental changes such as weather or the inhalation of trigger substances. 31 Patients with decompensated asthma or COPD who require positive-pressure ventilation- may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. 32 An increase in the number of EMS calls for patient with chronic respiratory problems MOST commonly occurs - during sudden weather changes. 33 A patient who is coughing up thick pulmonary secretions should NOT take - an antitussive. 34 Bedridden patients with excessive pulmonary secretions are MOST prone to developing - pneumonia. 35 Pickwickian syndrome is a condition in which respiratory compromise results from - extreme obesity. 36 You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on - heroin. 37 A hyperventilating patient - may be acidotic and trying to decrease her or his ph level. 38 Residual corticosteroid in the pharynx following a metered dose inhaler treatment can predispose the patient to - thrush. 39 CPAP is used to treat patients with sleep apnea by - maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. 40 Use of automated transport ventilato is NOT appropriate for patient who are - breathing spontaneously. 41 A 76 year old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 l/min. your initial action should be to - place her in a position that facilitates breathing. 42 You are dispatched to a residence for a 59 year old man with difficulty breathing. The patient who has a history of COPD , is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing- pneumonia. 43 A 66 year old man with chronic bronchitis presents with severe respiratory distress. The patients wife tells you that he takes medications for high blood pressure and bronchitis is on home oxygen therapy, and has recently been taking an over the counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patients respiratory distress ? - recent antitussive use. 44 A 29 year old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and has a breathing tube in place. Prior to your arrival, the patient took three puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should - apply a CPAP unit, transport immediately, amd attempt to establish vascular access en route to the hospital. 45 You are transporting a patient with a long history of emphysema. The patient called 911 because his shortness of breath has worsened progressively over the past few days. He is on high flow oxygen via nonrebreathing mask and has an iv of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should - begin assisting his ventilations with a bag mask device and 100% oxygen. 46 An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a 'water pill' and Vasotec for high blood pressure. You should- suspect acute right sided heart failure and administer oxygen. 47 A 36 year old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta 2 agonist but his poor respiratory effort is inhibiting effective drug dekivery via the nebulizer and his menta status is deteriorating. You should - assist his ventilations and establish vascular access. 48 You are transporting a middle aged man on a CPAP unit for severe pulmonary edema. An iv line of normal saline is in place. Prior to applying the CPAP , the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should - remove the CPAP unit, assist his ventilations with a bag mask device, and prepare to intubate him. 49 A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should - assist his ventilations with a bag mask device, administer naloxone, and reassess his ventilatory status. 50 Wheezing is resolved with medications that - rx the smooth muscle of the bronchioles. Chapter 17 1 under normal conditions ,the strength of cardiac contraction is regulated by - the nervous system. 2 Thousands of fibrils that are distributed throughout the inner surfaces of the ventricles, which represent the end of the cardiac conduction system, are called the - purkinje fibers. 3 Hypomagnesemia would MOST likely result in - decreased cardiac conduction. 4 During the refractory period - the cell is depolarized or in the process of repolarizing. 5 In most patients, the SA node is supplied with blood from the - right coronary artery. 6 If the hearts secondary pacemaker becomes ischemic and fails to initiate an electrical impulse- you should expect to see a heart rate slower than 40 bpm. 7 The P wave represents - atrial depolarization. 8 The brief pause between the P wave and ORS complex represents - a momentary conduction delay at the AV node. 9 Which of the following ECG waveforms represents ventricular depolarization ? - QRS complex. 10 The PR interval should be no shorter than ____ seconds and no longer than _____ seconds in duration - 0.12, 0.20. 11 Normally the ST segment should be - at the level of the isoelectric line. 12 Stimulation of the parasympathetic nervous system - slows SA nodal discharge and decreases conduction through the AV node. 13 Acetylcholinesterase is a naturally occurring chemical that - breaks down acetylcholine in the body. 14 Sympathetic nerves are regulated primarily by - norepinephrine. 15 Common complaints in patients experiencing an acute coronary syndrome include all of the following EXCEPT -headache. 16 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 ? - cancer. 17 Jugular venous distention in a patient sitting at a 45 degree angle - indicates right sided heart compromise. 18 Which of the following clinical findings is LEAST suggestive of left sided heart failure ? - sacral edema. 19 Which of the following clinical findings is LEAST suggestive of a peripheral vascular disorder ? - an s3 sound during auscultation of the heart. 20 Acute coronary syndrome is a term used to describe - any group of clinical symptoms consistent with acute myocardial ischemia. 21 Non ST elevation myocardial infarction (NSTEMI) - is not generally treated with cardiac catherization. 22 Stable angina - occurs after a predictable amount of exertion. 23 Cardiac arrhythmias following an acute myocardial infarction - tend to originate from ischemic areas around the infarction. 24 The levine sign is defines as - a subconsciously clenched fist over the chest. 25 The pain associated with an acute myocardial infarction - is not influenced by deep breathing or body movement. 26 Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction ? - 58 year old diabetic woman. 27 The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of - a reduction in cardiac output. 28 Which of the following would be considered an anginal equivalent in a patient with myocardial ischemia ? - generalized weakness. 29 Which of the following variables has the greatest impact on the efficacy of myocardial reperfusion therapy ? - the duration from symptom onset to treatment. 30 A 50 year old man is experiency and acute myocardial infarctio. He has no prior history of cardiac problems, takes no medications, and had no drug allergies. His oxygen saturation is 96 %. He should receive - aspirin. 31 Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct ? - treatment with oxygen should be individualized and titrated to maintain the sp02 level above 94 %. 32 When administering aspirin to a patient with an acute coronary syndrome , you should - have him or her chew and swallow 160 to 325 mg pf baby aspiring. 33 Which of the following situations would contraindicate the administration of nitroglycerin ? - the presence of right ventricular infarct. 34 Why may fentanyl (sublimaze) be preferred over morphine sulfate for pain management in patients experiencing acute myocardial infarction ? - relatively short duration. 35 Which of the following medications would be the MOST acceptable alternative to morphine for analgesia in patient with an acute coronary syndrome ? - fentanyl. 36 Patients experiencing a right ventricular infarction - may present with hypotension. 37 When monitoring a patients cardiac rhythm, it is important to remember that - the ECG does not provide data regarding the patients cardiac output. 38 Which of the following interventions would MOST likelyt be performed en route to the hospital during a lengthy transport of a patient with a suspected myocardial infarction ? - IV therapy and analgesia. 39 The MOST immediate forms of reperfusion therapy for an injured myocardium are - fibrinolytics and percutaneous coronary intervention. 40 The MOST significant risk associated with the use of fibrinolytic therapy is - hemorrhage. 41 Fibrinolytics medications are beneficial to certain patients with an acute myocardial infarction because they - convert plasminogen to plasmin and destroy a clot. 42 Percutaneous coronary interventions involve - recanalizing a blocked coronary artery by passing a balloon or stent through a catherter via a peripheral artery. 43 In a patient with left ventricular failure and pulmonary edema - increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.] 44 Cn signs of left ventricular failure include all of the following - hypotension., 45 A 68 year old male who has COPD presents with edema to his feet and ankles, jugular venous distention, and an enlarged abdomen. What should you suspect ? - right ventricular failure. 46 In addition to supplemental oxygen, treatment of a patient with left ventricular failure includes - an IV of normal saline to keep the vein open and nitroglycerin. 47 Patients with a continuous-flow ventricular assist device - may not have a palpable pulse, despite adequate perfusion. 48 Cor pulmonale is MOST often the result of - COPD. 49 A patient with right ventricular failure would most likely present with - an enlarged liver. 50 The treatment for cardiogenic shock is generally focused on - strengthening cardiac contractility without increasing the heart rate. 51 A patient with cardiogenic shock and pulmonary edema should be positioned - in a semi fowler position. 52 A patient with cardiogenic shock without cardiac arrhythmias will benefit MOST from - rapid transport to an appropriate hospital. 53 Vasoactive medications for cardiogenic shock should be titrated to achieve a minimum systolic blood pressure of - 90 mmHg. 54 The process of aortic dissection begins when - the intimal layer of the aortic wall is torn. 55 In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm- maximal from the onset. 56 Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of a(n) - ischemic stroke. 57 Disruption of blood flow through the innominate artery due to dissection is likely to produce - pulse or blood pressure deficits. 58 In addition to prompt transport the goal of prehospital management for a patient with a suspected aortic dissection includes - adequate pain relief. 59 If a patients aortic aneurysm is not compressing on any adjacent structures - he or she will likely be asymptomatic. 60 Hypertension is present when the blood pressure - is consistently greater than 140/90 mm Hg while at rest. 61 Which of the following mechanisms causes hypertension?- increased afterload stimulates the frank starling r3eflex which raises the pressure behind the blood leaving the heart. 62 Hypertensive disease is characterized by - persistent elevation of the diastolic pressure. 63 You patient has a BP of 220/110. What is this patients mean arterial pressure (MAP) ? -147 mm Hg 64 A hypertensive emergency is MOST accurately defines as - an acute elevation in blood pressure with signs of end-organ damage. 65 Abnormal neurologic signs that accompany hypertensive encephalopathy occur when - pressure causes a breach in the blod brain barrier and fluid leaks out, causing an increase in intracranial pressure. 66 If the paramedic must initiate drug therapy in the field for hypertensive encephalopathy, he or she should - maintain the patient in a supine position. 67 It is MOST important to evaluate a cardiac dysrhythmia in the context of the - patients overall clinical condition. 68 A decreased cardiac output secondary to a heart rate greater than 150 beats /min is caused by - decreases in stroke volume and ventricular filling. 69 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 - reentry. 70 If a patients ECG rhythm shows any artifact, you should - ensure the electrodes are applied firmly to the skin. 71 An electrical wave moving in the direction of a positive electrode will - cause a positive deflection on the ECG. 72 When applying the limb leads, the negative lead should be placed on the - right arm 73 According to the Einthoven triangle, lead 2 is assessed by placing the - negative lead on the right arm and the positive lead on the left leg. 74 On the ECG graph paper, amplitude is measured in ______ and width is measure in _____ - millimeters, milliseconds. 75 On the ECG graph paper, 6 seconds is represented by how many large boxes ? -30. 76 The normal P wave duration is less than ____ milliseconds and the amplitude is less than ____ millimeters tall - 110, 2.5. 77 A prolonged PR interval - indicates an abnormal delay at the AV node. 78 The duration of the QRS complex should be _____ milliseconds or less in a healthy adult - 110. 79 A wide QRS complex that is preceded by a normal P wave indicates - an abnormality in ventricular conduction. 80 Q waves are considered abnormal or pathologic if they are - more than one third the overall height of the QRS complex in lead 2. 81 The ______ represents the end of ventricular depolarization and the beginning of repolarization - j point. 82 The second half of the T wave - represents a vulnerable period during which a strong impulse could cause depolarization resulting in a lethal arrhythmia. 83 In males the QT interval is considered prolonged it it is _____ milliseconds or longer - 450. 84 The 6 second method for calculating the rate of a cardiac rhythm - involves counting the number of QRS complexes in a 6 second strip and multiplying that number by 10. 85 If the R-R interval spans ____ large boxes or less, the heart rate is greater than 100/min - 3. 86 If the R-R interval spans more than _____ large boxes on the ECG graph paper, the heart rate is less than 60/min - 5. 87 When analyzing a cardiac rhythm strip in lead 2, you should routinely evaluate all of the following componesnts, EXCEPT the - ST segment. 88 Normal sinus rhythm is characterized by all of the following EXCEPT - QRS complexes that are up to 140 milliseconds. 89 Inus bradycardia, the - pacemaker site is the SA node. 90 Which of the following would MOST likely cause bradycardia ? - beta blocker use. 91 Which of the following statements regarding sinus bradycardia is correct ? - treatment focuses on the patients tolerance to the bradycardia. 92 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 - sinus tachycardia. 93 The treatment for sinus tachycardia should focus on - correcting the underlying cause. 94 Sinus dysrhythmia is - an irregular sinus rhythm. 95 Sinus arrest is characterized by - a dropped PQRST complex. 96 Which of the following differentiates an atrial rhythm from a sinus rhythm ? - varying shapes in P waves. 97 A wandering atrial pacemaker - may have variable PR intervals. 98 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) - premature atrial complex. 99 Supraventricular tachycardia is MOST accurately defines as - a tachycardic rhythm originating from a pacemaker site above the level of the ventricles. 100In order to call a cardiac rhythm "paroxysmal" supraventricular tachycardia, you would have to - witness its onset and or spontaneous termination. 101Patient with a heart rate greater than 150 beats/min usually becomes unstable because of - reduced ventricular filling. 102Which of the following is NOT characteristic of multifocal atrial tachycardia ? - regular R-R intervals with a rate less than 150 beats/min. 103In contrast to treatment for supraventricular tachycardia, treatment for multifocal atrial tachycardia in the prehospital setting - is generally not effective. 104A classic sign of atrial flutter is - the presence of sawtooth F waves. 105Atrial fibrillation can be interpreted by nothing - an irregularly irregular rhythm and absent P waves. 106A major complication associated with atrial fibrillation is - clot formation in the fibrillating atria. 107Which of the following prescribed medications would a patient with chronic atrial fibrillation MOST likely take ? - digitalis and coumadin. 108Junctional escape rhythms are characterized by - a ventricular rate of 40 to 60 beats/min. 109If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles- an inverted P wave will appear before the QRS complex. 110A 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) -accelerated junctional rhythm. 111A first degree heart block has a PR interval greater than 0.20 seconds because - each impulse that reaches the AV node is delayed slightly longer than expected. 112Which of the following statements regarding treatment for a first degree heart block is correct ? - treatment is generally not indicated unless the rate is slow and cardiac output is impaired. 113Which of the following statements regarding second degree heart block is correct ? - 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. 114A second degree heart block, Mobitz type 1, occurs when - each successive impulse is progressively delayed, until one impulse is blocked from entering the ventricles. 115A key to interpreting a Mobitz type 2 second degree heart block is to remember that - the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant. 116On the ECG strip, a third degree AV block usually appears as a - slow wide QRS complex rhythm with inconsistent PR intervals. 117Any electrical impulse that originates in the ventricles will produce - wide QRS complexes and a rate between 20 and 40 beats/ min. 118Which of the following statements regarding an idioventricular rhythm is correct ? - most patients with an idioventricular rhythm are hemodynamically unstable. 119An accelerated idioventricular rhythm is characterized by all of the following, EXCEPT - irregular R-R intervals and a rate less than 40 beats/min. 120Monomorphic ventricular tachycardia - presents with wide QRS complexes of a common shape. 121Torsade de pointes - is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval. 122Untreated ventricular tachycardia would MOST likely deteriorate to - ventricular fibrillation. 123Premature ventricular complexes - are ectopic complexes that originate from a different pacemaker site. 124Premature ventricular complexes (PVCs) that originate from different sites in the ventricle - will appear differently on the ECG. 125A run of ventricular tachycardia occurs if at least _____ PVCs occur in a row - three. 126Ventricular bigamy occurs when - every second complex is a PVV. 127What is the R on T phenomenon ? - a PVC that occurs when the ventricles are not fully repolarized. 128Ventricular fibrillation occurs when - many different cells in the heart depolarize independently rather than in response to an impulse from the SA node. 129Fine ventricular fibrillation is characterized by fibrillatory waves that are - less than 3 mm in amplitude. 130Which of the following statemenets regarding asystole is correct ? - asystole is the result of prolonged myocardial hypoxia. 131Unlike an idioventricular rhythm, an agonal rhythm - does not produce a palpable pulse. 132The firing of an artificial ventricular pacemaker causes - a vertical spike followed by a wide QRS complex. 133A demand pacemaker - generate pacing impulses only when it senses that the heart's natural pacemaker has fallen below a preset rate. 134A 'runaway' pacemaker is characterized by - a tachycardic pacemaker rhythm. 135Patients with Wolff-Parkinson-White syndrome- have an accessory pathway that bypasses the AV node and causes early ventricular depolarization. 136A delta wave is identified on a cardiac rhythm strip as a(n)- slurring of the upstroke of the first part of the QRS complex. 137The presence of a J wave (Osborn wave) on the ECG is an indicator of - hypothermia. 138Which of the following ECG abnormalities is MOST consistent with hyperkalemia? - tall peaked T waves. 139Lead 1 views the ____ wall of the heart, while leave AVF views the _____ wall of the heart - lateral, inferior. 140The precordial leads do NOT view the _____ wall of the heart - inferior. 141When viewing leads v3 and v4 you are looking at the ____ wall of the ______ - anterior, left ventricle. 142Which of the following leads provides the BEST view of the anterolateral wall of the left eventricle?- v4 to v6. 143Leads v1 to v3 allow to view the ______ wall of the left ventricle- anteroseptal. 144The inferior wall of the left ventricle is supplied by the - right coronary artery. 145The circumflex branch of the left coronary artery supplies the _____ wall of the left ventricle - lateral. 146Anatomically contiguous leads view - the same general area of the heart. 147St elevation myocardial infarction (STEMI) should be suspected if - ST elevation greater than 1.5 mm in females is observed in leads v2 and v3. 148Which of the following statements is correct ? - lead 3 is contiguous with leads 2 and avf. 149Injury to the inferior wall of the myocardium would present with - ST segment elevation in leads 2, 3 and avf. 150A pathological Q wave - is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. 151A right ventricular infarct is characterized by - ST segment elevation greater than 1 mm in lead v4r and ST segment elevation in leads 2,3 and avf. 152Patients who are experiencing an infarction of the right ventricle - may present with significant hypotension. 153On the 12 lead ECG, extreme right axis deviation is characterized by - a negative QRS in lead 1 and a negative QRS in lead avf. 154Fibrinolysis may be contraindicated in all of the following, EXCEPT - a history of anaphylactic shock caused by salicylates. 155A patients considered a potential candidate for the fibrinolytic therapy if he or she had experienced chest discomfort for - less than 12 hours. 156When performing CPR on an adult patient in cardiac arrest, it is important to - allow the chest to recoil between compressions. 157The proper compression to ventilation ratio for two rescuer adult CPR when an oropharyngeal airway is in place is - 30:2. 158Once an advanced airway device has been inserted into a cardiac arrest patient - ventilations are delivered at a rate of 10 breaths/min. 159The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the - defibrillator and airway management equipment. 160After delivering a shock to a patient in pulseless ventricular tachycardia, you should - resume CPR. 161When managing cardiac arrest, the appropriate dosing regimen for epinephrine is - 1 mg of a 1:10,000 solution every 3 to 5 minutes. 162What drug is indicated for patients with refractory ventricular fibrillation ? -amiodarone. 163Which of the following pulseless rhythms is NOT treated as pulseless electrical activity ? -ventricular tachycardia. 164Regardless of the patients presenting cardiac arrest rhythm, the first IV or IO drug that should be given is - a vasopressor. 165Which of the following actions should NOT occur while CPR is in progress ? - cardiac rhythm assessment. 166Common causes of cardiac arrest include all of the following EXCEPT - hyperglycemia. 167Treatment for a patient with bradycardia and significantly compromised cardiac output includes : - transcutaneous cardiac pacing. 168Electrical capture during transcutaneous cardiac pacing is characterized by - a pacemaker spike followed by a wide QRS complex. 169The recommended first first line treatment for third degree heart block associated with bradycardia and hemodynamic compromise is - transcutaneous pacing. 170When assessing an anxious patient who presents with tachycardia, you must - determine if the tachycardia is causing hemodynamic instability. 171A 56 year old man presents with an acute onset chest pressure, shortness of breath, and diaphoresis. He has a history of hypertension and type 2 diabestes. His airway is patent and his breathing is adequate. You should- administer supplemental oxygen. 172You 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 - reassess her blood pressure. 173You are assessing a conscious and alert middle aged male who complains of chest discomfort and nausea. His blood preesure is 112/70 mm hg, pulse is 90 beats/min and regular, and respirations are 20 breaths/min and regular. The patients past medical history is significant for hypothyroidism and hyperlipidemia. His medictions include Synthroid, Lipitor, Cialis, and one baby aspirin per day. Which of the following medications would you LEAST likely administer ? - nitroglycerin. 174Shortly after administering a second dose of 4 mg of morphine to a 49 year old woman who is experiencing chest pain, the patients level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should - assist her ventilations and administer naloxone. 175You are dispatched to a residence at 2:00 am for an elderly man with shortness of breath. The patient tells you that he was sudeenly 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 probel,', for which he uses a prescribed inhaler and takes a 'heart pill'. You should suspect - left ventricular failure. 176A 67 year old woman presents with severe dyspnea, coarse crackles to all lung fields , and anxiety. She has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect ? - positive end expiratory pressure ventilation. 177A 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 shallow. The cardiac monitor reveals sinus tachycardia in lead 2 and a 12 lead ECG reveals evidence of myocardial injury. You should - keep the patient in a supine position, insert a ansal airway, assist 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. 178A 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? - difference in blood pressure between the two arms. 179You 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 - administer supplemental oxygen start an IV line of normal saline at a keep open rate and transport. 180You and your partner arrive at the scene of an unresponsive male patient. Your assessment revels that he is pulseless and apneic. The patients wife tells you that he collapsed about 10 minutes ago. You should - initiate CPR as your partner applies the defibrillator pads. 181You 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 - resume CPR at once. 182Following 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 - resume CPR as the defibrillator is charging. 183An unresponsive, pulseless, apneic patient presents with ventricular tachycardia on the cardiac monitor. After defibrillating the patient, you should - resume CPR and reassess the patient after 2 minutes. 184You 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 - perform asynchronous CPR while ventilating the patient at a rate of 10 breaths/min. 185A 39 year old man in asystole has been unresponsive to high quality CPR and two doses of epinephrine. The patient is inyubated and an IO catheter is in place. You should focus on - searching for reversible causes. 186You are performing CPR on an 80 year old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have nbeen 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 - continue CPR and administer crystalloid fluid boluses. 187A 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 ? - administer 300 mg of amiodarone via rapid IV push. 188You respond to the scene of an assault, where a 20 year old man was stuck 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 - perform 5 cycles of well coordinated CPR. 189A 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 - seriously consider ceasing resuscitative efforts. 190A positive QRS deflection in lead 1 means the vector is heading toward the - left arm. 191The QRS in lead 1 is a negative deflection and the QRS in lead AVF is a positive deflection. This indicates - right axis deviation. 192The QRS in lead 1 is a positive deflection and the QRS in lead AVF is a negative deflection. This indicates - left axis deviation. 193left bundle branch block is characterized - a QRS of greater than 120 milliseconds and a terminal S wave in lead v1. 194A concordant precordial pattern exists when all QRS complexes - are upright in leads v1 through v6. 195A patients 12-lead ECG shows qR complexes in lead 1 and AVL and rS complexes in lead 2,3 and AVF. This indicates - left anterior fascicular block. 196On the 12 lead ECG, right atrial abnormality is characterized by - a P wave amplitude greater than 1.5 mm in lead v1. 197Left ventricular hypertrophy should be considered in a 50 year old patient if the sum of the depth of the S wave in lead v1 and the height of the R wave in either v5 or v6 exceeds - 35 mm. 198You are evaluation a 60 year old woman's 12 lead ECG and note that the R wave height in lead v1 exceeds the S wave depth. What condition would MOST likely cause this ? - pulmonary hypertension. 199A 60 year old man with crushing chest pain has 3 mm of ST elevation in leads v1 through v4, what should you suspect ? - left anterior descending artery occlusion. 200A 33 year old male presents with chest pain that is alleviated when he sits forward, the 12 lead ECG shows ST elevation of 2 to 3 mm in multiple leads, what should you suspect ? - pericarditis. 201Takotsubo cardiomyopathy is MOST often associated with - emotional stress. 202What 12 lead ECG finding should make you suspect a posterior STEMI ? - ST depression in leads v1 and v2. 203The door to balloon time for a patient with an ST elevation myocardial infarction is _____ minutes or less - 90. 204A 59 year old female presents with severe substernal chest pain, she is anxious and diaphoretic, what should you do ? - administer aspirin. 205In which of the following situations is oxygen indicated for a patient who complains of chest pain, pressure, or discomfort ? - signs of heart failure are present. 206Nitroglycerin is contraindicated for patients - with suspected right ventricular infarction. 207A right sided ECG is indicated for patients who present with - ECG evidence of an inferior infarction. 208Cor pulmonale is a term used to describe - right ventricular failure caused by pulmonary disease. 209Which of the following clinical signs would you MOST likely observe in a patient with right ventricular failure ? - splenomegaly. 210A 69 year old female presents with a sudden onset of shortness of breath that woke her from her sleep, she is conscious, but anxious, and is coughing up pink sputum, she can only speak in two word sentences and has cyanosis to her face, her bp is 170/90 mmhg, pulse rate is 130 beats/min, and respirations are 28 breaths/min, what should you do ? - provide noninvasive positive pressure ventilation. 211A 48 year old man with a history of hypertension presents with a severe headache, tinnitus, and blurred vision, he is conscious and alert and denies any other symptoms, his bp 204/120 mm hg , his pulse rate is 100 beats/min , and his oxygen saturation is 96 %, the closest appropriate facility is 20 minutes away, you should - monitor his cardiac rhythm and transport. 212A 60 year old woman presents with fever, chills, and shortness of breath, she has a history of mitral valve prolapse, assessment reveals flat, painless red lesions on the palms of her hands, what should you suspect ? - endocarditis. 213The pain associated with pericarditis - improves when the patient leans forward. 214Cardiac symptoms of myocarditis usually appear ____ days after the onset of initial symptoms - 10 to 14. 215A 70 year old male presents with pain in his legs while walking, within a few minutes of sitting down, however, his symptoms resolve, what should you suspect ? - peripheral arterial disease. CHAPTER 18 1emotions such as rage and anger are generated In the -limbic system. 2 a loss of balance and equilibrium suggests injury to the -cerebellum. 3 chemicals that relay electronically conducted signals from one neuron to another are called - neurotransmitters. 4 prehospital treatment for a patient with a suspected stroke may include all of the following EXCEPT - up to 325 mg of aspiring 5 all of the following are examples of acute cerebrovascular emergencies EXCEPT - accumulation of atherosclerotic plaque. 6 what is the cerebral perfusion pressure of a patient with a mean arterial pressure of 80 mm hg and an intracranial pressure of 5 mm hg ? - 75 mm hg. 7 which of the following would have the MOST negative effect on the outcome of a patient with an intracranial hemorrhage ?- hypotension. 8 hyperventilating a patient who had increased intracranial pressure (ICP) will- constrict the cerebral vasculature and decrease cerebral perfusion. 9 all of the following cranial nerves are responsible for airway control, EXCEPT the - abducens. 10 what type of tremor occurs when a body part is placed in a particular position and required to maintain that position for a long period of time ? - postural. 11 when assessing a patients response to pain, you place your thumb in the notch above the eye and near the bridge of the nose, this region is called the - supraorbital foramen. 12 common causes of trismus in an unresponsive patient include all of the following, EXCEPT - opiate toxicity. 13 a patient with a head injury is found lying supine, the patients feet are extended with the toes pointed and the arms extended with the hands pronated this indicates - brainstem Injury. 14 ich of the following assessment findings would indicate dysfunction of the trigeminal nerve ? - inability to feel the part of the face you are touching. 15 which of the following is an example of receptive aphasia ? -you ask a patient who the president is and he or she says, 'january' 16 a stroke to the right cerebral hemisphere would MOST likely cause - left sided weakness and a righ side visual field loss. 17 a staggering gait is MOST suggestive of damage to the- cerebellum. 18 ________ is a term used to describe the changes in a persons ability to perform coordinated motions, such as walking- ataxia. 19 when performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by - one arm drifting downward and turning toward the body when the patients eyes are closed. 20 tremors that increase as the patients hand gets closer to an object that he or she is trying to grab are called ______ tremors and are MOST common in patients with _______ - intention, multiple sclerosis. 21 ahythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called ______ activity - clonic. 22 an idiopathic seizure is one in which - the cause is not known. 23 applying pressure to the supraorbital foramen of a patient with neurologic insult is intended to - elict a response to painful stimuli. 24 an elderly man who is a resident of a skilled nursing facility is found unresponsive by a staff nurse,when you and your partner arrive, you assess the patient and note that his respirations are slow and shallow, his heart rate is slow, weak, amd irregular, and his skin is cool and clammy, you should - assist his ventilations and assess his oxygen saturation. 25 you are assessing an unresponsive 66 year old man with a history of two prior strokes, according to the patients wife he complained of a severe headache and then passed out, his respiratory effort is poor, blood pressure is elevated and pulse is slow and bounding, the glucometer reads 'error' you should - assist ventilations apply the cardiac monitor start an IV line with normal saline administer 12.5 g of 50% dextrose and reassess his level of consciousness. 26 a9 year old woman presents with acute onset of confusion, left sided hemiparesis, and a right sided facial droop, her airway is patent and she is breathing adequately, her blood pressure is 150/100 mm hg and herpulse is 70 beats/min, the cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min, when obtaining the patients medical history from her husband, the MOST important question to ask him is - when did yoy first notice your wifes symptoms? 27an elderly man presents with slurred speech, confusion, and unilateral facial asymmetry, when asked to squeeze your hands, the strength is his left hand is markedly less than the strength in his right hand, the patients wife tells you that her husband has type 2 diabestes and hypertension, on the nasis of your clinical findings, you should - rule out hypoglycemia by assess his blood sugar, but suspect a right sided ischemic stroke. 28 you are dispatched to a residence for a middle aged woman with generalized weakness of approximately 18 hours duration, your primary assessment reveals right sided hemiparesis, a left sided facial droop and bilaterally equal and reactive pupils, further assessment reveals that her blood glucose level is 70mg/dl, en route to the hospital you note increased movement of her right arm, she is receiving oxygen via nasal cannula and has a patent IV line in place, which of the following statements regarding the scenario's correct? - although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke. 29 a 19 year old man presents with a decreased level of consciousness, according to his girlfriend he has no known medical problems and takes no medication, initial treatment for this patient involves - ensuring airway patency and adequate breathing. 30 you are dispatched to a local pharmacy where a 24 year old woman experienced an apparent seizure, during your assessment, you note that the patient is conscious but combative, the patients supervisor states that she had a history of seizures and takes Tegretol, the patients blood pressure is 146/90 mm hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate dept, the MOST appropriate treatment for this patient includes- administering oxygen as tolerated, establishing and IV line padding the rails of the ambulance cot, and transporting without lights and siren. 31 you arrive at the scene shortly after a 7 year old girl experienced a seizure, according to the child's mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly, the episode lasted less than 1 minute, after which the child's condition rapidly improved, this clinical presentation is consistent with a(N) ____ seizure - absence. 32 a woman brings her 18 year old son to your ems station, the patient is actively seizing and according to the mother, has been seizing for the past 10 minutes, she states that her son has a history of seizures and takes Depakote, the patient is cyanotic, is breathing erratically and has generalized muscle twitching to all extremities, you should - open his airway and begin assisting his ventilations, establish an IV or IO line, and administer diazepam. 33a 33 year old woman had an apparent syncopal episode, according to her husband she complained of dizziness shortly before the episode, he further states that he caught her before she fell to the ground. Upon your arrival, the ptient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dl. The MOST likely cause of her syncopal episode is - dehydration. 34 you are dispatched to a residence for a 44 year old woman with a severe headache. You arrive to find the patient lying on her sofa with a wet washcloth on her forehead. She tells you that she has a history of migraine headaches and that this is one of her 'typical' headaches. She also complains of nausea and photophobia. Her blood pressure is 170/94 mm hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes - oxygen as tolerated, starting and IV line and administering ondansetron, and transporting without lights and siren. 35 a 51 year old man complains of chronic headaches that have worsened over the past 3 months. Today , he called 9-1-1 because his headache is severe and he is nauseated. His vital signs are stable and he is breathing adequately. The patient denies any medical problems and stated that he has been taking acetaminophen for the headaches. You should be MOST suspicious for - an intracranial neoplasm. 36 a 29 year old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include - diphenhydramine, 25 mg. 37 which of the following signs or symptoms are MOST consistent with meningitis in and infant ? - high pitched cry and bulging fontanelles. 38 common signs and symptoms of a cerebral abscess include - high grade fever, persistent localized headache, confusion and focal impairment. 39 which of the following cranial nerves are assessed when you ask a patient to follow your finger as you move it in an 'H' shape ? - trochlear, oculomotor, abducens. 40 which of the following cranial nerves regulates movement of the head and shoulders ? -accessory. 41 pupils that differ in size by less than 1 mm - may be a normal variant in some patients. 42 which of the following causes of altered mental status is NOT an acute process ? - uremia. 43 spasmodic torticollis is characterized by - neck muscle contraction, which twists the head to one side. 44 an autoimmune disorder in which the body attacks the myelin of the brain and spinal cord is called - multiple sclerosis. 45 in contrast to a patient in shock, you would expect a patient with increased intracranial pressure to present with - a widened pulse pressure. 46 among other functions, the medulla oblongata - controls blood pressure and heart rate. 47 a synapse - the gap between an axon and dendrite. 48 as intracranial pressure rises - brainstem herniation may occur. 49 decerebrate posturing - is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem. 51 apneustic breathing is characterized by - a prolonged inspiratory phase with a shortened expiratory phase and bradypnea. Chapter 19 1 in contrast to the oculomotor nerve the optic nerve - is the second cranial nerve and provide the sense of vision. 2 cardiac monitoring is recommended when caring for a patient with and eye related emergency because - ocular pressure can stimulate the vagus nerve and cause bradycardia. 3 The large cartilaginous external portion of the ear is called the - auricle. 4 Which of the following statements regarding anisocoria is correct ? - anisocoria is a condition in which the pupils are unequal . 5 What is the pathophysiology of Meniere disease ? -endolymphatic rupture creates increased pressure in the cochlear duct, which then leads to damage to the organ of corti and the semicircular canals. 6 Paralysis of cranial nerve _____ can cause unilateral facial and gad reflex paralysis- V11 7 Systemic signs of a dental abscess include - fever and chills. 8 Which of the following statements regarding epiglottitis is correct ? - it now occurs more often in adults. 9 Young female presents with a headache, severe aching around her right ear, and difficuluty chewing. Assessment and treatment for her should focus on - analgesia as needed and transport. 10 A 70 year old female complains of ringing and itching in both of her ears, as well as loss of hearing. What should you suspect ? - cerumen impaction. 11 Aqueous humor - is contained in the anterior chamber of the eye. 12 ______ forms the principal mass of the tooth and is much denser and stronger than bone - dentin. 13 A patient with dysconjugate gaze following an ocular injury - has discoordination between the movements of both eyes. 14 Which of the following statements regarding conjunctivitis is correct ? - conjunctivitis usually spreads to the opposite eye. 15 Glaucoma is a condition caused by - increased intraocular pressure. 16 Headaches, nausea and vomiting, narrowing vision fields, and a 'graying' in the field of vision are consistent with - papilledema. 17 Vertigo or loss of balance following an ear infection or upper respiratory infection is MOST consistent with - labyrinthitis. 18 Treatment for meniere disease includes - diuretics and antiemetics. 19 A distorted sense of smell in which a person perceives unpleasant odors when the odors do not exist is called -dysosmia. 20 Which of the following is a complication associated with dysfunction of cranial nerves V1, V11, X1, X11 ? - aspiration pneumonia. 21 Leukoplaxia - is a smoker's disease that causes excess cell growth in the mouth. 22 Which of the following has the greatest potential for causing an airway problem ? -ludwig angina. 23 Patients with epiglottis present with - dysphagia. 24 A 4 year old child presents with a deep 'croup-like' cough, difficulty breathing , and a high fever. You should suspect - tracheitis. 25 A 34 year old female states that she feels like she has a grain of sand in her eye. Assessment reveals that her eye and the surrounding area are red. Treatment for her should include - gently irrigating her eye and taping the affected eye closed to prevent it from drying out. 26 A 55 year old female complains of severe vertigo, tinnitus, nausea, and a sense of fullness in her right ear. You should - administer an antiemetic and monitor her airway in case she vomits. 27 Symptoms of temporomandibular joint (TMJ) disorder include - an uneven bite. 28 Which of the following clinical signs would specifically indicate ethmoid sinusitis ? - headache. 29 Which of the following is the MOST immediate and significant complication associated with posterior epistaxis ? - nausea and vomiting. 30 Which of the following conditions can be caused by gastroesophageal reflux disease (GERD) ?- laryngitis. 31 Common symptoms of diabetic retinopathy include all of the following EXCEPT -yellow vision. 32 The middle ear consists of the - inner portion of the tympanic membrane and the ossicles. 33 Causes of rhinitis may include all of the following EXCEPT - high humidity. 34 A patient presents with fever, a headache, and a unilaterally sore throat. What should you suspect ?- peritonsillar abscess. Chapter 20 1 the portal vein transports venous blood from the gastrointestinal tract directly to the - liver. 2 The ________ controls the amount of food that moves back up the esophagus - cardiac sphincter. 3 Is water is not reabsorbed in the colon - diarrhea occurs. 4 When forming your general impression of a patient with gastrointestinal distress, which of the following observations would provide the MOST information regarding what happened ? - body posture or position. 5 Dunphy sign is observed when - coughing causes sevre right lower quadrant pain. 6 When auscultating bowel sounds, borborygmi is characterized by - loud gurgles occurring greater than 30/min. 7 Hepatic encephalopathy is a condition in which- liver disease causes reduced brain function. 8 A patient with pancreatitis would MOST likely present with pain that - is localized to the epigastric are and may radiate to the back. 9 A 52 year old man complains of severe abdominal pain but denies nausea or vomiting. He is conscious and alert, has a blood pressure of 130/70 mm hg, a heart rate of 120 beats/min and strong, and respirations of 20 breaths/min and regular. You should administer - nalbuphine. 10 A dehydrated patient who is hemodynamically stable should receive - a hypotonic solution at 125 ml/hr. 11 Drinking alcohol with a fatty meal - increases gastric reflux. 12 What is the parietal peritoneum ? - the bag that contains abdominal organs. 13 The conversion of glycogen to glucose occurs in the - liver. 14 Most of the digestive process occurs in the - small intestine. 15 The exocrine function of the pancreas produces - enzymes. 16 A patient with an extremely advanced bowel obstruction may have the odor of ____ on his or her breath - stool. 17 Hypotension during an episode of dehydration indicates that the body is - no longer capable of effectively pulling fluid from the intestinal space and the cellular area. 18 Which of the following conditions would be the LEAST likely to result in peritonitis ? - splenic laceration. 19 In contrast to a patient with peritonitis, a patient with hepatitis would MOST likely initially experience - right upper quadrant pain. 20 Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in - peptic ulcer disease. 21 The MOST likely cause of Crohn disease is - auto

119. A patient who overdosed on acetaminophen at at greatest risk for - liver failure. 120. A patient recently began taking an antipsychotic medication and is experiencing a dystonic reaction. What drug is indicated ? - diphenhydramine. CHAPTER 11 1 The history of present illness is defined as - a chronologic account of the patient's signs and symptoms. 2 ems providers who read off a list of questions to the patient to fill In all the blanks on the run report - tend to make little or no eye contact with the patient. 3 Paying attention, making eye contact and repeating key information from the pateints answers are examples of - facilitation. 4 Which of the following is an example of a leading question ? - "do you think that you are experiencing a cardiac emergency "? 5 The mnemonic "OPQRST" is a tool that - offers an easy to remember approach to analyzing a patients chief complaint. 6 When asking questions pertaining to a patient's sexual history it is important to remember that - obtaining the history in a private setting is essential. 7 Situational depression Is - a reaction to a stressful event in a patients life. 8 The residual pressure in the circulatory system while the left ventricle is called the - diastolic pressure. 9 To obtain a heart rate in infants younger than 1 year of age, you should - palpate the brachial artery. 10 A conscious patients respiratory rate should be measured - for a minimum of 30 seconds. 11 When using a tympanic device to obtain a patients's body temperature, you should - be aware of extrinsic factors that can skew the reading. 12 What does pulse oximetry measure ? - the percentage of hemoglobin saturation. 13 The skin becomes ______ when red blood cell perfusion to the capillary beds of the skin is poor - pale 14 Flushed skin is commonly seen as a result of all the following EXCEPT - vasoconstriction 15 Poor skin tugor in an infant or child is MOST indicative of - dehydration. 16 A patient who complains of double vision has - diplopia.

1. 11-Which of the following patient data id NOT typically communicated during your radio report to the hospital? The patient's ethnicity 2. 12-If the EMD suspects that your patient has a life-threatening emergency, the EMD should make you aware of the situation and then: give prearrival instructions to the caller 3. 13-Using the International Phonetic Alphabet, how should you spell Dr. Wilson? WHISKEY-INDIA-LIMA-SIERRA-OSCAR-NOVEMBER 4. 14-It is important to remember that if a patient is not personally sensitive to modesty because of an impaired mental state: the patient's family likely will be 5. 15-Which of the following questions would be appropriate to ask a patient who has no medical training? "Do you have any breathing problems?" 6. 16-It would be appropriate to ask a patient a closed-end question when: you are trying to obtain medical history information 7. 17-If a patient avoids answering a specific question, you should: redirect him or her to the question to elicit a response 8. 18-If a patient asks for your advice regarding a treatment decision that his or her physician made, you should: advise the patient to consult with his or her physician 9. 19-If the wife of a critically ill man asks you if her husband is going to die, the MOST appropriate answer should be: "He is very sick, but we are doing everything we can to help him" 10. 20-If a patient provides an inappropriate response to a paramedic's question, it should be assumed that the patient: has an impaired cerebral function. 11. 21-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: reflection 12. 22-Sitting in a chair next to a patient when conducting your interview promotes: trust 13. 23-When touching a patient as a form of reassurance, the paramedic should: touch the patient on a neutral part of his and her body 14. 24-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? "I'm sorry, sir. I don't know how I would feel in your situation, but I'm sure it would be similar." 15. 25-Statements such as, "Please say more," of "Please feel welcome to tell me about that," are examples of: facilitation 16. 26-Asking a patient a question about how she is feeling today, you sense that she is having difficulty putting her feelings into words. You should: be patient and give the patient time to express her feelings 17. 27-If a patient mentions something in passing or avoids answering a specific question, you should: politely redirect his or her attention to that question 18. 28-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: you should suspect decreased blood flow to the brain 19. 29-Stereotyping an elderly, very young, or hostile patient during your attempt to communicate with him or her: works against effective communication 20. 30-Which of the following statements is an example of providing false reassurance? "I'm sure that you will be fine, but let us take you to the hospital just to be on the safe side 21. 31-If the paramedic is unable to defuse a hostile patient's anger, the paramedic should: request law enforcement personnel at the scene 22. 32-When communicating with older patients, it is MOST important to remember that: their illnesses may be more complex because they may have more than one disease process and may be taking several medications concurrently 23. 33-If apparent insists on monitoring your conversation with his or her adolescent son or daughter, you should: communicate the situation to the emergency department physician and document it accurately 24. 34-When the paramedic encounters a patient who has difficulty communicating, he or she should: enlist the help of a family member or primary caregiver 25. 35-Which of the following is MOST indicative of a patient who is about to attack you? Clenched facial muscles 26. 36-Islamic and Hindu cultures avoid: touching with the left hand 27. 37-When attempting to interview a potentially violent patient, you should: ensure that you are positioned between the patient and the door 28. 38-During the course of your interview, your patient begins making sexual innuendos to you. You should: ensure that another paramedic or EMT is present at all times 29. 39-Which of the following statements regarding 12-lead ECG telemetry is correct? Most newer systems use facsimile technology to allow transmission of 12-lead ECG's 30. 40-The use of telemetry to confirm cardiac rhythms before treatment: is less common as most EMS systems rely on paramedics to assess the cardiac rhythm and make independent treatment decisions 31. 41-In order for the paramedic to talk and transmit an EKG simultaneously on frequency, a _______ system is required: multiplex 32. 42-The use of ten-codes over the radio: is not recommended by the National Incident Management System (NIMS) 33. 43-Before you begin to transmit over the radio, you should check the volume and then: listen to make sure that the channel is clear of traffic 34. 44-When relaying critical information using the situation, background, assessment, and recommendation (SBAR) technique, which component would address the question, "what got us to this point?" Background 35. 45-If a patient is reluctant to share personal information with you, you should: explain why you need his or her name and date of birth 36. 46-Maintaining eye contact with a patient enables the paramedic to: evaluate the patient's neurologic status 37. 47-What is the benefit of communicating over an assigned tactical channel? It leaves the main dispatch channel open for other radio traffic 38. 48-The purpose of a closed-end question is to: elicit a specific response from the patient 39. 49-When asking a man a question about his chest pain, he responds in a disorganized manner. What should you do? Put his response into simpler terms and asks if he agrees with your synopsis 40. 50-Which of the following statements conveys empathy? "I understand how difficult this must be, I'm here to help you 41. 1-Which of the following is a subjective finding? A complaint of chest pressure 42. 2-In order to ensure that all recorded times associated with an incident are accurate, the paramedic should: radio the dispatcher after an event occurs 43. 3-The Most significant problem associated with making up your own medical abbreviations and documenting them on the patient care report is: an error in patient care 44. 4-The National Emergency Medical Services Information System (NEMSIS); collects relevant date from each state and uses it for research 45. 5-Which of the following statements includes a pertinent negative? "The patient complains of nausea but denies vomiting." 46. 6-Prior to submitting a patient care report to the receiving hospital, it is a MOST important for: The paramedic who authored the report to review it carefully 47. 7-When a competent adult patient refuses medical care, it is most important for the paramedic to: ensure that the patient is well informed about the situation at hand 48. 8-Which of the following is a significant benefit of electronic documentation? The ability of the data to be shared between health care facilities 49. 9-Components of a thorough patient refusal document include: willingness of EMS to return to the scene if the patient changes his or her mind 50. 10-Additions or notations added to a completed patient care report by someone other than the original author: may raise questions about the confidentiality practices of the EMS agency 51. 11-All of the following are subjective findings, EXCEPT: Visible blood in the ear canal 52. 12:Data collected from the state EMS office for the purpose of research would likely NOT include: Average cost per call 53. 13-Which of the following incident times is NOT commonly documented on the patient care report? Time of primary assessment 54. 14-Which of the following statements is LEAST descriptive when documenting the events of a cardiac arrest call on your patient care report? "Followed ACLS protocols." 55. 15-The accuracy of your patient care report depends on all of the following factors, EXCEPT: The severity of the patient's condition 56. 16-For the purpose of refusing medical care, a patient's mental status may be considered impaired if he or she: makes nonsensical statements 57. 17-A poorly written patient care report: may raise questions by others as to the quality of patient care 58. 18-Anaccurate and legible patient care report: should be complete to the point where anyone who reads it understands exactly what transpired on the call 59. 19-Which of the following statements contains objective and subjective information? "The patient appeared confused and stated that he had a headache." 60. 20-Which of the following data would a state EMS office be the LEAST likely to require an EMS agency to report? Patient gender 61. 21-Which of the following constitutes minimum data that must be included on every patient care report? Chief complaint, level of consciousness, vital signs, assessment, and patients age and gender 62. 22-Most EMS agencies require a double signature system any time a: controlled substance is checked, used, discarded or replaced 63. 23-If the paramedic is unable to complete his or her patient care report before departing the emergency department, he or she should: Leave an abbreviated form with pertinent data with the receiving provider and complete the patient care report as soon as possible. 64. 24-If you make an error when completing a written patient care report, you should: use different colored ink when drawing a line through the error 65. 25-In which of the following situations would the documentation on a patient acre report MOST likely be limited? Mass-Casualty incident 66. 1-Which of the following directional terms describes the front surface of the body? Ventral 67. 2-A vertical plane that is parallel to the median plane and divides the body into unequal parts is called the: midsagittal plane 68. 3-When asking a patient to supinate his or her hand, you would expect him or her to: place the hand palm up 69. 4-Which of the following prefixes are synonymous? Angi/o; vas/o 70. 5-The combing from encephala/o refers to the: brain 71. 6-An imaginary plane that divides the body into ventral and dorsal portions is called the: coronal plane 72. 7-Costohondritis is inflammation of the: cartilage part of the ribs 73. 8-The diaphragm resides within the: infrathoracic region 74. 9-What color does the root word poli/o describe? Gray 75. 10-An endogenous chemical is one that: occurs inside the body 76. 11-Compared to the frontal region of the skull, the occiput is: posterior 77. 12-The most inferior portion of the heart is called the: Apex 78. 13-Movement of the distal point of an extremity toward the trunk is called: flexion 79. 14-Relative to the wrist, the elbow is: proximal 80. 15-A patient is place in the fowler position. In this position , the body is: sitting upright with the knees bent or straight 81. 16-The root word -phagia refers to: swallowing. 82. 17-What is the medical term for a woman who has been pregnant eight times? Octigravida 83. 18-An imaginary plane passing horizontally through the body at the waist, creating top and bottom portions, is called the: transverse plane 84. 19-What term pertains to the sole of the foot or palm of the hand? Volar 85. 20-In the anatomic position, all extremities are: extended 86. 21-A patient experiencing a stroke involving the left cerebral hemisphere has contralateral hemiplegia. This means that the patient: cannot move his right side 87. 22-What organ(s) lie in the periumbilical region? Small and large intestine 88. 23-What position is generally a position of comfort for patients who do not require spinal immobilization? Semi-Fowler 89. 24-A patient with blepharospasm has a spasm of the: eyelid 90. 25-The prefix melan—means: Black 91. 26-A patient with orchitis has inflammation of the: testicle 92. 27-Cardiomegaly is a term used to describe: An enlarged heart 93. 28-The root word cleid/o refers to the: clavicle 94. 29-A patient has a gunshot wound to just below the right nipple. How would you describe the injury location? Anterolateral 95. 30-The lateral aspect of the liver rests in what region? Hypochondriac 96. 31-The topographic term used to describe the location of body parts that are closer to the midline is: medial 97. 32-If the body is sliced so the result is a top and bottom portion, this is referred to as the: transverse plane 98. 33-Which of the following would be the MOST significant complication associated with incorrect use of medical terminology? Ineffective treatment could be rendered 99. 34-The Greek prefix burs/o refers to the: back 100. 35-Illium and Ileum are examples of: homonyms 101. 36-Tetralogy of Fallot is a congenital anomaly involving _____ anatomic abnormalities of the heart: four 102. 37-Which of the following would be a proper way of documenting a drug dosage? 5mg 103. 38-Medical control requests you to administer 50 micrograms of a drug. You should recognize that this is equivalent to: 0.05mg 104. 39-The abbreviation "amp" refers to: ampule 105. 40-Something that is homogenous is: the same 106. 1-The substance that contains all the cellular contents between the cell membrane and the nucleus is called the: Cytoplasm 107. 2-The average total body weight content of a healthy human adult is approximately _____% of his or her body weight: 60 108. 3-Which portion of the spinal column articulates with the pelvis? Sacral 109. 4-The point where the first cervical vertebra(C1) articulates with the base of the skull is called the: Atlanto-occipital joint 110. 5-The Broca region of the left frontal lobe is responsible for the muscular actions that are associated with: Speech 111. 6-The olfactory nerve (CN 1)is responsible for: Smell 112. 7-The sympathetic and parasympathetic nerves arise from the: autonomic nervous system 113. 8-The peripheral nervous system consists of the: somatic and autonomic nervous systems 114. 9-Stimulation of alpha-1 receptors of the sympathetic nervous system results in: peripheral vasoconstriction 115. 10-The catecholamine epinephrine (adrenaline) has an affinity for: alpha and beta receptors 116. 11-Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the: Islets of Langerhans 117. 12-Which of the following statements regarding type O blood is correct? It contains no surface antigens 118. 13-A portion of the immune system that recognizes foreign body substances is called a(n): Antibody 119. 14-The heart muscle lies within a space in the thoracic cavity called the: mediastinum 120. 15-Blood enters the right atrium of the heart from the: Vena cavae and coronary sinus 121. 16-What types of valves are the aortic and pulmonic? Semilunar 122. 17-The second heart sound (S2) represents: closure of the semilunar valves 123. 18-Nicotinic receptors are found: on skeletal muscle 124. 19-Afterload is defined as the: degree of pressure against which the left ventricle pumps 125. 20-Cardiac output is equal to: stroke volume multiplied by heart rate 126. 21-Increased myocardial contractility secondary to stretching of the myocardial walls is called the: Frank-Starling mechanism 127. 22-The pulmonary circulation is responsible for: ensuring that blood gets reoxygenated 128. 23-The two major veins that drain the head and neck of blood are the: Jugular veins 129. 24-End-diastolic volume is primarily a reflection of: venous return to the heart 130. 25-Tidal volume is defined as the volume of air that: is moved into or out of our lungs during a single breath 131. 26-Decrease in the PACO2 result in ________pH levels in the respiratory center and a(n) _________ in ventilation: increased, decrease 132. 27-The hypoxic drive, a backup system to control breathing, is stimulated when: arterial PaO2 levels decrease 133. 28-Noraml inhalation is the result of: negative pressure in the thoracic cavity 134. 29-A newborn's total body water content is approximately: 80% of total body weight 135. 30-Extracellular fluid accounts for what percentage of the total body water? 37% 136. 31-A(n)________ is a substance that can absorb or donate hydrogen ions: buffer 137. 32-The cell membrane is selectively permeable, which means that it: allows only certain substances to pass through it 138. 33-Osmosis is the movement of a: solvent from an area of low solute concentration to one of high concentration 139. 34-The movement of a substance against a concentration or gradient that requires energy is called: active transport 140. 35-If too much water moves out of a cell, the cell shrinks abnormally. This process is called: crenation 141. 36-Which type of nerve cells conduct electrical impulses toward the cell body? Dendrites 142. 37-The first two cervical vertebrae, in descending order, are called: atlas and axis 143. 38-The diencephalon, a region of the brain, contains which of the following structures? Thalamus and hypothalamus 144. 39-The limbic system, a portion of the cerebrum and diencephalon, contains structure that: Influence emotions and mood 145. 40-Of the 12 pair of cranial nerves, which two do NOT exit from the brainstem? Olfactory and optic 146. 41-Examples of steroid hormones are: cortisol and testosterone 147. 42-What is the action of adrenocorticotropic hormone (ACTH)? Stimulates hormone secretion from the adrenal cortex 148. 43-Glycogenolysis is the process in which: glycogen is converted to glucose 149. 44-What physiologic reaction occurs when a person's blood sugar level falls? Glucagon production is increased 150. 45-A bruit differs from a murmur in that a bruit: is auscultated over a main blood vessel 151. 46-What is the cardiac output of a person with a stroke volume of 60mL and a heart rate of 90 beats/min? 5.4L 152. 47-What is a function of the lymphatic system? Filtration of debris and bacteria from the blood 153. 48-Oxygen and carbon dioxide pass across the alveolar capillary membrane through a process called: Diffusion 154. 49-What happens when the PaCO2 of the arterial blood increases? pH decreases and respirations increase 155. 50-A pH of 7.30 indicates: Acidosis 156. 1-Which of the following conditions can cause edema secondary to decreased colloidal osmotic pressure in the capillaries? Liver Disease 157. 2-Which of the following conditions would cause a proportionate gain in both water and sodium? Steroid use 158. 3-Dehydration is generally a more serious concern in older adults than in younger adults because: total body water constitutes only 45% of body weight in older adults 159. 4-An isotonic fluid deficit is caused by a(n): decrease in extracellular fluid with proportionate losses of sodium and water. 160. 5-Ascites is defined as: an abnormal accumulation of fluid in the peritoneal cavity. 161. 6-Edema in an upper extremity following a mastectomy is the result of: decreased lymphatic drainage 162. 7-Which imbalance would MOST likely be observed in a patient with syndrome of inappropriate antidiuretic hormone(SIADH)? Normal fluid volume with hyponatremia 163. 8-The study of the functioning of an organism in the presence of disease is called: Pathophysiology 164. 9-A patient with kidney or liver failure would MOST likely develop: an increase in isotonic fluid 165. 10-Which of the following factors would MOST likely cause hyponatremia? Diuretic use 166. 11-Hyperakalemia is defined as: an elevated serum potassium level 167. 12-All of the following factors would cause potassium to shift into the cell EXCEPT: increased vagal tone. 168. 13-A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness id MOST likely: Hyperkalemic 169. 14-Which of the following represents an abnormal electrolyte serum level? Potassium, 5.9 mEq/L 170. 15-Half of the body's magnesium is stored in the: Bones 171. 16-Which of the following represents an abnormal electrolyte serum level? Magnesium, 2.4 mEq/L 172. 17-Carpopedal spasm that occurs during respiratory alkalosis is caused by a(n): intracellular calcium shift 173. 18-A patient who overdosed on heroin and is unconscious with slow, shallow respirations would MOST likely experience: an increased CO2 retention 174. 19-In the presence of infection, white blood cells release endogenous chemicals called ________, which produce fever. Pyrogens 175. 20-Unlike bacteria, viruses: do not produce exotoxins or endotoxins 176. 21-Apoptosis is defined as: normal cell death 177. 22-Allergies are acquired following: initial exposure to an allergen 178. 23-An inflammatory condition of the respiratory system that results in intermittent wheezing and excess mucus production is called: Asthma 179. 24-Major risk factors for lung cancer include: cigarette smoking and exposure to asbestos 180. 25-Early signs or systems of breast cancer include: a small, painless lump in the breast 181. 26-Patients with type 1 diabetes mellitus: need exogenous insulin to survive 182. 27-Hemolytic anemia is a disease characterized by: increased destruction of red blood cells 183. 28-Which of the following statements regarding hemophilia is correct? Hemophilia is an inherited disorder, is characterized by excessive bleeding, and occurs predominantly in males. 184. 29-Syncopy is probably NOT caused by a life-threatening dysrhythmia if it occurs: in a person whose cousin has syncope 185. 30-Hypertrophic cardiomyopathy is characterized by: enlargement or thickening of the heart muscle 186. 31-A person with normal total cholesterol level: is still at risk for coronary artery disease if his or her LDL levels are elevated 187. 32-Gout is a condition in which: uric acid accumulates in the blood 188. 33-Common signs and symptoms of ulcerative colitis include all of the following, EXCEPT: bloating after milk ingestion 189. 34-What disease is characterized by erosions in the mucous membrane lining of the gastrointestinal tract, specifically the stomach: Peptic Ulcer Disease 190. 35-Muscular Dystrophy is characterized by: weakness and wasting of groups of skeletal muscles, leading to increasing disability 191. 36-Early manifestations of Alzheimer disease include: memory loss and subtle personality changes 192. 37-Distributive shock occurs when: blood pools in expanded vascular beds and tissue perfusion decreases 193. 38-Which of the following is an early sign of shock? Decreasing end-tidal CO2 194. 39-Which of the following statements regarding basophils is correct? Basophils release histamine in response to inflammation 195. 40-B lymphocyctes produce antibodies when they are activated by: Helper T cells 196. 41-Opsonization is a process in which: an antibody coats an antigen to facilitate its recognition by immune cells 197. 42-The two Most common cause of inflammation are: infection and injury 198. 43-Aspirin and NSAIDs reduce inflammation and pain by: inhibiting prostaglandin synthesis 199. 44-The destruction of a blood clot is called: Fibrinolysis 200. 45-Interleukins function by: attracting white blood cells to the sites of injury and bacterial invasion 201. 46-When nerve cells and cardiac myocytes are injured: scar tissue forms because these cells cannot be replaced 202. 47-Angiogenesis is defined as: the growth of new blood vessels 203. 48-A type 1 hypersensitivity reaction is: an acute reaction that occurs in response to a stimulus 204. 49-If the cause of a disease is unknown, it is said to be: Idiopathic 205. 50-The resistance stage of the stress reaction is characterized by: stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure. 206. By definition, infancy begins at: 1 month of age 207. By the age of 1 year, an infant's tidal volume ranges from: 10 to 15 mL/kg 208. In contrast to infants, toddlers: Have a slower respiratory rate 209. Teething is commonly accompanied by: fever 210. In conventional reasoning, school-age children: Seek approval from their peers and society 211. Which of the following statements regard9ing growth spurts in adolescents is correct? Boys generally experience this stage of growth later in life than girls do. 212. Which of the following physical changes occurs in adults over 25 years of age? Settling of the disks in the spine 213. Which of the following statements regarding middle adults is correct? Middle adults view crisis as a challenge to be overcome rather than a threat to be avoided 214. The decline in cardiac function associated with aging is largely related to: atherosclerosis 215. Vascular compensation for changes in blood pressure decrease with age due to: reduced elasticity of the peripheral vessels secondary to decrease in the elastin and collagen 216. What is a "low normal" blood glucose level in a newborn? 45mg/dl 217. Barotrauma caused by bag-mask ventilation in an infant means that your ventilations: were too forceful 218. The_____ reflex happens when an infant is startled and opens his or her arms wide: Moro 219. An infant's sleep pattern is developed through the combination of: central nervous system development and parental efforts 220. In most infants, the primary method of communicating distress is: crying 221. Basic language mastery typically occurs by what age? 36 months 222. -Which of the following psychosocial changes is common during adolescence? Fixation on public image and fear of embarrassment 223. -Patients between 41 and60years of age are least susceptible to: acute immunosuppression 224. In late adults, the size of the airway _____ and the surface of the alveoli _______. Increases, decreases 225. -As the smooth muscles of the lower airway weaken with age: strong inhalation can collapse the walls of the airway, resulting in inspiratory wheezing 226. -Which of the following statements regarding the nervous system function in the older adult is true? Cerebral metabolism and oxygen consumption remain constant throughout life 227. -When assessing an older adult's pupils and ocular movements, you should recall that: it is not uncommon for lens deterioration to cause the pupils to be sluggish to react 228. An infant's fontanelles are typically fused by the age of: 24 months 229. At 2 months of age, an infant should be able to: track objects with his or her eyes 230. -Anxious avoidant attachment is observed in infants who are repeatedly: rejected 231. All of the following physical changes occur in school-age children, EXCEPT: their vital signs become the same as an adult 232. In general, normal psychosocial factors that affect life of a 35-year-old person include all of the following, EXCEPT: anxiety 233. Which of the following factors typically does NOT affect the vital signs of a 65-year-old patient? Living conditions 234. -You would MOST likely see an increased end-tidal CO2 reading in an otherwise healthy older adult because: residual volume increases with age, resulting in stagnant air remaining in the alveoli and hampering gas exchange 235. -According to the terminal drop hypothesis: mental function is presumed to decline in the 5 years preceding death Module 2 CHAPTER 15 1. The ______ are pyramid-like structures that form the posterior attachment of the vocal cords - arytenoid cartilages. 2. All of the following factors would increase a person's repiratory rate EXCEPT - narcotic analgesic use. 3. A patient with respiratory splinting - is breathing shallowly to alleviate chest pain 5. All of the following conditions will cause an increase in the circulating levels of carbon dioxide in the blood EXCEPT - acute hyperventilation. 6. Hypoventilation causes an __ and leads to ____ - decreased minute volume, hypercapnia. 4. Interpulmonary shunting is defined as - the return of unoxygenated blood to the left side of the heart. 7. A patient with orthopnea - has dyspnea while laying flat. 8. Asymmetric chest wall movement is characterized by - one side of the chest moving less than the other. 9. In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus ? - moderate asthma attack. 10. Which of the following clinical findings would be of LEAST significance in a patient experiencing respiratory distress ? - bp of 148/94 mm hg 11. A patient with a suppressed cough mechanism - is at serious risk for aspiration. 12. Biot respirations are characterized by - an irregular pattern of breathing with intermittent periods of apnea. 13. The average peak expiratory flow rate in a healthy adult is approximately - 550 ml. 14. When obtaining a peak expiratory flow rate for a patient with acute bronchospasm, you should - perform the test three times and take the best rate of the three readings. 15. An airway obstruction secondary to a severe allergic reaction - requires specific and aggressive treatment. 16. Complications of aspiration include all of the following EXCEPT - excess surfactant production. 17. Poor lung compliance during your initial attempt to ventilate an unconscious, apneic adult should be treated by - reopening the airway and reattempting to ventilate. 18. If an unresponsive patient does not have a gag reflex, an oropharyngeal airway - should be inserted whether the patient is breathing or not. 19. Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may - cause the device to enter the brain through a hold caused by a fracture. 20. Supplemental oxygen is indicated for any patient with - respiratory distress. 21. Which of the following statements regarding oxygen is correct ? - oxygen supports the process of combustion. 22. When administering oxygen via nonrebreathing mask, you must ensure that the - patient has adequate tidal volume. 23. The venturi mask is MOST useful in the prehospital setting when - a COPD patient requires a long-range transport. 24. Hyperventilating an apneic patient - may decrease venous return to the heart. 25. Complications associated with the one person bag mask ventilation technique are most often related to - inadequate tidal volume delivery. 26. When two paramedics are ventilating an apneic patient with a bag mask device, the paramedic not squeezing the bag should - maintain an adequate mask to face seal. 27. Which of the following is an indicator of inadequate artificial ventilation when ventilating an apneic, tachycardic adult with a bag mask device ? - about 20 breaths per minute are being delivered. 28. The pressure relief valve on an automatic transport ventilator may lead to unrecognized hypoventilation in patients with all of the following conditions, EXCEPT - prolonged apnea. 29. CPAP is NOT appropriate for patients with - slow, shallow respiratory effort. 30. Which of the following patients may benefit from CPAP ? - alert patient with respiratory distress following submersion in water. 31. When administering CPAP therapy to a patient it is important to remember that - the increased intrathoracic pressure caused by CPAP can result in hypotension. 32. Which if the following is NOT proper procedure when inserting a nasogastric tube in a responsive patient ? - keeping the patients head in an extended position while inserting the tube. 33. In contrast to the nasogastric tube, the orogastric tube - is safer to use in patients with severe facial trauma. 34. All of the following are complications associated with orotracheal intubation EXCEPT - necrosis of the nasal mucosa. 35. A disadvantage of ET intubation is that it - bypass the upper airway physiologic functions of warming, filtering, and humidifying. 36. The opening on the distal side of the ET tube allows ventilation to occur - even if the tip of the tube is occluded by blood or mucus. 37. Normally, an adult male will require an ET tube that ranged from - 7.5 to 8.5 mm. 38. The procedure in which the vocal chords are visualized for placement of an ET tube is called direct - laryngoscopy. 39. In contrast to a curved laryngoscopy blade, a straight laryngoscopy blade is designed to - extend beneath the epiglottis and lift it up. 40. Before performing orotracheal intubation, it is MOST important for the paramedic to - wear gloves and facial protection. 41. Orotracheal intubation should be performed with the patients head - in the sniffing position. 42. Intubation of the trauma patient is MOST effectively performed - by two paramedics. 43. After properly positioning the patients head for intubation, you should open his or her mouth and insert the laryngoscope blade - into the right side of the mouth and sweep the tongue to the left. 44. The BURP maneuver usually involves applying backward, upward, and rightward pressure to the - lower third of the thyroid cartilage. 45. The BEST way to be certain that the ET tube has passed through the vocal cords is to - visualize the tube passing between the vocal cords. 46. You should insert the ET tube between the vocal cords until the - proximal end of the cuff is 1 to 2 cm past the vocal cords. 47. After inserting the ET tube between the vocal cords, you should remove the stylet from the tube and then - inflate the distal cuff with 5 to 10 ml of air. 48. If the ET tube has been positioned properly in the trachea - the bag mask device should be easy to compress and you should see corresponding chest expansion. 49. Capnography is a reliable method for confirming proper ET tube placement because - carbon dioxide is nor present in the esophagus. 50. If the ET tube is placed in the trachea properly, the colorimetric paper inside the CO2 detector should - turn yellow during exhalation. 51. The use of capnography in patients with prolonged cardiac arrest may be limited because - of acidosis and minimal carbon dioxide elimination. 52. Typically ETCO2 is approximately - 2 to 5 mm hg lower than the arterial PACO2. 53. What point (s) on the capnography waveform represent (s) a mixture of alveolar gas and dead space gas ?- B 54. What phase of the capnography waveform is called the expiratory upslope ? - B-C 55. On a capnographic waveform, point _____is the maximal ETCO2 and is the best reflection of the alveolar CO2 level - D. 56. Assessment of a patient in respiratory distress reveals capnographic waveforms that resemble a shark fin. What should you suspect ? - bronchospasm 57. Capnography can serve as an indicator of - chest compression effectiveness. 58. Which of the following would MOST likely cause a prolonged alveolar plateau ? - heroin overdose. 59. A Cormack-Lehane Class 3 airway is characterized by - visualization of the epiglottis only. 60. Before securing the ET tube in place with a commercial device you should - note the centimeter marking on the ET tube at the patients teeth. 61. Compared to orotracheal intubation, nasotracheal intubation is less likely to result in hypoxia because - it must be performed on spontaneously breathing patients. 62. The use of phenylephrine hydrochloride (neo synephrine) during nasotracheal intubation will - reduce the likelihood and severity of nasal bleeding. 63. When performing nasotracheal intubation, you should use an ET tube that is - 1 to 1.5 mm smaller than you would use for orotracheal intubation. 64. Digital intubation is absolutely contraindicated if the patient - is unconscious but breathing. 65. Digital intubation should be performed only on a patient who is ___ - unresponsive and apneic. 66. Transillumination guided intubation can be difficult or impossible to perform - in a brightly lit environment. 67. Once you have confirmed that the lighted stylet ET tube combination has entered the trahea, you should - hold the stylet in place and advance the tube about 2 to 4 cm into the trachea. 68. During tracheobronchial suctioning it is MOST important to - monitor the patients cardiac rhythm and oxygen saturation. 69. Approximate insertion of a soft tip (whistle tip) suction cathether down the ET tube involves - gently inserting the catheter until resistance is felt. 70. The MOST obvious risk associated with extubation is - overestimating the patients ability to protect his or her own airway. 71. The MOST significant complication associated with the use of multilumen airways is - unrecognized displacement of the tube into the esophagus. 72. Multilumen airways are contraindicated in patients with - esophageal cancer. 73. The LMA is - an alternative to bag mask ventilation when intubation is not possible. 74. The main disadvantage of the LMA is that it - does not provide protection against aspiration. 75. When checking the cuff of the LMA prior to insertion, you should - inflate the cuff with 50 % more air than is required. 76. Proper insertion of the LMA involves - inserting the LMA along the roof of the mouth and using your finger to push the airway against the hard palate. 77. The king airway should NOT be used in patients - with known esophageal disease. 78. Proper placement of the king LT airway is performed by all of the following techniques, EXCEPT - the esophageal detector device. 79. If ventilation is difficult after inserting a king LT airway should - gently withdraw the device, without deflating the cuffs, until ventilation is easier. 80. When correctly placed the distal tip of the cobra perilaryngeal airway (COBRAPLA) - is proximal to the esophagus and seals the hypopharynx. 81. How does the i-gel differ from the LMA ? - the i-gel has a noninflatable mask. 82. Undersedation of a patient during airway management would likely result In all of the following EXCEPT - respiratory depression. 83. Fentanyl (sublimaze) is a - narcotic analgesic. 84. Which of the following medications is a dissociative anesthetic that produces anesthesia through hallucinogenic, amnesic, analgesic, and sedative effects ? - Ketamine 85. Which of the following closing regimens for ketamine would MOST likely be used to induce sedation prior to administering a neuromuscular blocker ? - 2 mg/kg 86. Which of the following medications does NOT possess hypnotic properties ? - alfentanil 87. Diazepam and midazolam provide all of the following therapeutic effects EXCEPT - analgesia. 88. Which of the following medications is safest to use in patients with borderline hypotension or hypovolemia ? - Etomidate 89. Neuromuscular blocking agents - convert a breathing patient with a marginal airway into an apneic patient with no airway. 90. When a patient is given a paralytic without sedation - he or she is fully aware and can hear and feel. 91. Paralytic medications exert their effect by - functioning at the neuromuscular junction and relaxing the muscle by impeding the action of acethylcholine. 92. Nondepolarizing neuromuscular blocking agents include all of the following EXCEPT - succinylcholine chloride. 93. Which of the following is NOT characteristic of a depolarizing neuromuscular blocking agent ? - tachycardia. 94. To prevent muscular fasciculations associated with the use of succinylcholine you should administer - 10 % of the usual dose of a nondepolarizing paralytic. 95. Drugs such as vecuronium bromide (norcurion) and pancuronium bromide (pavulon) are MOST appropriate to administer when - extended periods of paralysis are needed. 96. Before intubating a patient who has been chemically sedated and paralyzed it is MOST important for the paramedic to - adequately preoxygenate with 100 % oxygen. 97. The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because - no important structures lie between the skin covering the cricothyroid membrane and the airway. 98. Open cricothyrotomy is generally contraindicated in all of the following situations EXCEPT - any patient who is younger than 16 years of age. 99. In contrast to a needle cricothyrotomy, an open cricothyrotomy - enables the paramedic to provide greater tidal volume. 100. When performing an open cricothyrotomy, you should FIRST - palpate for the V notch of the thyroid cartilage and stabilize the larynx. 101. Needle cricothyrotomy is contraindicated in patient with - obstruction above the catheter insertion site. 102. Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, _____ and _____ may result - barotrauma, pneumothorax. 103. After inserting the needle into through the cricothyroid membrane you should not - insert the needle about 1 cm further and then aspirate with the syringe. 104. You should turn the jet ventilator release wave off when - the patients chest visibly rises. 105. Patients with a partial laryngectomy - are called partial neck breathers because they breathe through both a stoma and the nose and mouth. 106. If a patient has a stoma and no tracheostomy tube in place - ventilations can be performed by placing a mask over the stoma. 107. In order for tracheostomy tube to be compatible with a mechanical ventilator or bag mask device - it must be equipped with a 15/22 mm proximal adaptor. 108. When ventilating a patient with facial injuries, it is MOST important to -be alert for changes in ventilation compliance. 109. If the distance between the hyoid bone and the thyroid notch is at least ___ fingerbreadths wide, the difficulty of intubation should be low - two 110. With regard to intubation difficulty , neck mobility problems are MOST commonly associated with - elderly patients. 111. After opening an unresponsive patients airway, you determine that his respirations are rapid irregular and shallow. You should - begin positive pressure ventilations. 112. Which of the following findings is MOST clinically significant in a 20 year old woman with difficulty breathing and a history of asthma ? - prior ICU admission for her asthma. 113. 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 - recognize that the patients condition has improved. 114. A 50 year old woman presents with acute respiratory distress while eating. You're 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 - encourage her to cough and closely monitor her condition. 115. 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 involved - inserting a nasal airway and assisting ventilations with a bag mask device. 116. 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 - suspect that the patient has a pneumothorax on the right side of the chest. 117. You have intubated a 70 year old woman with chronic bronchitis and are en route to the hospital. During transport you note that ventilations are becoming increasingly difficult and her ETCO2 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 ? - tracheobronchial suctioning. 118. 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 able to intubate him. Furthermore, bag mask ventilations are producing no chest rise. The quickest way to secure a patent airway in this patient is to - perform a needle cricothyrotomy. 119. The process of delayed sequence intubation involves - administering a sedative in order to facilitate oxygenation of the patient. 120. The concept of apneic oxygenation is based on the fact that - oxygen uptake by the alveoli will continue, even when the diaphragm is not moving. CHAPTER 14 1. which of the following statements regarding isotonic solutions is correct ? - Isotonic solutions have almost the same osmolarity as bodily fluids. 2. It is MOST important to exercise caution when administering isotonic solutions to patients with - hypertension and congestive heart failure. 3. Lactated ringer (LR) solution may be beneficial to patients who have lost large amounts of blood because - the lactate contained within LR is converted to bicarbonate in the liver and can help combat intracellular acidosis. 4. Hypotonic solutions - hydrate the cells while depleting the vascular compartment. 5. A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution - has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. 6. Colloid solutions - contain proteins that are too large to pass out of the capillary memebranes, so the solutions remain in the vascular compartment. 7. The use of o-negative blood in the prehospital setting is impractical because - it requires refrigeration. 8. The MOST important point to remember about IV therapy is to - keep the IV equipment stable. 9. A microdrip administration set - delivers 1 ml for every 60 drops. 10. The purpose of a Volutrol (Buretrol) administration set is to - avoid inadvertent fluid overload. 11. When suctioning the most appropriate IV catheter, you should routinely consider all of the following EXCEPT - the patients gender. 12. If an adult patient requires fluid replacement for hypovolemic shock, the paramedic should use at least a/an _____ gauge over-the-needle catheter - 18. 13. Regardless of the technique you use to start an IV, you should always - keep the beveled side of the catheter up during insertion and maintain adequate traction on the vein during cannulation. 14. When changing an IV bag, it is important to - ensure that fluid remains in the drip chamber. 15. The first step in discontinuing an IV line is to - shut off the flow of fluid with the roller clamp. 16. Thrombophlebitis is MOST commonly caused by - lapses in aseptic technique. 17. The first sign(s) of IV occlusion is/are - a decreasing drip rate or the presence of blood in the IV tubing 18. Pain, tenderness and blood rapidly pooling around the IV site are MOST indicative of - hematoma. 19. The MOST prominent clinical indicator of a pyrogenic reaction is - fever. 20. Pyrogenic reactions can be largely avoided by - inspecting the IV solution carefully before use. 21. Signs and symptoms of circulatory overload include - hypertension. 22. 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 - an air embolus. 23. The IO space collectively comprises the ______ bone of the ______ and the medullary cavity of the _______. - cancellous, epiphyisis, diaphysis. 24. Which of the following IO devices is NOT used in children ? - FAST 1 25. If the posterior aspect of the leg rapidly becomes edematous during IO infusion, you should - suspect extravascation of fluid. 26. IO cannulation is contraindicated in all of the following situations, EXCEPT - penetrating thoracic trauma. 27. 1 cc is equal to ____ ml - 1. 28. 100 ml is equal to - 0.1 L. 29. To convert 2.5 Liters to milliliters, you should - multiply 2.5 by 1000. 30. To administer a drug, you must know the weight of the drug that is - 1 ml. 31. How many mg/ml are contained in a prefilled syringe of 50% dextrose with a concentration of 25g/50ml - 500. 32. A !% lidocaine (xylocaine) concentration contains - 1000mg/100ml. 33. A hypoglycemic patient requires IV dextrose medical control orders you to administer 25 ml you have a prefilled syringe of 50 % dextrose that contains 25g/50ml how many dextrose will you give ? . 12.5g 34. Medical asepsis is MOST accurately defines as . the practice of preventing contamination of the patient. 35. Which of the following statements regarding sharps containers is correct. Sharps containera should be puncture proof and should bear a biohazard logo. 36. If you give a medication via the oral route in the prehospital setting you should give it early because. Absorption via this route is slow. 37. Which of the following medications is appropriate to administer via the rectal route. Diazepam (valium). 38. The ______ route is the MOST commonly used medication route in the prehospital setting. IV 39. Drug reconstitution involves . injecting diluent or sterile water from one vial into the vial that contains the powdered form of the medication. 40. Which of the following statements regarding subcutaneous medication administration is correct ? . volumes of a drug given subcutaneously are typically 1 ml or less. 41. When administering a medication via the intramuscular route, you should. Stretch the skin over the injection site and insert the needle at a 90 angle. 42. After inserting the needle during an intramuscular injection, but before delivering the medication, you should. Pull back on the plunger to aspirate for blood. 43. Neither subcutaneous nor intramuscular injections should be given to patients . with adequate peripheral perfusion. 44. When administering a drug via IV bolus, you are giving the drug. In one mass 45. Failure to pinch the tubing proximal to the injection port when administering a drug via the IV bolus route will. Cause the medication to flow up the tubing and away from the patient. 46. All of the following medications or preparations are commonly given via the transdermal route, EXCEPT . acetaminophen 47. Medication absorption through a nitroglycerin patch would be increased if the patient has. Skin that is thin or nonintact. 48. Typically, intranasal medications require. 2 to 2.5 times the standard IV dose. 49. Shortly after establishing an IV line of normal saline your patient complains of a burning sensation along the course of the vein you should. Observe the patient for signs and symptoms of an allergic reaction. 50. To make push dose epinephrine you should . place 1ml of epinephrine into 9 ml of normal saline. CHAPTER 13 1. All of the following medications fall in the same classification EXCEPT - diazepam 2. Common components of a medication profile include all of the following EXCEPT - the weight of the drug. 3. Which of the following statements regarding pharmacology is correct ? - despite the advanced science of pharmacology, adverse reactions are commonplace. 4. All of the following are schedule II substances, EXCEPT - heroin. 5. Stimulation of beta 1 adrenergic receptors would produce all of the following effects, EXCEPT - decreased myocardial contractility. 6. In order to cause a negative inotropic effect on the heart, you would have to administer a(n)- beta 1 adrenergic antagonist. 7. A medication that possesses a negative cnhronotropic effect will - cause a decrease in the heart rate. 8. Which adrenergic receptor, when stimulated, inhibits norepinephrine release ? - alpha -2 9. Lipid soluble medications require higher weight based doses in elderly patients because - elderly patients have a higher body fat percentage and fat distribution. 10. The ideal body weight for a woman who is 5 ft 5 in tall is - 57 kg. 11. Which of the following factors would be the LEAST likely to affect a patients response to a medication ?- past medical history. 12. A drug is assigned a pregnancy category 'A' if - 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. 13. A paramedic gives a woman with chronic pain an injection of sterile saline and tells her that it is a narcotic analgesic. The paramedics action - could result in criminal prosecution. 14. A drug that possesses the same desired clinical effect in several smaller doses as it does in a larger single dose has demonstrated - a cumulative action. 15. Which of the following medications is derived from a plant source ? -atropine 16. Which of the following conditions would make a patient the MOST susceptible to an adverse effect from a medication ? - renal failure. 17. Certain antibiotics and antiseizure medications are known to cause stevers johnson syndrome, which is a - severe possibly fatal reaction that mimics a burn. 18. an abnormal susceptibility to a medication that is peculiar to an individual patient is called an - idiosyncratic reaction. 19. the therapeutic index of a medication is defined as the - difference between the median effective dose and the median toxic dose. 20. A (n) _______ medication typically includes a stem that links it to other medications in the same class - generic. 21. Patients who are genetically predisposed to an immune mediated medication response - had an initial exposure and sensitization to a particular antigen. 22. Which of the following medications would MOST likely cause an immune mediated medication response ? - penicillin 23. Decreased efficacy or potency of a medication when taken repeatedly by a patient is called - tolerance 24. Cross tolerance to a medication occurs when - repeated exposure to a medication within a particular class causes tolerance to other medications in the same class. 25. 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 - tachyphylaxis. 26. The physical, emotional, or behavioural need for a medication in irder to maintain a certain level of 'normal' function is called - dependence. 27. Which of the following factors would have the least influence on the duration and effectiveness of a medication ? - patient's dietary habits. 28. Metoprolol has the brand name _______, which may be a subtle reference to lowering the blood pressure. - Lopressor 29. The percentage of an unchanged medication that reaches the systemic circulation is referred to as - bioavailability. 30. The generic name of a medication - is proposed by the manufacturer. 31. Newer medications are designed to target only specific receptor sites on certain cells in an attempt to - minimize the adverse effects. 32. A patient experiences profound sedation when an opoid, such as fentanyl is given together with a benzodiazepine, such as midazolam. This is an example of - synergism. 33. Physiologic drug antagonism occurs when - two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes. 34. A medication undergoes first pass metabolism in the - liver. 35. First pass metabolism of a medication occurs when - the bioavailability of a medication is reduced before it reaches the systemic circulation. 36. Which of the following statements regarding the endotracheal route of medication administration is correct ? - the endotracheal route is no longer considered a reliable method of medication administration. 37. Which of the following medications can be administered via the intranasal route ? - midazolam 38. When the paramedic administers a medication via the IV route - he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation. 39. IO infusion rates are comparable to IV infusion rates - when a pressure bag or mechanical infusion device is used. 40. All of the following are common sites for emergency IO cannulation EXCEPT the - iliac crest. 41. Which of the following statements regarding the IM route of medication administration is correct ? - medications have a bioavailability of 75 % to 100 % following IM administration. 42. Transdermal medication patches - may alter a patients clinical presentation or interfere with medications administered by the paramedic. 43. Which of the following statements regarding the sublingual administration of nitroglycerin is correct ? - nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability. 44. Medications commonly administered via a nebulizer include all of the following EXCEPT - lidocaine 45. The rectal route is preferred over the oral route for certain emergency medications because - rectal medications are usually not subject to first pass metabolism. 46. In which of the following situations would the paramedic MOST likely administer a drug via the rectal route? - seizure termination. 47. Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption ? - urinary tract. 48. The process that the cells of large medication molecules use to ingest intracellular fluids and their contents is called - pinocytosis. 49. Which of the following statements regarding plasma-protein binding is correct ? - plasma protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action. 50. As a medication undergoes biotransformation, it becomes a(n) - metabolite. 51. Most medication biotransformation occurs in the - liver. 52. The paramedic should suspect altered medication metabolism in a patient with - chronic alcoholism. 53. Patients with _______ are at significant risk for toxic effects of medications or metabolic waste products in the body. - renal failure. 54. Which of the following describes first-order elimination ? - the rate of elimination is directly influenced by the plasma levels of the substance. 55. A patient takes 500 mg of a medication that has a half life of 2 hours. How much medication will be in the patients body after 6 hours ? - 62.5 mg 56. All of the following medications are used to reduce a patients heart rate and blood pressure, EXCEPT - lorazepam 57. Which of the following statements regarding benzodiazepine medications is NOT correct ? - high doses of a benzodiazepine may be needed to maintain a patients blood pressure. 58. Unlike a nondepolarizing paralytic, a competitive depolarizing paralytic - causes muscle fasciculations. 59. Compared to succinylcholine, rocuronium - has a rapid onset of action, a longer (15 to 60 minutes) duration of action, and fewer adverse effects. 60. Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia ? - albuterol. 61. Which of the following occurs during phase 1 of the cardiac cellular action potential ? - sodium influx decreases while potassium slowly exits the cell. 62. What phases of the cardiac cellular action potential comprise the absolute refractory period ? - through 3. 63. Beta blockers should be used with extreme caution in patients with reactive airway because - beta 2 receptors can potentially be antagonized, resulting in bronchospasm. 64. Toxic effects from beta blockers include all of the following EXCEPT - tachycardia. 65. What class of medication is typically used to control the heart rate in patients with atrial fibrillation or atrial flutter ? - calcium channel blocker 66. In general alpha-adrenergic receptor antagonists - lower the blood pressure. 67. Patients who take alpha blocking medications at home are frequently prone to - postural hypotension. 68. Stimulation of alpha 2 receptors - suppresses the release of norepinephrine. 69. ACE inhibitors medications lower blood pressure by - blocking the conversion of angiotensin 1 to angiotensin 2. 70. Under normal conditions, the renin-angiotensin system functions by - promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion. 71. Patients taking ACE inhibitor medications may experience - a chronic, dry cough. 72. The vagus nerve releases _____ which acts on _____ receptors - acetylcholine, muscarinic 2. 73. Acetychlorase is an enzyme that - breaks down acetylcholine. 74. Massive doses of atropine may be required when - acetylcholine increases dramatically due to acetylcholinesterase inhibition. 75. Paradoxical bradycardia may occur if atropine is given - in doses less than 0.1 to 0.2 mg. 76. All of the following are endogenous catecholamines, EXCEPT - atropine. 77. Which of the following statements regarding sympathomimetic chemicals is correct ? - they are not found naturally in the body. 78. Catecholamines and sympathomimetic medications should be administered with caution because they - can increase cardiac workload and myocardial oxygen demand. 79. in contrast to epinephrine, norepinephrine - primarily stimulates alpha recptors. 80. At 5 to 10 mcg/min, dopamine - activates beta 1 receptor sites, causing an increased heart rate and increased cardiac contractility. 81. dopamine is commonly used in the prehospital setting as the primary medication for - nonhypovolemic hypotension. 82. At 15 mcg/kg/min dopamine - causes vigorous vasoconstriction 83. The primary physiologic effect of dobutamine is - increased inotropy. 84. Hypotension may occur following initiation of a dobutamine infusion because it - reduces cardiac afterload. 85. which of the following medications has the ability to increase cardiac contractility while simultaneously causing dilation of systemic arteries and veins ? - milrinone (Primacor). 86. The physiologic effects of nitroglycerin when given to patients with cardiac related chest pain include - decreased preload and coronary vasodilation. 87. For which of the following conditions is sodium nitroprusside used ? - unstable vascular aneurysm. 88. What type of medication is used to eliminate certain toxins from the body ? - diuretic. 89. For which of the following conditions may a patient be prescribed furosemide ? - kidney dysfunction. 90. In critical care settings, mannitol is used to - reduce cerebral edema. 91. If unmatched blood is administered in the prehospital setting. It will almost always be - 0, Rh negative. 92. The preferred IV fluid for Y site tubing administration during a blood product transfusion is - nal saline. 93. Assuming no ongoing blood loss, one unit of packed red blood cells will increase the hematocrit by - 3 % 94. Which of the following statements regarding packed red blood cells (PRBCs) is correct ? - in general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss. 95. Fresh frozen plasma is used to - replace critical clotting factors. 96. Which of the following statements regarding fresh frozen plasma (FFP) is correct ? - FFP must be compatible with the recipient's blood type, but does not have to be Rh compatible. 97. The paramedic may be called upon to administer platelets to patients with - thrombocytopenia. 98. What is the mechanism of action of anticoagulant medications ? - they prevent new clot formation and the growth of existing clots. 99. What specific abnormally does tranexamic and (TXA) address in a trauma patient ? - hyperfibrinolysis. 100. Traexamic acid (TXA) has been shown to significantly decrease patient mortality when administered - within 3 hours of a traumatic injury. 101. When is aspirin indicated for the treatment of a stroke ? - only after an intracranial hemorrhage has been ruled out. 102. Which of the following is NOT an oral antiplatelet medication ? - ReoPro 103. Which of the following is an influencing factor regarding the administration of a fibrinolytic drug to a patient experiencing an acute myocardial infarction ? - time of symptom onset. 104. Which of the following indications actually dissolves a clot ? - activase. 105. In contrast to morphine, fentanyl - has a lower risk of causing nausea and histamine release. 106. Patients who receive opoid substances on a long term basis - often need higher doses of an opoid medications for pain relief. 107. in up to 60 % of all patients, morphine sulfate causes - nausea and vomiting. 108. Fentanyl (Sublimaze) is the preferred opoid analgesic for patients in critical or unstable condition because - it is not as prone to causing hypotension as morphine. 109. When administering naloxone to a patient who overdosed on an opoid, it is important for the paramedic to remember that - the duration of action of naloxone in the body is less than that of many opoid chemicals. 110. What type of medication is used to decrease gastric acid secretion ? - histamine 2 receptor antagonist. 111. Phenothiazine medications exert their antiemetic properties by - activating a dopaminergic recptors in the brain and releasing hormones that depress the reticular activating system. 112. The paramedic should administer promethiazine (Phenergan) by - diluting it in 50 ml of normal saline and administering it over 10 minutes. 113. All of the following medications possess antiemetic properties - famotidine 114. IV calcium is routinely used to treat - magnesium sulfate toxicity. 115. Glucagon is used in the treatment of beta blocker overdose because it - produces positive inotropic and chronotropic effects. 116. What classification of medication is ketorolac (Toradol) ? - nonsteroidal anti inflammatory . 117. Which of the following medications is used to provide cardiac cell membrane stabilization following tricyclic antidepressant overdose ? - sodium becarbonate. 118. a malnourished patient with a history long term alcohol abuse would MOST likely receive - thiamine.

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1 Clinical signs of hypokalemia include - weakness and flattened T waves. 2 Common signs and symptoms of acute gastroenteritis include all of the following, EXCEPT -chest pain. 3 Common signs of bleeding in the upper gastrointestinal tract include all of the following EXCEPT- hematochezia. 4 Which of the following statements regarding Grey Turner sign is correct ? - Grey Turner sign is characterized by flank bruising and indicates internal bleeding. 5 Blood that has been digested by stomach acids manifests as - coffee grounds emesis. 6 You are caring for a middle aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should - administer high flow oxygen start two large bore IV lines, and administer 20 ml/kg normal saline boluses until his radial pulses strengthen. 7 A 38 year old man presents with an acute on set of severe right upper quadrant abdominal pain, pain to his right shoulder, and nausea. He is conscious and alert, but is restless from the pain. His blood pressure is 150/86 mm hg, pulse rate Is 120 beats/min and strong, and respirations are 22 breaths/min and regular. You should - start an IV with normal saline and set it to keep the vein open, place him a position of comfort, and administer morphine and promethazine. Chapter 21 1 the structural and functional unit of the kidney is - nephron. 2 Most unrinary tract infections - occur in women due to the relatively short urethra and its close proximity to the vagina and rectum. 3 The pain associated with a kidney stone MOST often - begins in the flank region and radiates to the groin. 4 More than half of all cases of chronic kidney disease are caused by - systemic diseases such as diabetes. 5 In a patient with chronic kidney disease, you would MOST likely find that his or her skin is - jaundiced. 6 Unlike peritoneal dialysis, hemodialysis - involves the circulation of blood through a machine. 7 Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of - hypokalemia. 8 Which of the following abdominal segments is anterior and is the most inferior ? - hypogastric region. 9 ECG monitoring of a patient with a suspected urologic emergency is especially important because of - the potential for electrolyte imbalances and their effect on the heart. 10 Which of the following would MOST likely cause urge incontinence ? - caffeinated beverages. 11 The MOST common acute renal disease is - nephrolithiasis. 12 Which of the following statements regarding pyelonephritis is correct ? - pylepnephritis is an inflammation of the linings of the kidney. 13 Urine output of less than 500 ml per day is called - oliguria. 14 A common cause of intrarenal acute kidney injury is - type 1 diabetes. 15 Acute kidney injury is MOST accurately defines as - sudden decrease in filtration through the glomeruli. 16 Azotemia is defined as - increased nitrogenous wastes in the blood. 17 Patient with chronic kidney disease may present with uremic frost, especially - around the face. 18 Definitive treatment for a patient with end stage renal disease involves - kidney transplant. 19 The skin of a patient with end stage renal disease - may appear bruised. 20 Which of the following statements regarding peritoneal dialysis is correct ? - in peritoneal dialysis, large amounts of specially formulated dialysis fluid are infused into the abdominal cavity and left for 1 to 2 hours. 21 An arteriovenous fistula is usually located in the - forearm or upper arm. 22 Disequilibrium syndrome is a condition in which - water initially shifts from the blood stream into the cerebrospinal fluid, causing an increase in intracranial pressure. 23 The MOST important aspect of assessing a patient with a genitourinary emergency is to - detect and treat life threatening conditions. 24 Which of the following is a potentially life threatening complication of missing one or more dialysis treatments ? - hyperkalemia. 25 A young woman presents with left sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. You should suspect - pyelonephritis. 26 You receive a call to a residence for a 60 year old man who is bleeding from his dialysis shunt. Whem you arrive, the patient's wife, who has been properly trained on the use of the dialysis machine, tells you that she panicked and called EMS. The dialysis cannula has loosened from the needle, which is still in the shunt. Your initial action should be to - attempt to tighten the connection between the needle and cannula. 27 A 70 year old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm hg, has a pulse rate of 90 beats /min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should - monitor her cardiac rhythm, transport, and start an IV line en route to the hospital. 28 Symptoms of benign prostatic hypertrophy (BPH) may include - incomplete bladder emptying. 29 During a dialysis treatment, a 39 year old man presents with a sudden onset of dyspnea and cyanosis. You should - disconnect him from the dialysis machine. 30 Which additional medication should be readily available when administering analgesia to a patient with kidney stone ? - naloxone. 31 all of the following are internal regions of the kidneys, EXCEPT the - hilum 32 common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT - gross hematuria. 33 A renal calculus that has become lodged in a lower ureter would likely produce all of the following signs and symptoms, EXCEPT - fever 34 Clinical manifestations of chronic kidney disease include all of the following EXCEPT - dehydration. 35 All of the following conditions may cause urinary retention EXCEPT - testicular torsion. 36 A 59 year old woman with chronic kidney disease presents with an acute onset of dyspnea while undergoing a hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm hg. Based on this patient's medical history and clinical presentation, which of the following interventions is likely NOT indicated ? - IV crystalloid fluid boluses. 37 A 20 year old male presents with an acute onset of severe testicular pain. He denies any trauma to the genital groin. He is conscious and alert, his blood pressure is 144/84 mm hg, his heart rate is 120 beats/min, and his respirations are 24 breaths/min with adequate depth. The MOST important aspect in the care of this patient involves - prompt transport. 38 A 50 year old man presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation? - antidepressant use. 39 A 40 year old man presents with difficulty urinating, fever, and tremors. Which of the following should you suspect ? - prostatitis. 40 Anytime a patient with end stage renal disease is found in cardiac arrest, the paramedic should strongly consider which of the following as the cause ? -hyperkalemia. Chapter 22 1 the MOST common cause of amenorrhea is - pregnancy. 2 Which of the following statements regarding endometritis is correct ? -untreated endometritis may result in septic shock. 3 Pelvic inflammatory disease MOST commonly affects - sexually active women. 4 Which of the following statements regarding ectopic pregnancy is MOST correct ? -in ectopic pregnancy, a fertilized egg implants somewhere other than the uterus. 5 A ruptured ovarian cyst typically presents with - a sudden onset of abdominal pain that can be related to the menstrual cycle. 6 When conducting the scene size up of a call involving a gynecologic emergency, it is MOST important to - assess for danger because any scene should be considered volatile. 7 The MOST important aspect in the care of a woman with severe vaginal bleeding is - treating for shock and transporting rapidly. 8 Within a few days after having a miscarriage, a 33 year old woman presents with malaise, fever, constipation, and pelvic pain. Her blood pressure is 124/84 mm hg, pulse rate is 104 beats/min and strong, and respirations are 22 breaths/min and regular. You should be MOST suspicious for - endometritis. 9 Law enforcement requests that you respond to a local apartment complex for a young woman who was sexually assaulted. When you arrive at the scene, you find the patient sitting on her couch, clearly upset. You see a small amount of blood on her shorts, near the groin area. What is your initial priority in the care of this patient ? - identifying and trating immediate life threats. 10 A 29 year old female was diagnosed with cystitis, but never had her antibiotic prescription filled. She presents today with fever, chills, and vomiting. What should you suspect ? - pyelonephritis. 11 Which of the following conditions, if it remains undetected until puberty, can result in acute pain, severe constipation, and low back pain at the onset of menses ? -imperforate hymen. 12 During normal menstruation, approximately ____to ____ ml of blood is discharged from the vagina - 25,65 13 The onset of menses is called - menarche. 14 Pelvic inflammatory disease commonly affects all of the following organs, EXCEPT the - urinary bladder. 15 Risk factors for pelvic inflammatory disease include all of the following, EXCEPT - monogamy. 16 The candida albicans fungus is the causative agent in - vaginal yeast infections. 17 If a young female with a known history of gonorrhea presents with abdominal pain, nausea and vomiting, and bleeding between periods - she most likely has pelvic inflammatory disease. 18 You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient lying on her side in the manager's office. She is confused, diaphoretic, and appears to be bleeding from her vagina. Her blood pressure is low, and her pulse and respiratory rates are elevated. You should - apply high flow oxygen, visually inspect her vagina and cover ir with sterile dressing, keep her warm, begin transport, establish at least one large bore IV en route, and administer enough crystalloid fluid to maintain radial pulses. 19 A 30 year old woman complains of an 'achy' pain to both lower abdominal quadrants, which she states is made worse by walking. She further tells you that she recently finished her menstrual period. She had a fever of 101.9 f. her blood pressure is 122/62 mm hg, pulse rate is 84 beats /min and strong, and respirations are 14 breaaths/min and unlabored. Asfter gathering the rest of her medical history, you should - provide emotional support, make her as comfortable as possible, and safely transport her to an appropriate hospital. 20 You are caring for a young woman with constant, diffuse abdominal pain, referred pain to both shoulders, and vaginal bleeding. She states that her last menstrual period was 2 months ago, but she adamantly denies being pregnant. Her blood pressure is 86/50 mm hg, pulse rate is 120 betas/min and weak, and respirations are 24 breaths/min and regular. Which of the following interventions is NOT appropriate for this patient ? - narcotic analgesia. 21 You are dispatched to a residence for a 34 year old woman who is 'sick'. Upon your arrival, the patient greets you at the door. She tells you that she began experiencing a dull aching pain in the left lower quadrant of her abdomen. She further states that she recently had her menstrual period, which was accompanied by more pain than usual. Her vital signs are stable, she is conscious and alert, and she denies vaginal bleeding or fever. This patient MOST likely has - a ruptured ovarian cyst. 22 You are caring for a 44 year old woman who was sexually assaulted by several men. She Is conscious but very quiet. Your partner, a female paramedic, quickly examines her and finds no immediate life threatening injuries. The patient tells you that all she wants to do is go home and take a shower. After multiple attempts to convince the patient to consent to transport, you are unsuccessful. Your MOST appropriate action should be to - ask the patient if there is a friend you can call with whom she can stay. 23 Whiled caring for an unresponsive young woman who was apparently sexually assaulted, you note that her respirations are slow and shallow, her pulse is slow and weak, and her blood pressure is low. There is a small amount of dried blood on her thigh, but no grossly active bleeding. Immediate care for this patient involves - maintaining her airway and providing ventilatory assistance.' 24 An obese 30 year old female had two children within an 18 month time span. She presents with a feeling of 'heaviness' in her pelvis and lower back pain. She states that the symptoms resolve slightly when she lies down. What should you suspect ? - uterine prolapse. 25 How should you transport a patient who has a beer bottle stuck in her vagina ? - knees flexed, legs together. 26 A young female with experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should - transport immediately. 27 A woman is diagnosed with a prolapsed uterus. Her cervix has dropped, but remains within the vagina. This is a ____ degree prolapse. - first. Chapter 23 1 the endocrine system comprises a network of _____ that produce and secrete chemical messengers called _____ - glands, hormones. 2 the primary anatomic link between the endocrine system and the nervous system is / are the - hypothalamus. 3 Diabetes is MOST accurately defines as - a metabolic disorder in which the body's ability to metabolize simple carbohydrates is impaired. 4 A person with type 1 diabetes - generally does not produce any insulin and requires daily insulin injections. 5 Adrenal insufficiency is characterized by decreased function of the _____ and consequent underproduction of _____ - adrenal cortex, cortisol and aldosterone. 6 Which of the following statements regarding Addison disease is MOST correct ? - Addison disease most often occurs when the immune system creates antibodies that attack and estroy the adrenal cortex. 7 The MOST common cause of Addisonian crisis is -abrupt termination of corticosteroid use. 8 Which of the following would MOST likely cause cushing syndrome ? - administration of large amounts of methylprednisolone to an asthma patient 9 Signs and symptoms of hypothyroidism include - bradycardia and sluggish reflexes. 10 Which of the following clinical presentations is MOST consistent with thyrotoxicosis ? - severe tachycardia, fever, nausea and vomiting, and confusion. 11 When the body's metabolic rate decreases - the thyroid gland secretes thyroxine. 12 The adrenal medulla secretes norepinephrine following stimulation from the - hypothalamus. 13 The release of glucagon into the bloodstream stimulates - the liver to convert glycogen to glucose. 14 What is the function of estrogen ? -it signals the anterior pituitary gland to secrete lutenizing hormone. 15 Type 1 diabetes that is secondary to an autoimmune disorder occurs when - the body builds up antibodies that destroy the islets of Langerhans. 16 Cessive alcohol consumption can lead to low blood glucose levels because - alcohol depletes glycogen stores in the liver. 17 Diabetic patients would MOST likely present with atypical signs and symptoms of - acute coronary syndrome. 18 The tissues of the central nervous system - depend entirely on glucose as their source of energy. 19 Prior to administering 50 % dextrose (d50) via IV push, it is MOST important to - ensure that the IV line is patent and freely flowing. 20 Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by - hyperglycemia -induced osmotic diuresis and vomiting . 21 A patient with diabetic ketoacidosis experiences polydipsia as a result of - dehydration. 22 Prehospital treatment for patients with hyperosmolar hyperglycemic nonketotic coma focuses on - airway management and fluid rehydration. 23 In contrast to primary adrenal insufficiency, secondary adrenal insufficiency is caused by - decreased cortisol secretion secondary to a lack of adrenocorticotropic hormone secretion from the pituitary gland. 24 You are dispatched to the resident of a 60 year old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several 'small strokes'. In addition to managing her airway, you should - perform a field glucose test to rule out hypoglycemia. 25 A 30 year old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm hg, her pulse is 110 beats/min and full, and her respirations are rapid and deep. On the basis of this patients clinical presentation, she will MOST likely require - crystalloid fluid hydration. 26 You are assessing a 70 year old man with a blood glucose reading of 400 mg/dl and note the presence of sharply peaked T waves on the cardiac monitor. Which of the following medications would this patient MOST likely receive in the prehospital setting ? - bicarbonate. 27 You are dispatched to a residence for an elderly woman who is 'sick'. When you arrive and assess her, you note that she is responsive to pain only and has hot, moist skin and rapid, shallow respirations. You find predisone, paxil, and multivitamins on her nightstand. Further assessment of this patient will MOST likely reveal - hypoglycemia, hypotension, and ECG evidence of hyperkalemia. 28 A 68 year old obese woman presents with a markedly decreased level of consciousness. She was found in bed by her husband. Your primary assessment revels that her respirations are slow and shallow, her pulse is slow and weak, and her skin is cold and dry. According to the patients husband, she has had a recent infection, but he cannot remember what the doctor called it. You should be MOST suspicious that this patient is experiencing - myxedema coma. 29 Acanthosis is a clinical finding that indicates - cushing syndrome 30 Clinical characteristics of syndrome of inappropriate antidiuretic hormone (SIADH) include - systemic fluid overload. 31 Secretion of the parathyroid hormone is regulated by blood levels of - calcium. 32 The endocrine component of the pancreas - comprises the islets of Langerhans. 33 Which of the following statements regarding insulin is correct ? - insulin is the only hormone that decrease blood glucose levels. 34 Microvascular compliance of diabetes include all of the following EXCEPT - hypertension. 35 Common symptoms of type 2 diabetes include all of the following EXCEPT - dysuria. 36 Which of the following would NOT cause hypoglycemia in the patient with type 1 diabetes ? - insulin underdose. 37 The clinical presentation of a hypoglycemic patient would MOST likely resemble that of a patient with - alcohol intoxication. 38 Diabetic ketoacidosis occurs when - the cells metabolize fat and produce ketones. 39 Unlike the patient with hypoglycemia, the patient with severe hyperglycemia - is tachypneic and hyperpneic. 40 Patients with hyperosmolar hyperglycemic nonketotic coma - present with severe dehydration and neurologic deficts. 41 A decrease in adrenal hormone production will result in all of the following , EXCEPT - hypertension. 42 The chief clinical manifestation of Addisonian crisis is - shock. 43 A 29 year old man presents with bizarre behaviou and profuse sweating. His wife tells you he has type 1 diabetes and that he took his insulin today. During your assessment, you will MOST likely find that the patient is - tachypneic. 44 You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being 'drunk'. Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dl. As your partner assists the patient's ventilations, you start and IV and administer 50 % dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dl. You should - administer a second dose of dextrose and prepare for immediate transport. 45 A 51 year old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man's wife, he has had a fever and flu like symptoms for the past few days she further tells you that he has ' stuck to his diet' as advised by his physician. His blood pressure is 90/50 mm hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level , which reads 'high'. This patient is MOST likely - experiencing hyperosmolar nonketotic coma. 46 Which of the following is consistent with hyperosmolar hyperglycemic syndrome ? - glucose, 612 mg/dl; ph, 7.39; ketone bodies, absent. Chapter 24 1 formed elements of the blood account for approximately ____ % of the total blood volume - 45. 2 Red blood cell production is stimulated by erythropoietin, which is secreted by the - kidneys. 3 Approximately one-third of the body's platelets - are stored in the spleen. 4 If an individual has a A positive blood - his or her blood contains the RH antigen. 5 Anemia resulting from an autoimmune disorder occurs when - red blood cells are destroyed by the body's own antibodies. 6 A patient who presents with petechiae is MOST likely - thrombocytopenic. 7 A painless, progressive enlargement of the lymphoid glands that most commonly affects the spleen and lymph nodes is called - Hodgkin lymphoma. 8 During the second stage of disseminated intravascular coagulation - decreased clotting factors cause uncontrolled hemorrhage. 9 Which of the following statements regarding sickle cell disease is correct ? - patient with sickle cell disease become hypoxic because their misshapen red blood cells are poor carries of oxygen. 10 During your primary survey of a patient with hematologic disorder, your priority should be to - note any signs and symptoms that may be immediately life threatening. 11 You would expect a person's hematocrit to be low if he or she - is hemorrhaging 12 A patient with thrombocytopenia - has a decreased platelet count. 13 Which of the following is NOT a major component of the hematologic system ? - pancreas. 14 The primary site for cell production in the human body is the - bone marrow. 15 The majority of the circulating white blood cells are - neutrophil. 16 Anemia would result from all of the following conditions, EXCEPT - an increase in iron. 17 Which of the following is NOT typically associated with leukemia ? - absence of fever. 18 In contrast to chronic leukemia, acute leukemia occurs when - bone marrow is replaced with abnormal lymphoblasts. 19 Indolent non-hodgkin lymphoma - may never spread from the lymphoid syste. 20 Abdominal pain that is associated with polycythemia is usually associated with - an enlarged spleen. 21 Patient with type A hemophilia - have a deficiency of factor V111. 22 As multiple myeloma progresses, the patient would MOST likely experience - spontaneous fractures. 23 You are transferring a 60 year old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of prior stroke, and hypertension. The patient tells you that he feels a fluttering in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190 beats/min. the patient's blood pressure is 116/70 mm hg and he remains conscious and alert. You should - ensure adequate oxygenation and ventilation, adnminister 6 mg of adenosine, and reassess his cardiac rhythm. 24 you receive a call to a residence for a patient who is 'sick'. Upon arriving at the scene, you find the patient, a 39 year old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/59 mm hg. Her medical history is significant for hemophilia, for which she is receiving factor V111 therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should - advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death. 25 A 22 year old male with sickle cell disease presents with severe abdominal pain. On assessment, his abdomen appears bloated and is rigid to the touch. What should you suspect ? - splenic sequestration syndrome. Chapter 25 1 physiologic effects of histamine include all of the following EXCEPT - increased cardiac contractility. 2 Histamine release causes all of the following effects, EXCEPT - increased cardiac contractility, which results In hypertension. 3 Early clinical manifestations of an allergic reaction include all of the following EXCEPT - stridor. 4 Common central nervous system manifestations of anaphylactic shock include all of the following EXCEPT - combativeness. 5 Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT - a secondary assessment. 6 An antigen is MOST accurately defined as a - substance that causes the immune system to produce antibodies. 7 Anaphylaxis is classified as a response mediated by _____ antibodies - IgE 8 The longer the time between exposure to a substance - the less likely a severe anaphylactic reaction will occur. 9 Following the primary response to a foreign substance, the body- develops sensitivity and is able to recognize the substance following subsequent exposure. 10 Hypotension secondary to histamine release is due to - vasodilation and decreased cardiac contractility. 11 Cardiovascular effects of anaphylaxis include - tachycardia, flushed skin, and hypotension. 12 The three MOST significant indicators of anaphylactic shock are - dyspnea, hypotension, and tachycardia. 13 An unresponsive patient with signs of anaphylactic shock - indicates cerebral hypoxia and hypercarbia. 14 The alpha adrenergic effects of epinephrine produce - vasoconstriction. 15 What is the MOST common cardiac disorder associated with lupus ? -pericarditis. 16 Patients with ______ are at an increased risk for anaphylaxis - atopic dermatitis. 17 In contrast to cellular immunity, humoral immunity - involves the use of antibodies dissolved in the blood plasma to fight off invading organisms. 18 The chemical mediators that initiate and maintain the immune response are - basophils and mast cells. 19 Which of the following statements regarding leukotrienes is correct ? - leukotrienes compound the physiologic effects of histamine and cause additional bronchoconstriction. 20 Which of the following clinical signs or symptoms are MOST indicative of upper airway swelling in a patient experiencing a severe allergic reaction ? - hoarseness and stridor. 21 What physiologic effect of anaphylactic shock is seen MOST commonly in patients with neurogenic shock ? - widespread vasodilation 22 The MOST ominous respiratory sign in a patient with anaphylactic shock is - diminished lung sounds. 23 During the secondary assessment of a patient experiencing a severe allergic reaction, you should - apply the cardiac monitor to detect dysrhythmias. 24 The primary treatment for hypotension secondary to anaphylaxis is - epinephrine. 25 Which of the following is considered the major contributing factor to fatalities in anaphylactic shock ? - delayed epinephrine administration. 26 When administering an epipen to a 30 year old man with a severe allergic reaction, you should recall that - the drug cartridge contains 0.3 mg of a 1;1000 solution. 27 Systemic lupus erythematosus is a disease caused by - a multisystem autoimmune disorder. 28 Assessment os a patients with collagen vascular diseases should focus on - ruling out life threats. 29 Which of the following medications has the SLOWEST onset of action when given to a patient with a severe allergic reaction ? - methylprednisone 30 You have treated the same patient several times for a severe allergic reaction. While educating him about the prevention of future reactions, you should advise him to - avoid the substance he is allergic too. 31 A 20 year old woman complains of difficulty breathing and the feeling of a lump in her throat approximately 10 minutes after being stung by a wasp. Your assessment reveals that she is anxious, is in obvious respiratory distress, and has hives covering her arms and legs. Further assessment revelas diffuse wheezing, a blood pressure of 80/50 mm hg, and a heart rate of 120 beats/min. you should - apply high flow oxygen via nonrebreathing mask, administer epinephrine via the IM route, and establish vascular access. 32 You have administered the appropriate dose of epinephrine to a patient with a severe allergic reaction. Reassessment revelas that the patient's condition has improved markedly. The patient, who has a history of coronary artery disease, is receiving high flow oxygen and is on a cardiac monitor. You should next - transport immediately, monitor airway and breathing en route, and administer Benadryl IV or IM. 33 For which of the following reasons would a corticosteroid be administered to a patient who is experiencing an allergic reaction ? - to cause bronchodilation and restore adequate breathing. 34 A middle aged male who received a kidney transplant called EMS because he was not feeling well. Which of the following assessment findings is MOST suggestive of organ rejection ? - fever with swelling and tenderness over the implanted kidney. 35 Chest pain in patients with a heart transplant is uncommon because - the denervated heart cannot generate angina like pain. Chapter 26 1 which of the following is NOT a factor in determining a person's risk of contracting an infectious disease following exposure ? - the age and sex of the patient. 2 A person is exposed to the mumps virus, is asymptomatic for 16 days, and then becomes ill. The 16 day period is called the - incubation period. 3 In contrast to body substance isolation precautions, standard precautions - emphasize protection from moist body substances that may transmit bacterial or viral infections. 4 Which of the following is NOT included in the centers for disease control and prevention's list of recommended immunizations and tests for health care providers ? - annual HIV testing. 5 Personal protective equipment - serves as a secondary protective barrier beyond what your body provides. 6 Which of the following medical procedures would pose the LEAST risk of exposure to an infectious disease ? - assessing a patient's temperature by the oral route. 7 When washing your hands after a call, you should - use an antimicrobial, alcohol based foam or gel. 8 Postexposure prophylaxis is available for all of the following diseases, EXCEPT - hepatitis c. 9 Following a significant exposure, the source patient is routinely tested for all of the following, EXCEPT - HBV antibody. 10 According to the Ryan White Comprehensive AIDS Resources Emergency Act, the medical facility must - release the source patient's status to the designated infection control officer. 11 W restriction guidelines enforced by OSHA require an employee to use sick time for an illness, unless - the illness is the result of an occupational exposure. 12 According to the centers for disease control and prevention, all children should be immunized against all of the following diseases, EXCEPT - smallpox 13 Rubella is transmitted and spreads when an infected person - sneezes. 14 Transmission of mumps occurs by direct contact with the _____ of an infected person - saliva. 15 In older adults, shingles arises when the _____ virus resides in the ganglion of a nerve - varicella 16 Which of the following statements regarding meningitis is correct ? - most epidemic outbreaks involve meningococcal meningitis. 17 Antibiotic therapy following exposer to meningitis is NOT appropriate for individuals who are - taking birth control pills. 18 A person with tuberculosis (TB) infection - has tested positive for exposure to TB. 19 A paramedic would MOST likely be infected with TB if he or she - performed mouth to mouth resuscitation on a patient with active untreated TB. 20 A person who is taking antibiotics theraphy following a positive TB skin test and chest radiograph should not consume alcohol because - the antibiotics are toxic to the liver. 21 The leading cause of lower respiratory tract infections in infants, older people, and immunocompromised individuals is the - respiratory syncytial virus. 22 The primary infection with syphilis produces - an ulcerative chancre at the site of infection. 23 Secondary syphilitic infection is characterized by all of the following, EXCEPT -petechiae 24 Which of the following statements regarding genital herpes is correct ? - acyclovir is used to reduce a perpetic outbreak, but there is no cure. 25 Chlamydia trachomatis is caused by a ____ and is treated with an _____ - bacterium, antibiotic. 26 Nocturnal itching and the presence of a rash involving the hands are indicative of - scabies. 27 Early signs and symptoms of hepatitis B infection include all of the following except - jaundice. 28 The third dose of the three series hepatitis B vaccine is given - 6 months after the first dose. 29 Occupationally acquired hepatitis C virus infection - is related to a contaminated needlestick with visible blood on the sharp. 30 Which of the following statements regarding the hepatitis D virus (HDV) is correct ? - infection with HDV requires the host to be infected with the hepatitis B virus. 31 The primary target of infection with the human immunodeficiency virus is the - immune system. 32 The communicable period for HIV - is largely unknown. 33 Signs and symptoms of HIV infection may include all of the following EXCEPT - Right upper quadrant pain. 34 Acquired immunodeficiency syndrome - is characterized by the presence of opportunistic infections. 35 If the source patient's blood tests positive for HIV - the blood will be assessed for viral load and the exposed individual may be offered a 4 week trial of antiretroviral therapy. 36 In addition to children, the hepatitis A vaccine is recommended for - emergency response team members traveling outside the united states. 37 In developing countries, there is a strong association between the hepatitis E virus and - inadequate hygiene. 38 A 49 year old woman presents with a severe headache, a temperature of 103.2 f, and photosensitivity. Her blood pressure is 140/76 mm hg, pulse rate is 120 beats/min and strong, and respiratory rate is 22 breaths/min and regular. While caring for this patient, it is MOST important to - protect yourself from any nasopharyngeal secretions. 39 You are dispatched to an apartment complex for a 20 year old woman who is sick. When you arrive at the acene and begin assessing the patient, she tells you that she has been experiencing a purulent vaginal discharge, but denies vaginal bleeding or a fever. Her blood pressure is 104/64 mm hg, pulse rate is 88 beats /min and strong and respirations are 14 breaths/min and regular. What should yu suspect - gonorrhea. 40 A 70 year old homeless man presents with a rash to his hands, wrists, and ankles. He denies any known allergies and states that the rash itches severely at night. His vital signs are stable, and he is breathing without difficulty. You should - transport him to the hospital and thoroughly wash your ahnds after patient care has been completed. 41 A known intravenous drug abuser presents with anorexia, body aches, a low grade fever, and scleral icterus. She is very quiet and is not willing to share her medical history information with you. Which of the following additional clinical signs would reinforce your suspicion regarding the cause of this patient's condition ? -jaundiced skin. 42 You receive a call for an 'unresponsive person'. Law enforcement arrives at the scene before you and advises that the scene is secure. When you arrive, you find the patient, a young man, lying supine on the floor of his poorly kept apartment. He is unresponsive and his breathing is slow and shallow. One of the police officers recognizes that the patient as a known intravenous drug abuser. During your care of this patient you should - avoid removing his wallet or any other possessions from his pockets. 43 You transported a patient with flu like symptoms to the hospital 4 days ago. Your designated infection control officer advises you that the patient was diagnosed with the avian flu. If you documented an exposure to this patient, you will MOST likely be - offered an antiviral medication. 44 Initial symptoms of ebola include - fever, weakness, and sore throat. 45 Which of the following is a treatment focus for a patient infected with the ebola virus ? - fluid rehydration 46 Unlike bacteria, viruses - die when exposed to the environment. 47 Rubella is characterized by - enlarged lymph nodes. 48 Which of the following statements regarding the mumps is correct ? - mumps presents with fever and swelling of the salivary glands. 49 Following exposure to the hepatitis B virus, a person may remain asymptomatic for up to - 150 days 50 Hepatitis A is often described as a benign disease because - lifelong immunity occurs once the disease is acquired. Chapter 27 1 which of the following drugs is described as an antichlolinergic ? - atropine. 2 An acetone breath odor is common following exposure to all of the following toxins, EXCEPT - camphor. 3 Drug abuse is MOST accurately defined as - any use of a drug that causes physical, psychological, or legal harm to the user. 4 A middle aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of - tolerance. 5 Alcohol potentiates Valium. This means that - alcohol enhances the effects of valium. 6 Toxic effects of alcohol on the liver include all of the following EXCEPT - hyperglycemia. 7 Your FIRST priority when dealing with a patient who may have overdosed is to - request law enforcement. 8 Crack is a combination of - cocaine, baking soda, and water. 9 Which of the following types of medications does NOT contain amphetamine ? - drugs used to treat insomnia. 10 Appropriate prehospital treatment for a patient who has overdosed on a stimulant and is excessively tachycardic and violent includes all of the following, EXCEPT - beta adrenergic antagonists. 11 Fluid refractory hypotension following a barbiturate overdose is treated MOST effectively with - dopamine. 12 Which of the following is a sign of severe barbiturate withdrawal ? -hallucinations. 13 If you are treating a patient with a suspected benzodiapine overdose and find that the patient is hypotensive, bradycardic, and comatose - you should consider concomitant overdose with another CNS depressant. 14 Which of the following drugs are an opiate ? - morphine. 15 Immediate treatment for a patient who overdosed on a narcotic and is hypercarbic includes - ventilation with a bag mask device. 16 Which of the following cardiac rhythm disturbances MOST commonly results from inadvertent overdose of a prescribed cardiac medication ? - bradycardia. 17 Organophosphate exert their effect by - stimulating the cholinergic nervous system. 18 Signs and symptoms of organophosphate poisoning include - vomiting. 19 The toxicity of carbon monoxide arises primarily from - its affinity for hemoglobin in red blood cells. 20 The LEAST common sign or symptom of carbon monoxide toxicity is - cherry red skin colour. 21 Pulse oximetry will not provide a true assessment of arterial oxygenation in patient with carbon monoxide toxicity because - the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin. 22 When chlorine gas comes in contact with the body's mucous membranes, it forms - hydrochloric acid. 23 Cyanide blocks the utilization of oxygen at the cellular level by - combining with cytochrome oxidase. 24 Treatment for cyanide poisoning may include all of the following EXCEPT - calcium gluconate 25 In adults patients, oral ingestion of a caustic substance - is usually intentional. 26 If administered in conjunction with nitrates, sildenafil would MOST likely cause - severe hypotension. 27 What is the lethal dose of ethylene glycol in a 190 pound man ? - 175 ml 28 Tricyclic antidepressant medications - may produce toxic effects with even minimal dosing errors. 29 Which of the following medications is NOT a tricyclic antidepressant ? - fluoxetine. 30 Common signs and symptoms of a tricyclic antidepressant overdose include - altered mental status and tachycardia. 31 Which of the following is an ECG change that would MOST likely be observed in a patient with tricyclic antidepressant toxicity ? - terminal R wave in a VR. 32 Which of the following is a sign of severe MAOI toxicity ? - hyperthermia. 33 Metabolic acidosis, hyperkalemia, and rhabdomyolysis that occurs with MAOI toxicity are usually the result of - persistent seizures. 34 Which of the following antidepressant medications has the HIGHEST safety margin ? - paroxetine 35 Inadvertent lithium toxicity would MOST likely occur in a patient who is taking - NSAIDs. 36 Severe salicylate toxicity produces - metabolic acidosis. 37 Prehospital treatment for a patient who overdosed on aspirin may include - sodium bicarbonate. 38 A patient who ingested a significant quantity of acetaminophen less than 24 hours ago would MOST likely present with - malaise, nausea, and a loss of appetite. 39 Death from acetaminophen overdose is MOST often caused by - progressive liver failure. 40 Hematologic manifestations of lead poisoning include - anemia. 41 Which of the following is NOT a common sign of lead poisoning ? - hypotension. 42 The toxic chemical in castor beans is - ricin. 43 The foxglove plant contains ______ and can result in _____ when it is ingested - cardiac glycosides, dysrhythmias. 44 Poisoning with ________ is MOST often the result of improper food storage or canning - clostridium botulinum. 45 A young man is found unresponsive by his girlfriend. Your assessment reveals marked respiratory depression, a slow, weak pulse, and pinpoint pupils. There are numerous medication bottles found in his home. Of the following, he has MOST likely ingested - oxycodone. 46 You are caring for an alcoholic patient who has been abstinent for about 2 days. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52 mm hg, pulse rate is 140 beats/min and weak, and respirations are 24 breaths/min with adequate depth. In addition to administering oxygen, you should - treat his hypotension with crystalloid fluid boluses. 47 You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm hg, a pulse rate of 140 beats/min and a respiratory rate of 24 breaths/min. the patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. Aster asking your partner to stop the ambulance to assist you with the patient you should - administer 4 mg/kg of ketamine IM. 48 You have administered a total of 10 mg of Narcan to an unresponsive 30 year old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypo ventilating, and is bradycardic. Your transport times to the closest hospital is 40 minutes. You should - continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately. 49 A 69 year old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he as an odd odor on his breath; however, he denies being diabetic. You should - have him inhale amyl nitrate for 20 seconds and then 100 % oxygen for 40 seconds out of each minute. 50 A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should - assess his blood glucose level and apply a cardiac monitor. Chapter 28 1 many ems personnel may experience a lack of confidence in their ability to deal with emotional disturbance for all of the following reasons EXCEPT - the uncontrollable fear of personal injury. 2 Metabolic causes of abnormal behavior include - diabetic ketoacidosis. 3 Disorders of thought content include all of the following, EXCEPT - anxiety. 4 A man who smiles pleasantly when he tells you of the recent death of his wife - has an appropriate effect. 5 While assessing a patient you note that she is making repetitive hand gestures as though she is trying to grasp at something. This is an example of ________ movements - stereotyped. 6 At a minimum, you should be able to assess an emotionally disturbed patient's - general appearance. 7 Which of the following assessment findings is MOST suggestive of an organic cause of abnormal behavior ? - unusual breath odor. 8 Wich of the following is NOT a general guideline to follow when caring for a patient with a psychiatric problem ? - be indirect when possible. 9 Common signs and symptoms of a panic attack include all of the following, EXCEPT - a prolonged loss of consciousness. 10 Which of the following scenarios is MOST indicative of posttraumatic stress disorder ? -a paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor vehicle versus pedestrian incident . 11 Which of the following medications would MOST likely cause prolongation of the QT interval ? -inapsine. 12 Signs and symptoms of depression that last for at least 2 years - are highly suggestive of dysthymic disorder. 13 Psychomotor abnormalities associated with depression include - agitation and pacing. 14 Which of the following is NOT an identified risk factor for suicide ? - Hispanic woman older than 55 years of age. 15 Many paramedics are reluctant to broach the subject of suicide with a depressed patient for fear that - they might put ideas into the patients head. 16 Which of the following questions would be the MOST appropriate initial question to ask when broaching the subject of suicide with a depressed patient ? - 'have you ever thought that life wasn't worth living ? ' 17 The MOST important aspect in the care of a patient who is at risk for suicide is - never leaving the patient alone. 18 Manic patients may report that their thoughts are racing and they may rapidly skip from one topic to another . this is called - tangential thinking. 19 A hallmark sign of mania - an elated affect. 20 When a person has a personality disorder - another psychiatric illness typically is present. 21 An agitated man with an antisocial personality - will not think twice about hurting you . 22 People who are overly concerned with their physical health and appearance MOST likely have a - somatoform disorder. 23 In hypochondriasis, patients have significant anxiety or fear that they - may have a serious disease. 24 A patient is a very demanding and is trying to dictate the care that you provide to him. This is characteristic of a(n) ____ personality- histrionic. 25 Unlike a person with bulimia nervosa, a person with anorexia nervosa - experiences weight loss that may cause poor health or even death. 26 The BEST example of an impulse control disorder is - pathologic gambling. 27 Which of the following statements regarding schizophrenia is correct ? - the typical onset of schizophrenia occurs during early adulthood. 28 A state of delusion in which a person is out of touch with reality is MOST appropriately termed - psychosis. 29 An acute dystonic reaction is characterized by - muscle spasms of the neck, face, and back within a few days of starting treatment with a antipsychotic drug. 30 If a psychotic person's level of consciousness is fluctuating, you should - suspect an organic brain syndrome. 31 A psychotic person may have thought insertions, which are defined as - the belief that thoughts are being thrust into his or her mind by another person. 32 When caring for a patient experiencing a psychotic episode, you should - first assess the situation for danger. 33 The BEST way to ensure that no one is harmed during an EMS call is to - assess the potential for violence on every EMS call. 34 You are dispatched to a residence for a patient who has overdosed. You immediately recognize the address as that of a patient with a know psychotic condition. Law enforcement is at the scene and has ensured its safety. When you arrive and enter the residence, you find the patient, a man in his mid-20s, sitting on the floor. He is conscious and appears anxious. Which of the following questions should you ask the patient FIRST ? - 'what medication did you take ? ' 35 You receive a call to an apartment complex for a patient with an unknown behavioural problem. The scene has been secured by law enforcement prior to your arrival. The patient, a 39 year old man, appears very anxious and worried. He tells you that he has obsesseive-compulsive disorder and stopped taking his prescribed medication a week ago because he did not like its side effects. He tells you that he has had fleeting thoughts of suicide, but denies homicidal thoughts. You should - safely transport him to the hospital and monitor his behavior en route. 36 A 50 year old woman called 9-1-1 after she was suddenly awakened in the middle of the night with the feeling that she was being smothered. Your assessment reveals that she is clearly anxious, is trembling, and complains of chest pain and numbness and tingling to ther face and hands. Her blood pressure is 168/96 mm hg, pulse rate is 140 beats/min. her medications include Xanax, Lipitor, and Vasotec. The MOST appropriate treatment for this patient includes - coaching her to slow her breathing, monitoring her osycgen saturation and end-tidal carbon dioxide levels, administering supplemental oxygen, assessing her cardiac rhythm, establishing vascular access, and transporting. 37 A 41 year old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient's vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should - remain with the patient, contact medical control, and request law enforcement intervention. 38 You are dispatched to a skilled nursing care facility for a 74 year old male resident who is ill. During your assessment, you note that the patient has his head cocked to the side and is unable to move it. The charge nurse tells you that the patient was placed on Seroquel 2 days ago. Based on this patient's clinical presentation and medication history, you should - administer 25 to 50 mg of diphenhydramine. 39 Law enforcement personnel request your assistance in caring for a violent patient. When you arrive at the scene, the patient, a 48 year old man, is yelling obscentities and is threatening to kill anyone who comes near hi. Despite your attempts to calm him verbally, he continues his threatening behavior. It is MOST important for you to - ensure that you have a route for rapid egress and visually scan the patient for potential weapons. 40 You are transporting a 22 year old woman whose violent behavior required physical restraint. A law enforcement officer is in the back of the ambulance with you. The patient tells you that she is sorry for her behavior and did not mean to take it out on you and your partner. You should - continue to talk to the patient and monitor her peripheral circulation. 41 A patient is speaking rapidly, skipping from one irrelevant topic to another. This is an example of - tangenital thinking. 42 Which of the following conditions would be the LEAST likely to produce psychotic symptoms / - hyperglycemia. 43 When extreme anxiety occurs in conjunction with restlessness, a patient - becomes agitated. 44 When evaluating a patient with a behavioural emergency, virtually all of the diagnostic information you obtain must come from - your conversation with the patient. 45 When confronted with a feared object or situation, the phobic person- experiences intolerable anxiety and autonomic symptoms. 46 When caring for a patient who is experiencing a panic attack - your manner must convey that everything is under control. 47 Any patient who is experiencing a panic attack - should be evaluated to rule out an underlying medical condition. 48 Following the administration for haloperidol, your patients body becomes rigid and he is extremely restless. What should you suspect / - extrapyramidal reaction. 49 A small percentage of clinically depressed patients - may report an increased appetite. 50 A patient who is taking Aventyl - may have nonspecific t wave changes on the ECG. Chapter 39 1 impedance threshold device , such as the RESQPOD, function by - creating a vacuum in the chest , which increases blood flow to the heart. 2 Defibrillation of a patient who Is in asystole is detrimental to the patient because it - causes an unnecessary interruption in chest compressions. 3 How does CPR change after an advanced airway device is inserted ? - ventilations should be asynchronous with chest comepressions. 4 You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that - compressions are hard and fast, with full chest recoil between compressions. 5 Your assessment of a 68 year old woman revels an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT - cardiac pacing. 6 If a cardiac arrest patient's airway is maintained with an oral airway and ventilation with a bag mask device is producing adequate chest rise, then - insertion of an advanced airway device is not a high priority. 7 When using an impedance threshold device during cardiac arrest, it is important to - deliver each ventilation over a period of 1 second. 8 The chance for return of spontaneous circulation is BEST when - timely chest compressions are performed with little or no interruption . 9 Epinephrine is primarily administered during cardiac arrest because its _____ effects cause ______ - vasoconstrictive, enhanced coronary blood flow. 10 You and your partner arrive at the scene of an unresponsive middle aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient ? - CPR at the appropriate rate and with minimal interruptions. 11 You and your partner are off duty and are playing golf. Suddenly you see an elderly man grab his chest and collapse to the ground. You should - tell your partner to call 9-1-1 as you proceed to assess the man. 12 Your team is attempting resuscitation of a man in cardiac arrest. One of the team members intubates the patient and confirms proper placement of the endotracheal tube. Your MOST appropriate next action should be to - instruct the person ventilating to proive one breath every 6 seconds while chest compressions are continuous. 13 You and your partner are performing CPR on a 60 year old woman who was initially in asystole. After 2 minutes, you look at the cardiac monitor and determine that she is in ventricular fibrillation. Your next action should be to - deliver a single shock and instruct your partner to resume chest compressions while you resume ventilations. 14 Anterior posterior placement of the defibrillation pads should be used if the patient is younger than ___ year(s) of age or less than ___ kg - 1,10. 15 As you are administering epinephrine to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should - instruct your team to continue CPR as the defibrillator Is charging. 16 After approximately 6 minutes of attempted resucitatio, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus bradycardia at 30 beats per minute. In addition to continuing ventilations, what should be done next ? - transcutaneous pacing. 17 You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes, she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next - give 1 to 2 g of magnesium sulfate without interrupting chest compressions. 18 You have an impedance threshold device (ITD) attached to the endotracheal tube as you ventilate an apneic and pulseless patient. Following defibrillation and 2 additional minutes of CPR, it is determined that return of spontaneous circulation has occurred. However, the patient is still apneic. You should - remove the ITD and continue ventilations at a rate of 10 to 12 breaths/min. 19 You have been attempting resuscitation of an 80 year old woman for approximately 15 minutes. And advanced airway has been placed, ventilations have been delivered at the appropriate rate, high quality CPR was performed with minimal interruptions, and rhytms specific medications were administered. Despite your efforts, the patient remains in asystole. Which of the following statements regarding this scenario is correct ? - you have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered. 20 A 6 year old, 40 pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to - defibrillate with 70 joules. 21 Prior to defibrillating a patient who is pulseless ventricular tachycardia, you should - ensure that the patient is not touching any metal. 22 a patient remains in pulseless ventricular tachycardia despite two shocks, a dose of epinephrine, high quality CPR and 300 mg of amiodarone. Following the next shock, you should resume CPR and then - administer 150 mg of amiodarone. 23 Which of the following roles would the code team leader MOST likely perform ? - interpreting the ECG. 24 According to the flat management hierarchy - everyone has a responsibility to speak up about safety issues,. 25 A nontraumatic cardiac arrest patient who has not responded to a successfully executed prehospital ACLS resuscitation effort - should likely not be transported to the hospital. 26 Following return of spontaneous circulation, a patient remains comatose. Which of the following interventions would MOST likely be performed ? - targeted temperature management. 27 When practicing a code, whether in the out of hospital or in hospital setting, the primary focus should be on - teamwork and minimal interruptions in CPR. 28 Hyperventilation of a patient who is in cardiac arrest - has been shown to reduce coronary artery perfusion. 29 In which of the following situations would endotracheal intubation MOST likely be indicated ? - following return of spontaneous circulation, the patient remains comatose. 30 Full recoil of the chest in between compressions enhances blood return to the heart by which of the following mechanisms ? - negative intrathoracic pressure. 31 While en route to the scene of a patient in cardiac arrest, the emergency medical dispatcher advises you that she has the caller on the phone, but the caller refuses to do CPR on the patient. With an estimated times of arrival at the scene of 5 minutes, you should - ask the dispatcher to inform the woman to do chest compressions only. 32 You are performing one rescuer CPR on a 50 year old woman in cardiac arrest. A bystander returns with an AED. You ask the bystander to attach the pads to the patient's chest as you continue CPR. After rhythm analysis , the AED states, ' shock advised.' You should - deliver a single shock and immediately resume CPR. 33 An unresponsive, apneic, and pulseless woman presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to her arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of her condition ? - no pulse with CPR and jugular venous distention. 34 During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient's end tidal CO2 has abruptly increased from 17 mm hg to 40 mm hg. You should - assess for a pulse for up to 10 seconds. 35 Which of the following interventions would MOST likely require a sterile cockpit approach ? - rapid sequence intubation. Chapter 40 1 which of the following premorbid conditions would MOST likely occur in an otherwise healthy adult ? - drug toxicity. 2 In medicine intuition would MOST likely be used to - triage a patient to a higher category. 3 What is the mean arterial pressure of a person who has a blood pressure of 140/90 mm hg ? - 107 mm hg 4 Clinical indicators of sympathetic nervous system discharge include - pupillary dilation. 5 Which of the following is an element of the fick principle ? - an adequate number of red blood cells. 6 Carbonic acid is formed by the combination of - water and carbon dioxide. 7 Baroreceptors function by - sensing decreased blood flow and activating the vasomotor center. 8 Anaerobic metabolism is the process in which - inefficient cellular metabolism produces lactic acid. 9 Afterload is increased following alpha 1 stimulation because of - arteriolar constriction. 10 During anaerobic metabolism, the precapillary sphincters _____ in response to _____ - relax, lactic acid buildup. 11 Incomplete glucose breakdown leads to an accumulation of - pyruvic acid. 12 Accumulating acids and other waste products in the blood - inhibit hemoglobin from binding with and carrying oxygen. 13 The capillary 'washout' phase occurs when - postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide and thrombosed red blood cells. 14 Disseminated intravascular coagulation is defined as (n) - pathological condition in which the proteins that normally control blood clotting become inappropriately active. 15 Which of the following is the MOST accurate definition of multiple organ dysfunction syndrome ? - combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness. 16 During multiple organ dysfunction syndrome, the release of ____, a potent vasodilator, leads to tissue hypoperfusion and may contribute to hypotension - bradykinin. 17 Signs and symptoms of multiple organ dysfunction syndrome may include - uncontrollable bleeding . 18 A patient with severe dehydration is found to be hypotensive during your assessment. The MOST important intervention in this case is - transport with fluid resuscitation en route. 19 When an adult patient with hemorrhagic shock loses more than 40 % of his or her blood volume - cardiovascular deterioration cannot be reversed by compensatory mechanisms. 20 When administering IV fluids boluses to an elderly patient in shock, it is especially important to monitor his or her - lung sounds. 21 A patient with suspected internal bleeding has a systolic BP of 104 mm hg. What is the appropriate fluid management ? - fluid challenge is not necessary. 22 The vasodilation that accompanies distributive shock creates - relative hypovolemia. 23 You have given an 800 ml normal saline bolus to a patient in shock. How much of this fluid will remain in the intravascular space after 20 minutes ? -320 ml 24 Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock

1 The MOST likely cause of Crohn disease is - autoantibody destruction of the intestinal wall. 2 An incarcerated hernia is one that - cannot be reduced and becomes trapped. 3 During your examination of a patients abdomen, you note the presence of striae. This finding is MOST indicative of - change in the size of the abdomen over a short period of time. 4 In contrast to somatic pain, visceral pain - is difficult to localize. 5 Which of the following medications should be given with caution in patient who are taking blood thinners? - Toradol. 6 A positive murphy sign is characterized by - a sudden stop in inspiration due to sharp pain when pressure is applied to the right upper quadrant. 7 A sudden onset of discomfort in the throat, severe dysphagia, and vomiting bright red blood are MOST indicative of - ruptured esophageal varices. 8 A 62 year old man presents with an acye onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should- turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large bore IV with normal saline, and administer enough fluids to maintain adequate perfusion. 9 A 55 year old male who is currently receiving radiation therapy for cancer complains of dyspepsia and upper abdominal pain. He tells you that the pain worsens when he lies supine. What should you suspect ? - esophagitis. 10 The MOST common signs and symptoms of colorectal cancer are - abdominal pain, rectal bleeding, and changes in bowel habits. 11 Which of the following behaviours does NOT place a person at risk for gastrointestinal disease ? - high fiber diet. 12 Which of the following is NOT a function of the liver ? - storage of bile. 13 Pain over the suprapubic region is MOST suggestive of injury to the - bladder.

1 the primary reason for the extent of trauma a patient sustains are - amount of energy in the object and the mechanism by which the object is delivered to the body. 2 Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced ? - mechanism of injury 3 A specific attribute of a level 1 trauma center is that it - has a 24 hour in house coverage by general surgeons. 4 If a level 1 trauma center is 30 miles away, and a level 2 trauma center is 10 miles away, it would be MOST appropriate to transport a patient with a severe traumatic brain injury - via air transport to the level 1 trauma center. 5 Which of the following is NOT a factor when considering a transport of a trauma patient via helicopter ? - the need for definitive airway management. 6 When summoning an air transport service to transport a crtically injured patient, it is MOST important to - activate the service as soon as possible. 7 The greatest amount of kinetic energy would be created if a _____ pound driver struck a tree while traveling at _____ mph - 140,50. 8 Rapid deceleration of a motor vehicle that is traveling at 60 mph - dissipates tremendous forces and can cause major injuries. 9 The MOST common site of deceleration injury in the chest is the - aorta. 10 The MOST reliable indicator that significant energy was dissipated by braking before a motor vehicle collision is - the presence if tire skid marks at the scene. 11 The forces applied to the driver during a frontal vehicle collision will differ based on all of the following factors, EXCEPT - the physical size of the patient. 12 The initial point of bodily impact when an unrestrained passenger takes the 'down and under ' pathway during a frontal collision is the - knees. 13 During a frontal collision, MOST pneumothoraces occur when - the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. 14 Following a rotational impact, the MOST severely injured patient(s) will likely be found at the point of - greatest deceleration. 15 Which of the following is NOT a benefit of a properly worn seat belt ? - minimal risk of whiplash injuries after a rear-end collision. 16 All of the following statements regarding front air bags are correct, EXCEPT - air bags will provide protection from both initial and secondary impacts. 17 Lap belts that are worn alone and too high by a pregnant woman - allow enough forward flexion and subsequent compression to rupture the uterus. 18 A properly worn motorcycle helmet will - not protect the cervical spine. 19 When an adult pedestrian is struck by a motor vehicle, lateral and posterior injuries are most common because - adults tend to turn to the side or away from the impact. 20 The second impact that occurs when an adult pedestrian is struck by a motor vehicle would MOST likely result in injuries to the - pelvis and chest. 21 Unlike adults, children who are struck by a motor vehicle are MORE likely to - be run over by the vehicle as they are propelled to the ground. 22 The MOST significant fall occurs from a height greater than - 15 feet. 23 If a person survives the initial trauma from a shot gun wound at close range - contamination that were driven into the wound can cause a severe infection. 24 Which of the following characteristics of an entry wound indicates that the weapon was fired at close range ? - tattoo marks from powder burns. 25 Which of the following statements regarding exit wounds is correct ? - exit wounds occur when the projectiles energy is not entirely dissipated along its trajectory through the body. 26 The peak magnitude of the pressure wave experienced by a person - lessens as the person is farther away from the center of the explosion. 27 Which of the following organs is LEAST susceptible to pressure changes caused by an explosion ? - liver. 28 Which of the following general statements regarding trauma is correct ? - blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma. 29 If the mechanism of injury does not appear to be significant, you should consider transporting an injured patient to a level 1 trauma center if he or she - has a known bleeding disorder. 30 At a minimum, a level 2 trauma center should - be able to initate definitive care for all injured patients. 31 If the windshield of a wrecked vehicle is cracked or broken - the front seat occupant has a cervical spine injury until proven otherwise. 32 When a patient takes the 'up and over' pathway during a head on collision - the anterior part of the neck may strike the steering wheel resulting in a fractured larynx. 33 Common air bag related injuries include - minor skin burns. 34 Structural protection afforded to a motorcycle rider during a crash comes from - protective gear worn by the rider. 35 According to the waddell triad, the second impact from a motor vehicle occurs when the - chest and abdomen strike the grille or low on the hood of the car. 36 Compared to stab wounds to the posterior part of the body, stab wounds to anterior part of the body are generally - upward. 37 Which of the following statements regarding gunshot wounds is correct ? - the most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes. 38 The shock wave velocity from an explosion is slower and its duration is longer if a person is - farther from the explosion. 39 A vagus nerve mediated form of cardiogenic shock without compensatory vasoconstriction that may be seen following a blast injury would MOST likely present with - bradycardia and hypotension. 40 The trauma lethal triad consists of - hypothermia, coagulopathy, and acidosis. CHAPTER 30 1. Hemogloinbin functions by - binding to oxygen that is absorbed in the lungs and transporting it to the tissues. 2. Which of the following organs or body systems requires a constant blood supply, regardless of external factors ? - kidneys 3. Your patient has a blood pressure of 80/60 mmhg. What is his mean arterial pressure ? - 27 mmhg 4. a healthy adult can tolerate blood loss of up to ______ ml over a period of 15 to 20 minutes without any negative effects - 500. 5. A fall in blood pressure and the resultant changes in plasma osmolality cause the release of - aldosterone and antidiuretic hormone. 6. After packing a severe groin injury with hemostatic gauze, you should - hold direct pressure for 3 minutes . 7. Which of the following injury locations can cause a junctional hemorrhage ? - in the axilla. 8. How can you tell if bleeding from the ears or nose contains (CSF) - CSF has a high glucose content. 9. Afterload is defined as the - pressure in the aorta against which the left ventricle must pump. 10. Which of the following statements regarding blood flow is correct ? - ejection fraction is the percentage of blood that the heart pumps per contraction. 11. Perfusion is defined as - the circulation of blood through an organ or tissue in amounts adequate to meet the bodys demands. 12. Which of the following organs can sustain the longest period of inadequate perfusion ? - GI tract. 13. The amount of blood returned to the heart is called - preload. 14. What is the approximate total blood volume of a 150 pound male ? - 4.8 L 15. Which of the following factors would have the MOST negative effect on the bodys process of hemostasis ? - anticoagulant use. 16. The presence of a radial pulse - can lead to a gross overestimation of blood pressure. 17. Agents such as Celox, HemCon, and QuikClot are used to - promote hemostasis. 18. Which of the following would be the earliest sign of hemorrhagic shock ? - tachycardia. 19. Which of the following injuries or mechanisms would MOST likely lead to nonhemorrhagic shock ? - severe burns. 20. Which of the following types of medication would MOST likely reduce a patient's ability to compensate when in shock ? - calcium channel blockers. 21. The physiologic process of hemostasis is achieved through - vasoconstriction and platelet aggregation. 22. In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with - mottled skin and dilated pupils. 23. What is the ejection fraction of a patient whose ventricle fills with 120 ml of blood and contrats 90 ml - 75% 24. if you discover minor external bleeding during your primary assessment of a patient, you should - make note of ir and continue your assessment. 25. Which of the following signs would you MOST likely observe in a patient with compensated shock ? - anxiety or agiatation. 26. You are treating a 20 year old woman with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should - apply a proximal tourniquet, administer high flow oxygen, transport, and establish vascular access en route. 27. You have successfully controlled a large arterial hemorrhage from a 42 year old man's leg with direct pressure and a pressure dressing. He is conscious, but restless. His blood pressure is 84/58 mmhg, pulses is 120 beats/min, and respirations are 24 breaths/min. you should - administer high flow oxygen, keep him warm, transport, and establish two large bore IV lines en route. 28. Air splints will not apply enough pressure to control arterial bleeding until the patient's systolic BP is - 50 mmhg. 29. Which of the following components is LEAST crucial to the continuous circulation of oxygenated blood throughout the body ? - spleen 30. Which of the following two factors DIRECTLY affect cardiac output - stroke volume and pulse rate. 31. External bleeding would be the MOST difficult to control in a patient with a large laceration to the _____ and a blood pressure of _____ mmhg - carotid artery , 100/70. 32. the MOST significant factor that determines how well the body compensates for blood loss is - the period of time over which the blood is lost. 33. If you suspect internal bleeding during the primary assessment, you should - keep the patient warm and administer oxygen. 34. Most external hemorrhage can be controlled with a combination of - direct pressure and pressure dressings. 35. Much of the bleeding associated with unsplinted fractures continues because - bone ends will continue to move and destroy partially formed clots. 36. A trauma patient with suspected internal hemorrhage and inadequate breathing requires - ventilation assistance and rapid transport. 37. Which of the following types of shock is caused by poor blood vessel function ? -anaphylactic. 38. Decompensated shock in the adult is characterized by - falling blood pressure. CHAPTER 31 1. All of following are functions of the skin, EXCEPT - providing the immune response for the body. 2. The skin help regulate body temperature through - the production of sweat, which is evaporated from the surface of the skin. 3. A laceration that lies perpendicular to the skin's tension lines - often remains open, heals more slowly, and is more likely to result in abnormal scar formation. 4. A patient taking _____ would MOST likely experience a delay in the healing of a wound - corticorsteroids. 5. Which of the following patients is at HIGHEST risk for a pressure injury ? - bedridden patient. 6. Systemic signs of infection secondary to a soft tissue injury include - fever and chills. 7. A crushing or tearing amputation - can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly. 8. Which of the following statements regarding crush injury is correct ? - crush syndrome can occur if the body part is entrapped for more than 4 hours. 9. Applying direct pressure to a bleeding wound stops the flow of blood because - it allows platelets to seal the vascular walls. 10. When applying a dressing and bandage to a scalp wound, you should - carefully assess the skull for an underlying fracture. 11. When caring for a patient with an open chest wound, you should - frequently assess breath sounds for indications of a pneumothorax. 12. A 30 year old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should suspect - tetanus. 13. A 41 year old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semi conscious. He has massive soft tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should - suction the blood from his mouth and assist ventilations with a bag mask device. 14. A 32 year old man was struck in the forehead by a softball. He is conscious an d alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should - apply an icepack to the hematoma and monitor his level of consciousness. 15. A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting form the injury site. Despite direct pressure, the wound continues to bleed heavily. You should - apply a tourniquet between her elbow and wrist. 16. The outermost layer of the epidermis - consists of nonliving cells that are continuously being shed. 17. When the ambient temperature is high - blood vessels in the dermis dilate, which increases blood flow to the skin and allow heat to dissipate. 18. During the neovascularization phase of the wound healing process - new blood vessels form as the body attempts to bring oxygen ad nutrients to the injured tissue. 19. a wound is at HIGHEST risk for infection if - it is caused by a human or animal bite. 20. Which of the following wounds usually requires substantial irrigation and debridement prior to closure ? - degloving injuries. 21. An infection characterized by painful muscle contractions is called - tetanus. 22. Whether the contamination form an open wound produces infection depends MOSTLY on - how the wound is managed. 23. Compared to the bleeding from an open wound, bleeding from a closed wound - is limited because the skin is unbroken. 24. In addition to bleeding and contamination, the principal danger associated with an avulsion is - a loss of blood supply to the avulsed flap. 25. When a patient's leg is entrapped under a crushing object for a prolonged period of time, toxic metabolic waste products are released into the systemic circulation - after the patient's leg is freed from entrapment. 26. the bite from a _____ poses the greatest risk for serious infection - human. 27. If your patient has an open wound in which there is a risk of air being drawn into the vasculature, you should - cover the wound with an occlusive dressing. 28. Which of the following bandages is associated with the HIGHEST risk of blood flow compromise ? - elastic bandages. 29. You should splint an open soft tissue in jury to an extremity because - motion of the extremity may disrupt the blood clotting process. 30. When caring for an amputated body part - early notification of the hospital is important. 31. In which of the following patients should be impaled object be removed ? - cardiac arrest patient with an ice pick impaled in the center of the back. 32. Your MAIN concern when caring for a patient with a soft tissue injury to the face should be - airway compromise 33. A 63 year old diabetic woman presents with an open wound to her forearm that she experienced when she fell a week ago. She tells you that the wound has been draining purulent fluid, but has not been bleeding. The wound itself is red, inflamed, and warm to the touch. You should - apply a dry sterile dressing and transport her to the hospital. 34. You are dispatched to a residence for a man who cut his hand with a chainsaw. Upon arriving at the scene, your FIRST action should be to - carefully assess the scene for safety hazards. 35. You have dressed and bandaged a laceration to the arm of a 16 year old woman and are transporting her to the hospital. En route the patient complains that her fingers are tingling. You touch her hand and note that it is cool. You should - readjust the bandage if needed and reassess distal neurovascular function. 36. the MOST significant immediate threat to a patient with a soft tissue Injury is - hemorrhage. 37. The skin is also referred to as the - integument. 38. Which of the following statements regarding soft tissue injuries is correct ? - they are often the most obvious, but are seldom the most life threatening injuries. 39. During the process of wound healing, hemostasis- temporarily stops bleeding via vasoconstriction and platelet aggregation. 40. Which of the following is the MOST common of necrotizing fasciitis? - hemoplytic streptococci. 41. The swelling that occurs in conjunction with a contusion is caused by - leakage of fluid into spaces between the damaged cells. 42. Primary treatment in the prehospital setting for an abrasion involves - covering it lightly with a sterile dressing. 43. The FIRST aspect to address in an patient with a soft tissue injury is - your safety. 44. Which of the following interventions encourages drainage form the site of a closed wound and reduces swelling ? - elevation. 45. The use of wet dressings in the field is usually limited to - superficial burns. Chapter 32 1. Flash burns - are usually relatively minor compared with the potential for trauma from whatever caused the flash. 2. Which of the following statements regarding carbon monoxide (CO) poisoning is correct ? - never rule out CO poisoning in the absence of cherry red skin. 3. Which of the following chemicals causes a painless burn and can result in significant damage before it is identified ? - phenol. 4. A person who is exposed to cement - may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat. 5. The two MOST common causes of death from an electrical injury are - asphyxia and cardiopulmonary arrest. 6. Most lightening related injuries occur when the victim- receives a splash effect after lightning strikes a nearby object. 7. Which of the following locations would provide the BEST protection from a lightning strike ? - a car with the windows rolled up. 8. After an adult victim is struck by lightning and experiences cardiac arrest - his or her heart may resume beating spontaneously. 9. Compared to beta radiation particles, alpha radiation particles - have minimal penetrating energy. 10. ________ radiation is very penetrating and easily passes through the body and solid material - gamma 11. Many of the physiologic changes caused by acute radiation syndrome - occur over time and will not be apparent in the prehospital setting. 12. The onset of _____ soon after exposure to radiation is a predictor of poor outcomes - vomiting. 13. Unlike chemical burns, radiation burns- may appear hours or days after exposure. 14. Upon initial contact with a severely burned patient, you must - ensure that the patient is not still burning. 15. If a burn patient presents with a hoarse voice and states, "Im cold", your MOST immediate concern should be - inhalation injury. 16. A superficial burn is - characterized by reddened skin with varying degrees of pain. 17. Which of the following statements regarding partial thickness burns is correct ? - partial thickness burns are usually extremely painful for the patient. 18. Unlike partial thickness burns, full thickness burns - destroy the base membrane of the dermis that produces new skin cells. 19. According to the rule of nines, an adult with partial and full thickness burns to his or her head, face, and anterior chest has burns to _____% of his total body surface area - 18 20. Which of the following statements regarding the rule of palms is correct ?- the patient's palm excluding the fingers represents 1 % of his or her total body surface area. 21. The secondary assessment of a severely burned patient is intended to - identify other injuries that may have a higher priority for treatment . 22. Full thickness circumferential burns to the chest - may cause significant restriction of respiratory excursion. 23. A burn patient with a history of chronic obstructive pulomonary disease - may be triaged as a critically burned patient , even if the burn injury is small 24. Assessment of a patient who may have been exposed to radiation begins by - determining if the scene is safe to enter. 25. What medication should be administered if significant tissue damage is suspected following an electrical burn injury ? - sodium bicarbonate. 26. A patient with full thickness burns surrounded by areas of superficial and partial thickness burns should be treated with all of the following , EXCEPT - moist dressings. 27. Which of the following statements regarding sodium metal chemical burns is correct ? - do not flush with water as doing so may produce heat and cause and explosion. 28. Specific treatment for a hydrofluoric acid burn is - calcium chloride. 29. Which of the following burn injuries would MOST likely require transport to a burn specialty center ? - burns that involve the hands, feet, or genitalia. 30. A partial thickness burn is considered to be a major burn in a 40 year old person if it - involves more than 25 % of the body surface area. 31. You are caring for a 41 year old man who was trapped in his burning house before being rescued by fire fighters. He has full thickness burns to his head and anterior trunk , and mixed partial and full thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned ? - 36 % 32. A 52 year old man sustained superficial and partial thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His bp is 138/76 mm hg, pulses is 110 beats/min and strong, respirations are 22 breaths/min and regular and oxygen saturation is 97 % on room air. He denies any other injuries. initial management for this patient involves - applying cool, wet dressings to the burn and elevating his arm. 33. You respond to an industrial plant for a 42 year old man with a chemical burn. Upon arrival at the scene , you find the patient to be ambulatory. He tells you that he was moving some bags of lime when one of the bags broke and spilled lime all over him. After donning the appropriate personal protective equipment, you should - remove his clothing brush as much of the lime off of him as possible and flush the affected areas with copious amounts of water. 34. A 24 year old woman was struck by lightining. Bystanders moved the patient to an area of safety but did not provide any other care before arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves - continuing CPR protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of cpr and defibrillating if necessary. 35. You are transporting a conscious but confused 29 year old man after he was electrocuted. The patient is on high flow oxygen has an IV line of normal saline in place, is on a cardiac monitor and has his spine fully immobilized. During transport it is especially important for you to - remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. 36. What medication may be administered to a patient with a severe electrical burn in order to facilitate osmotic diuresis ? - mannitol 37. A patient has a partial thickness burns to both lower extremities and blisters have formed. What should you do ? - elevate the extremities to reduce edema. 38. The peripheral area surrounding the zone of coagulation, which has decreased blood flow and inflammation, is called the zone of - stasis. 39. What type of thermal burn is MOST commonly associated with inhalation injury ? - steam burns. 40. Supraglottic damage following a burn is MOST often caused by - the inhalation of superheated gases. 41. The degree of absorption of a corrosive chemical determines - whether toxicity is local or systemic. 42. Exposure to hydrofluoric acid causes - immediate pain and coagulation necrosis. 43. A burn caused by a sodium metal should be treated by - covering the burn wound with oil. 44. Damage to the kidneys following an electrical injury - occurs when damaged muscle produces myoglobin. 45. When assessing a burn patient, it is MOST important to - be alert for occult trauma that could affect patient outcome. 46. Th regard to a thermal burn injury, the zone of coagulation - is the central part of the burn and suffers the most damage. 47. The purpose of estimating a patient total body surface area burns in the prehospital setting is to - help the paramedic determine the most appropriate destination hospital. 48. Narcotic analgesia should cause the MOST acutely significant problems in a patient with - airway burns 49. During your primary assessment of a 21 year old woman with a suspected inhalation injury, you note that she is combative and her respirations are profoundly labored and stridorous. The closest appropriate medical facility is approximately 25 miles by ground, and the local air transport service is unavailable. You should - assist ventilations with a bag mask device, start an IV administer a sedative and a neuromuscular blocker and intubate her trachea. 50. A 33 year old man was burned when the hot water heater on which he was working exploded. The patient has superficial and partial thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His bp is 80/54 mm hg and his heart rate is 120 beats/min and weak. You should - administer high flow oxygen, keep him warm, start at least one large bore IV of normal saline, and administer fluid boluses to maintain equate perfusion. Chapter 33 1. In addition to massive bleeding injury to a carotid or vertebral artery would MOST likely cause - cerebral hypoxia. 2. Because significant force is required to fracture the mandible- it is often fractured in more than one place is unstable to palpation . 3. A fracture of all midfacial bones, separating the entire midface from the cranium- is commonly associated with facial elongation and dental malocclusion. 4. A flattened appearance to the face and loss of sensation over the check following blunt facial trauma is MOST indicative of a (n) - zygomatic fracture. 5. If you are unable to oratrahceally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform - a needle or surgical cricothyrotomy. 6. Appropriate management for a patient with severe epistaxis, tachycardia, and diaphroresis following an injury to the face includes - administering enough IV crystalloid fluids to maintain adequate perfusion. 7. What part of the eye is MOST commonly injured following a thermal burn ? - eyelid. 8. When treating a patient with an ocular injury what should you do to avoid an increase in intraocular pressure ? - discourage the patient from coughing. 9. Movement of both of the eyes in unison is called - sympathetic eye movement. 10. Alkali or strong acid burns to the eye should be irrigated continuously for at least _____ minutes - 20 11. The ONLY indication for removing contact lenses in the prehospital setting is - chemical eye burns. 12. Significant blunt injuries to the larynx or trachea a pose an IMMEDIATE risk of - airway compromise. 13. When managing the airway of an unresponsive patient with serious anterior neck trauma and shallow breathing, you should - assist ventilations with a bag mask device and prepare to intubate. 14. Vascular injury following trauma to the anterior neck would MOST likely present with - pulse deficits. 15. Following blunt trauma to the face, a 30 year old man presents with epistaxis double vision and an inability to look upward. You should suspect - an orbital blowout fracture. 16. You are dispatched to a high school where a 16 year odl female was stabbed in the eye with a pencil. The patient is conscious and in severe pain, a classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient injury includes - covering the affected eye with a sterile dressing and protective eye shield covering the unaffected eye and transporting promptly. 17. You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place is in severe pain and tells you that he cant see. Proper care for this patient includes- carefully removing his contact lenses, flushing both eyes for at least 20 minutes and transporting with continuous eye irrigation. 18. A 51 year old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to - ensure that she is sitting up and leaning forward. 19. During an explosion a 42 year old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious but complains of difficulty hearing. In addition to protecting his spine you should be MOST concerned with - covering the laceration with an occlusive dressing and controlling the bleeding. 20. You are transporting a conscious middle aged woman with anterior neck trauma. She is on high flow oxygen has spinal precautions in place, and has a large bore IV line of normal saline in place. When you reassess her vital signs you note that her blood pressure is 90/64 mm hg her pulse rate is 120 beats/min and her respirations are 22 breaths/min with adequate depth. You should - keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. 21. Which of the following cranial nerves innervates the muscles that cause motion of the eyeballs and upper eyelids ? - oculomotor. 22. Open soft tissue trauma following a significant mechanism of injury - suggests that the patient may have a closed head injury or spinal injury. 23. Which of the following is the MOST significant complication associated with a fractured nasal bone ?- posterior epistaxis. 24. General care for an eye injury involves - covering both eyes to minimize further injury. 25. Signs and symptoms of retinal detachment include - flashing lights, specks, or floaters in the field of vision. 26. A ruptured tympanic membrane - is extremely painful but typically heals spontaneously. 27. The primary risk associated with oral and dental in juries is - airway compromise. 28. Proper treatment for an open wound to the neck includes - sealing the wound with an occlusive dressing. 29. A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semi-conscious, has shallow breathing and has blood draining from the corner of his mouth. Initial management for this patient involves - manually stabilizing his head in a neutral position suctioning his orophatynx and assisting ventilations with a bag amsk device and 100 % oxygen. 30. a conscious but combative patient with severe facial is fully immobilized on a backboard. During your assessment the patient begins coughing up large amounts of blood. You suction her oropharynx but her mouth quickly refills with blood. You should - roll the backboard on its side suction her orpharynx and prepare to perform pahrmocoligically assisted intubation. Chapter 34 1. the parietal lobe of the brain - controls the bodys ability to perceive body limb movement. 2. What portion of the brainstem is responsible for maintenance of consciousness ? - reticular activating system. 3. The dura mater - folds in to form the tenitorium a structure that separates the cerebral hemispheres from the cerebellum and brainstem. 4. secondary brain injuries include all of the following, EXCEPT - axonal injury. 5. Autoregulation is defined as - an increase in mean arterial pressure to maintain cerebral blood flow. 6. Early signs and symptoms of increased intracranial pressure include - headache and vomiting. 7. Decebrate posturing is characterized by - extension of the arms and extension of the legs. 8. A diffuse axonal injury - involves stretching shearing or tearing of the extension of the neuron that conducts electrical impulses away from the cell body. 9. Common clinical findings associated with a subdural hematoma include all of the following EXCEPT - rapidly increasing intracranial pressure. 10. A subdural hematoma is classified as acute if clinical signs and symptoms develop - within 48 hours following the injury. 11. What type of intracranial hemorrhage would MOST likely be caused by a penetrating head injury ? - intracerebral hematoma. 12. Which of the following statements regarding the brainstem is correct ? - the brainstem connects the spinal cord to the brain. 13. The innermost meningeal layer that rests directly on the brain and spinal cord is the - pia mater. 14. The crescent shaped fold that divides the cerebrum into left and right hemispheres is called - falx cerebelli 15. the phrenic nerve arises from the _____ plexus and innervates the _____ - cervical, diaphragm 16. what spinal nerve tract carries information regarding pain and temperature ? - lateral spinothalamic 17. beta receptor stimulation results in all of the following effects, EXCEPT - vascular smooth muscle contraction. 18. Vagal tone remains intact following a spine injury because - the vagus nerve originates outside the medulla and regulates the heart via the carotid arteries. 19. A compression or burst fracture of the cervical spine would MOST likely occur following - a significant fall in which the patient lands head first. 20. Which of the following statements regarding the hangman's fracture is correct ? - it is a fracture of c2 that is secondary to significant distraction of the neck. 21. A spinal cord concussion is - caused by a short duration shock or pressure wave within the cord. 22. A complete spinal cord injury to the upper cervical spine - will result in permanent loss of all cord mediated functions below the level of injury. 23. Displacement of bony fragments into the anterior portion of the spinal cord results in - anterior cord syndrome. 24. Which of the following statements regarding central cord syndrome is correct ? - the patient typically presents with greater loss of function in the upper extremities than in the lower extremities. 25. Proprioception is defines as - the ability to perceive the position movement of one's body. 26. Spinal shock is a condition that - is usually temporary and results from swelling of the spinal cord. 27. Signs of neurogenic shock include all of the following EXCEPT - diaphoresis. 28. Hypotension thagt is associated with neurogenic shock is the result of - loss of alpha receptor stimulator. 29. A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of - T2 30. Treatment for a patient with neurogenic shock may include all of the following EXCEPT - prevention of hyperthermia. 31. Which of the following is a sign of a moderate elevation in intracranial pressure ? - widened pulse pressure. 32. The FIRST step in any neurologic assessment involves - determining the patient's level of consciousness. 33. When assigning a Glasgow coma scale (GCS) score to a patient who has limb paralysis due to a spinal cord injury you should - ask the patient to blink or move a facial muscle. 34. Horner syndrome is identified when a patient with a spinal cord injury - has a drooping upper eyelid and small pupil. 35. Wrist extension is controlled at the level of - C6. 36. Hyperacute pain to touch is called - hyperesthesia. 37. A positive Babinski reflex is observed when the - toes move upwards in response to stimulation of the sole of the foot. 38. Spinal cord injuries that cause neurogenic shock generally produce - flaccid paralysis and complete loss of sensation distal to the injury. 39. Spinal cord injury without radiographic abnormalities can occur in children because - their vertebrae lie flatter on top of each other. 40. A motorcycle or football helmet should be removed if - the patient is breathing shallowly and access to the airway is difficult. 41. you have intubated an unresponsive apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube you should- ventilate at 10 to 12 breaths/min and monitor end tidal co2. 42. Upon arriving at the scene of a motor vehicle crash you find the driver of the car still seated in her two door vehicle. The passenger side of the vehicle has sustained and severed severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger a young child who was unrestrained is bleeding from the head and appears to be unconscious. You should - rapidly extricate the driver so you can gain quick access to the child in the backseat. 43. General treatment for a 40 year old patient with a significant head injury and signs of cushing triad includes - elevating the head 15 to 30 degrees. 44. A subluxation is defined as - a partial or incomplete dislocation. 45. Paralysis of the extremities would MOST likely result from injury to the - cerebral cortex. 46. The cerebellum is located in the ______ part of the brain and is responsible for ______ - inferiorposterior, posture and equilibrium. 47. An epidural hematoma typically causes rapid deterioration in the patients condition because - it is associated with brisk arterial bleeding. 48. Chronic subdural hematoma are MOST commonly seen in patients who - have alcoholism. 49. Nuchal rigidity is MOST commonly seen in patients with a(n)- subarachnoid hemorrhage. 50. If signs of brain herniation the paramedic should maintain an ETCO2 of - 30 to 35 mm hg. Chapter 35 1. bony structures of the thorax include all of the following EXCEPT the - acromion 2. by definition a massive hemothorax is characterized by - more than 1500 ml of blood within the pleural space. 3. Common clinical findings associated with a traumatic asphyxia include all of the following EXCEPT - hyphema. 4. which of the following thoracic injuries would you LEAST likely discover in the primary survey ? - myocardial contusion. 5. You would NOT expect a patient with a flail chest to present with - hyperpnea. 6. Immediate treatment for an open pneumothorax involves - converting the pneumothorax to a closed injury. 7. Which of the following is an appropriate site for performing a needle thoracentesis ? - superior to the third rib into the intercoastal space at the midclavicular line. 8. Unlike a tension pneumothorax a massive hemothorax would MOST likely present with - collapsed jugular veins. 9. You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and - normal lung sounds. 10. A 16 year old boy collapsed after being struck in the center of the c hest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner iniitates one rescuer CPR, your MOST important action should be to - attach the ECG leads and be prepared to defibrillate. 11. A 26 year odl unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. Your assessment of her chest reveals a segment of obviously fractured ribs that bulges outward during exhalation. Her breathing is labored and shallow and her oxygen saturation is 80 %. You should- assist her ventilations with a bag mask device and 100 % oxygen. 12. You are transporting a conscious and alert woman who experienced an isolated blunt injury to the right anterolateral chest. Her vital signs are stable, but she is dyspneic and her breath sounds ae diminished over the apex of her right lung. In addition to administering high flow oxygen, the MOST critical intervention for this patient involves- frequently reassessing her for signs of clinical deterioration. 13. You are dispatched to a residence for an injured person. The scene has been secured by law enforcement. The patient a young female tells you that her boyfriend kicked her on the chest yesterday during an argument. Your assessment revelas that the patient in significant pain is dyspneic, has a strong pulse rate of 98 beats/min and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient ? - IV fluids boluses. 14. Following blunt trauma to the anterior chest, a 44 year old woman presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of the chest. You should- perform an immediate needle thoracentesis to the right side of the chest. 15. Which of the following clinical findings would MOST likely differentiate a massive hemothorax from a tension pneumothorax ? - hemoptysis. 16. which of the following statements regarding the thorax is correct ?- the diaphragm inserts into the anterior thoracic cage below the fifth rib. 17. A flail chest is characterized by - a free floating segment of fractured ribs. 18. Ribs four through nine are the most commonly fractured because - they are less protected by other bony and muscular structures. 19. Pneumothorax is MOST accurately defined as - air or gas within the pleural cavity. 20. What type of chest injury is characterized by air accumulation in the pleural space when a perforation in the lung parenchyma acts as a one way valve ? - tension pneumothorax. 21. Which of the following statements regarding a pericardial tamponade is correct ? - in a pericardial tamponade blood collects between the visceral and parietal pericardium. 22. Traumatic injuries to the aorta are MOST commonly the result of - shearing forces. 23. Which of the following statements regarding diaphragmatic injury is correct ? - because the diaphragm is protected by the liver on the right side most diagrammatic injuries caused by blunt force trauma occur on the left side. 24. Which of the following clinical findings is MOST suggestive of inadequate oxygenation ? - altered mental status 25. in general patients suspected of having a partial tracheal tear should be managed with - the least invasive airway techniques possible. CHAPTER 36 1. the upper peritoneal cavity includes all of the following organs , EXCEPT the - pancreas. 2. Which of the following is NOT a function of the pancreas ? - reservoir for bile. 3. The major complication associated with hollow organ injury is - peritonitis caused by rupture and spillage of toxins. 4. Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen ? - size of the patient. 5. Fractures of the lower rib cage should make you MOST suspicious for injuries to the - liver or spleen. 6. Ems providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by - recognizing the need for rapid transport. 7. What organs are the primary sources of exsanguination during abdominal trauma ? - liver or spleen. 8. The diaphragm curves from its point of attachment at the ____ rib and peaks in the center at the _____ intercoastal space - twelfth, fourth. 9. What do the spleen and liver have in common ? - they are both highly vascular and bleed profusely when injured. 10. Penetrating abdominal trauma MOST commonly results from - low velocity gunshot or stab wounds. 11. What type of motor vehicle crash poses the LEAT threat for abdominal trauma if the patient is properly restrained ? - rear end crash. 12. Referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect in jury to the - spleen. 13. Which of the following statements regarding stomach injuries is correct ? - rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use. 14. Grey turner sign is defined as ecchymosis to the ____ and is indicative of ____ - flank, retroperitoneal bleeding. 15. Periumbical ecchymosis is - referred to as Cullen sign and may take several hours to develop following abdominal trauma. 16. Injuries to the vascular structures in the intraperitoneal space- are often caused by shearing forces secondary to blunt trauma. 17. Which of the following assessment findings is MOST suggestive of intrabdominal hemorrhage ? - signs of shock. 18. The LEAST practical technique when assessing the patient with abdominal trauma in the field is - auscultation. 19. Following blunt force trauma to the lower right rib cage, a 40 year old woman presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that she has a - liver injury. 20. You are dispatched to the parking lot of a shopping mall for a person who was kicjed in the abdomen numerous times. While en route to the scene, it Is MOST important for you to - request law enforcement assistance. 21. You are caring for a patient who experienced bklunt abdominal trauma. The patient is conscious but restless. Her repsirations are rapid and shallow and her pulse is rapid and weak. What will maximize this patient;s chances of survival ? - basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluids boluses as needed en route 22. You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and - pain with inhalation. 23. The MOST frequent presentation of blunt trauma is - flank pain and hematuria. 24. Which of the following injuries is the patient with mononucleosis prone to following relatively minor blunt abdominal trauma ? - ruptured spleen. 25. In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of - 80 to 90 mm hg. 26. Anatomically the abdominal cavity extends from the - diaohragm to the pelvis. 27. the abdomen extends superiorly to the level of the - fourth intercostal space 28. what memebraneous tissue functions as the point of attachment for the various abdominal organs ? - mesentery. 29. Intraabdominal bleeding may produce few signs and symptoms of trauma because - the intraabdominal cavity can accommodate large amount of blood. 30. Most abdominal injuries - involve blunt trauma 31. Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of - diffuse peritoneal contamination. 32. When blood is released into the perioneal cavity - nonspecific signs such as tachycardia and hypotension may occur. 33. a 59 year old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic and has a 12 inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR you should - control and external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large bore IV line en route to the hospital. 34. Fournier gangrene is a potential complication associated with - scrotal lacerations. 35. A 36 year old female was sexually assaulted and is experiencing intense pain. Your assessment revelas several open laceration to her vaginal area and a painful distended abdomen. Her blood pressure is 86/50 mm hg and her heart rate is 120 beats/min and weak. In addition to administering supplemental oxygen your should - cover her open wounds with sterile dressings establish at least one large bore IV and administer IV fluid. CHAPTER 37 1. Which of the following structures is NOT part of the axial skeleton ? - femoral shaft. 2. Which of the following is the BEST example of an indirect injury ? - shoulder dislocation secondary to falling on an outstretched hand. 3. In a closed femur fracture, blood loss may exceed ____ before enough pressure develops to tamponade the bleeding - 1000 ml 4. Which of the following statement regarding a nondisplaced fracture is correct ? - nondisplaced fx are generally caused by low energy trauma and are typically not associated with deformity. 5. Eliciting for crepitus during your exam of a deformed extremity - may cause further injury to the bone and surrounding soft tissue. 6. A dislocation is considered an urgent injury because of its potential to cause - neurovascular compromise. 7. Signs of bruitis include all of the following, EXCEPT - deformity. 8. Which of the following is NOT one of the 6Ps of muscoskeletal injury assessment ? - passive extension. 9. During your assessment of a patient with a femur fx you discover a rapidly expanding hematoma on the medial aspect of his thigh. what should you suspect ? - arterial injury. 10. the MOST practical of splinting multiple fractures ina critically injured patient is to - splint the axial skeleton using a scoop stretcher. 11. You should NOT apply a pneumatic splint on a patient if he or she - has an open fracture in a which bone ends are exposed. 12. The likelihood of experiencing systemic complications from a muscoskeltal injury is related to all of the following factors, EXCEPT the - splinting method used in the field. 13. Which of the follwoung is NOT an intervention the paramedic can perform to help reduce the risk of long term disability following a muscoskeletal in jury - prehospital fx reduction. 14. The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions , EXCEPT - METABOLIC alkalosis. 15. Common signs and symptoms of an acute pulmonary embolism include all of the following EXCEPT - pulmonary edema. 16. You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike he is still wearing his helmet. as you approach him, you note that he is has bilaterally deformed femurs. You should - manually stabilize his head and assess his airway. 17. A 60 year old woman slipped and fell on an icy sidewalk she landed on her outstretched hand, you assessment revelas that she has an obvious colles fracture, the patient denies any other injuries and is conscious and alert, her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10, given thus patients current status, the MOST appropriate way to treat her injury involves - administering analgesia and then properly splinting her injury. 18. A 19 year old man experienced direct trauma to his left elbow, his assessment reveals gross deformity and ecchymosis, his arm is pink and warm and he has a strong radial pulse, your transport time to the hospital will be delayed you should - splint the elbow in the position found and reassess distal circulation. 19. Pain and tenderness in the anatomic snuffbox is a classic finding in fractures of which bone ? -scaphoid. 20. A 20 year old female has a midshaft humeral fx, assessment reveals the presence of wrist drop, what should you suspect ? - radial nerve injury. 21. Which of the following statements regarding open book pelvic fx is correct ? - despite IV fluids patients may remain hypotensive in the field. 22. Which of the following is typically the first complaint in a patient who is developing compartment syndrome ? - disproportionate pain. 23. The ______ supports is 90 % of the weight of the upper body - tibia. 24. When a person jumps from a height and lands on his or her feet, direct trauma occurs to the - calcaneus. 25. A pathologic fx occurs when - an occult medical condition causes normal bone weakness. 26. Which of the following muscoskeletal injuries would MOST likely occur together ? - knee dislocation and tibia fx. 27. The MOST significant immediate risk associated with an open fx is - hemorrhage. 28. The MOST reliable sign of a fx is - deformity. 29. A patient standing with his or her head cocked toward a knocked down left shoulder MOST likely has a fx of the - left clavicle. 30. A subluxation occurs when - a joint is partially dislocated. 31. The sudden twisting of a joint beyond its normal range of motion, causing a temporary subluxation is called a - sprain. 32. After ensuring your own safety your next priority when caring for a patient with an extremity is to - prevent further injury. 33. When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to - compare the strength of the pulses in both lower extremities. 34. Swelling and inflammation associated with musculoskeletal injuries are reduce - if cold packs area applied during the acute stage of the injury. 35. The FIRST step in splinting a muscoskeltal injury involves - exposing and assessing the injury site. 36. A 40 year old woman has a unstable pelvis showing a motor vehicle crash, she is conscious but confused, her blood pressure is 80/50 mm hg, pulse is 120 beats/min and weak at the radial arteries and respirations are 24 breaths/min and shallow, after starting at least one large bore iv line you should - give enough cystallod fluids to improve her mental status and radial pulses quality. 37. A young man has an isolated injury to his left lower leg, your assessment reveals obvious deformity and ecchymosis, distal circulation as well as motor and sensory functions are grossly intact and the patient is hemodynamically stable, in addition to stabilizing the suspected frx site you should - immobilize the knee and ankle. 38. You have applied board splints to a suspected lower lef fx in a young woman and have given her fentanyl for pain, en route to the hospital the patient states that the painis excruciating, further narcotics fail to relieve the pain, reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak, you should - len the splint elevate the lef, apply ice, and notify the hospital . 39. A 68 year old woman presents with an acute onset of dyspnea and sharp chest pain, her medical history is significant for a hip replacement 2 weeks ago, the patient is conscious and alert with a blood pressure of 112/58 mm hg pulse rate of 90 beats/min and irregular and respirations of 22 breaths/min and labored, which of the following treatment interventions is MOST appropriate for the patient ? - oxygenation and ventilatory support and rapid transport. 40. Avascular necrosis is a major complication of a fx of which bone ? - scaphoid. 41. An open book pelvis fx has the potential for massive blood losss because - the volume of the pelvis is increased. 42. Treatment for suspected compartment syndrome include - IV boluses of a crystalloid solution. 43. Isolated muscoskeletal injuries - often result in short or long term disability. 44. The appendicaular skeleton is composed of the - pectoral girdle, pelvic girdle, and bone of the extremities. 45. What type of fx occurs at an angle across the bone and is typically caused by direct or twisting force ? -oblique. 46. The BEST way to detect deformity or any other abnormality in an injured extremity is to - compare it to the extremity on the opposite side. 47. Immediate pain from the heel to the calf and a sudden inability for plantar flexion of the foot is MOST indicative of - achilles tendon rupture. 48. In contrast to osteoarthritis, rheumatoid artritis - is a systemic inflammatory disease that affects joints and other body systems. 49. Closed bilaterally fractured femurs can result in internal blood loss of up to - 3000 ml. 50. Compartment syndrome occurs when - pressure in the fascial compartment leads to impaired circulation sensory changes and progressive muscle death. CHAPTER 38 1. thermoregulation is a function of the - anterior hypothalamus. 2. An increase in core body temperature due to inadequate thermolysis is called - heat illness. 3. Which of the following statements regarding frostbite is correct ? - frostbite is a superficial, partial thickness, or full thickness ischemic injury. 4. Which of the following statements regarding freshwater and saltwater drownings is correct ? - both freshwater and saltwater can lead to pulmonary injuries. 5. During saturation diving - the diver remains at depth for prolonged periods of time. 6. Altitude illness is a problem caused by - hypoxia due to low atmospheric pressures. 7. The hymenoptera family of insects include _____ which usually cause death secondary to ____ - yello jackets, anaphylaxis. 8. The transfer of heat from a hotter object to a cooler object by direct physical contact is - conduction. 9. Which of the following factors decreases the body's ability to eliminate excess heat through evaporation ? - high humidity. 10. For evaporation of sweat to be an effective cooling mechanism - ambient air must be relatively unsaturated with water. 11. Heat cramps are caused by - sodium loss due to sweating. 12. The diagnosis of heatstroke is usually made when a patient has an elevated core body temperature and - an altered mental status. 13. The MOST common symptom of superficial frostbite is - an altered sensation. 14. A deeply frostbitten extremity - is cold, hard, and without sensation. 15. In addition to your transport time to the hospital prehospital treatment of a frost bitten body parts MAINLY dependent upon - whether the affected part has been partially or completely thawed prior to your arrival. 16. Pulmonary overpressurization syndrome occurs when a diver - holds his or her breath during ascent 17. A patient with high altitude cerebral edema- presents with ataxia and confusion after experiencing acute mountain sickness for greater than 24 hours. 18. Pharmacologic management for a black widow spider bit may include - diazepam 19. Of the many factors that affect the basal metabolic rate, the MOST important factor is - the person's body surface area. 20. A person blowing on hot food in an attempt to cool it is an example of - convection. 21. In a cold environment the body produces and censervates heat through all of the following mechanisms, EXCEPT - hyperventilation. 22. All of the following factors contribute to heat cramps, EXCEPT - gender. 23. The FIRST step in treating a patient with a heat cramps is to - move the patient to a cooler area. 24. In contrast to sodium depleted heat exhaustion, water-depleted heat exhaustion - occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility. 25. Classic heatstroke - typically affects older people and is not associated with exertion. 26. In contrast to classic heatstroke, exertional heatstroke - affects young, healthy people. 27. A person taking a beta blocker is at an increased risk for a heat related illness secondary to - an increased metabolic rate. 28. Patients with heatstroke - usually have a lowered ETCO2 reading 29. The MOST important treatment for a patient experiencing heatstroke involves - removal from the hot environment and rapid cooling. 30. When frozen tissues thaw slowly - partial refreezing of melted water may cause greater tissue damage. 31. Hypothermia is defines as a decrease in core body temperature generally starting at - 95 F 32. A patient may become hypothermic for all of the following reasons, EXCEPT - decreased thermolysis. 33. Alcohol predisposes a patient to hypothermia due to - impaired shivering thermogenesis. 34. A patient with diabetes would MOST likely experience heat loss secondary to - peripheral neuropathy. 35. Liver disease predisposes a patient to hypothermia secondary to - inadequate glycogen stores. 36. In trauma patients with shock, hypothermia - interferes with the coagulation of blood. 37. The effects of hypothermia are MOST dramatically apparent in the - central nervous system. 38. In early hypothermia the cardiovascular system typically responds with - tachycardia. 39. On the ECG an Osborne wave can be recognized as - a positive deflection immediately after the QRS complex. 40. If you are unsure if a patient became hypothermic prior developing cardiac arrest you should - begin resuscitative efforts. 41. When a person experiences a crisis in the water, the amount of time the person can hold his or her breath depends on all of the following factors EXCEPT - the water's tonicity. 42. Gass filled organs are affected by the pressure changes experienced during descent and ascent through water because they - are compressible. 43. Nitrogen causes decompression sickness - on ascent because of the bubbles that form on reduction of pressure. 44. Other than using a nitro system the only effective way to counteract nitrogen narcosis is to - lower the nitrogen partial pressure through controlled ascent. 45. What is the pathophysiology of decompression sickness ? - an imbalance of nitrogen in the tissues and alveoli due to rapid ascent. 46. Shallow water blackout occurs when - a swimmer hyperventilates prior to entering the water. 47. Rewarming efforts of a patient with severe hypothermia should continue until the core body temperature is at least _____ degrees Fahrenheit - 95 48. The bile of a brown recluse spider - may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister. 49. The venom from a pit viper causes all of the following effects, EXCEPT - increased blood clotting. 50. A hiker was bitten on the left lower leg by a rattlesnake. he is conscious and alert, but complains of nausea and generalized weakness. The affected area, which has two distinct puncture wounds, is swollen markedly. The patients blood pressure is 114/66 mm hg pulse rate is 120 beats/min and regular and respirations are 22 breaths/min and regular. The MOST appropriate treatment for this patient involves - keeping him calm, administering high flow oxygen immobilizing the affected extremity and keeping It below heart level and establishing vascular access. CHAPTER 41 1. An immature egg is called (n)- oocyte. 2. The dome shaped top of the uterus is called the - fundus. 3. The egg is referred to as a blastocyst when - it has been fertilized and enters the uterus and begins absorbing uterine fluid through the cell membrane. 4. Gestational diabetes is caused by - increased insulin production and decreased cellular sensitivity to insulin. 5. Abortion is defined as expulsion of the fetus, from any cause, before the _____ week of pregnancy - 20th 6. Uterine rupture MOST commonly occurs- during active labor. 7. A primigravia woman - is pregnant for the first time. 8. The corpus luteum continues to secrete hormones to support pregnancy for - 90 days. 9. Unlike the prenatal period, the gestational period - is 38 weeks in duration. 10. deviation. 11. Systolic and diastolic blood pressure decrease until approximately ___ weeks gestation - 24. 12. The onset of eclampsia is marked by the presence of - generalized seizures. 13. During third trimester vaginal bleeding - the mother may lose as much as 40 % of her blood volume before significant signs of hypovolemia occur. 14. A nulliparous woman - has never delivered a baby. 15. The typical upper limit of the fetal heart rate is - 160 beats/min. 16. The fetal side of the placenta should normally be - gray and shiny with a smooth texture. 17. Average blood loss during the third stage of labour is approximately - 150 ml. 18. Which of the following medications would MOST likely be indicated for a patient with a prolapsed umbilical cord ? - terbutaline. 19. Fertilization of an egg usually occurs in the - fallopian tube. 20. All of the following processes takes place in the uterus EXCEPT - fertilization. 21. Which of the following is NOT a function of the placenta ? - fetal protection against all harmful substances. 22. Which of the following statements regarding the amniotic sac and fluid is correct ? - in the latter stages of pregnancy the fetus aswallows amniotic fluid and passes wastes out into the fluid. 23. If a woman's prepregnancy resting heart rate is 70 beats per minute, you should expect her heart rate to range between ____ and ____ at term - 85,90. 24. At term displacement of the diaphragm by the uterus causes a (n) - decrease in expiratory reserve volume. 25. Common signs and symptoms of preeclampsia include - edema, hypertension, and headache. 26. During pregnancy which of the following respiratory conditions can occur due to the effects of stress or respiratory irritants on an already sensitized respiratory system ? - asthma. 27. Seizures during pregnancy should be treated with - magnesium sulfate. 28. The leading cause of life threatening infections in newborns is - group B streptococous 29. Cholestasis occurs when - hormones slow or block the normal flow of bile from the liver. 30. When caring for a woman with an incomplete abortion, you should be MOST concerned with - bleeding and shock. 31. In contrast to an abruptio placenta, a placenta previa- usually presents with painless vaginal bleeding. 32. Abruptio placenta is MOST accurately defined as - premature separation of a normally implanted placenta from the uterine wall

1 Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock ? - they do not have oxygen carrying capacity 2 The MOST common cause of cardiogenic shock is - myocardial infarction. 3 Intrinsic causes of cardiogenic shock include - cardiomyopathy. 4 If the left ventricle fills with 85 ml of blood and ejects 60 ml during a contraction, the ejection fraction is approximately ___ % - 70 5 The MOST immediate treatment for the patient with a tension pneumothorax is to - eate air from the pleural space. 6 Which of the following blood pressure is MOST consistent with a pericardial tamponade ? - 90/70 mm hg. 7 By which of the following mechanisms do patients with septic shock become hypovolemic ? - fluid leakage out of the vascular space. 8 Which of the following clinical signs would differentiate septic shock from hypovolemic shock ? - warm or hot skin. 9 Relative bradycardia during neurogenic shock occurs because - the sympathetic nervous system is not stimulated to release catecholamines . 10 The negative target organ effects of anaphylactic shock are reversed with - epinephrine. 11 Hypotension during anaphylactic shock is caused primarily by - relative hypovolemia. 12 A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. The is MOST descriptive of ____ shock - psychogenic. 13 A 40 year old man had a syncopal episode after receiving news of the death of a loved one. He complains of a headache and is unable to walk without becoming dizzy. You should be the MOST suspicious for - a head injury. 14 If you can feel a pulse over the femoral artery of an adult, but are unable to feel a pulse over the radial artery, his or her systolic blood pressure is likely between ___ and ___ mm hg - 70,80. 15 What is formed when carbon monoxide binds to the hemoglobin molecule ? - carboxyhemoglobin 16 Adequately perfused kidneys put out at least ___ to ___ ml of urine per hour - 30,50. 17 Shock in the trauma patient should be considered ____ until proven otherwise - hemorrhagic 18 Which of the following volume expanders has been shown to interfere with platelet function and cause clotting problems ? - dextran 19 Premorbid conditions are those that - precede the onset of a disease. 20 The force or resistance against which the heart pumps is called - afterload. 21 The mean arterial pressure must be greater than or equal to ____ mm hg to ensure that the brain, coronary arteries, and kidneys remained perfused - 60. 22 Which of the following statements regarding gas exchange in the lungs is correct ? - oxygen molecules move from the alveoli into the blood by diffusion. 23 Which of the following substances or elements reinforces red blood cells , creating the final step in the formation of a blood clot ? - fibrinogen 24 Which of the following is normal response of the body to hypoperfusion ? - antidiuretic hormone is released by the pituitary gland. 25 Systemic effects of epinephrine include ? - increased afterload. 26 According to the frank starling mechanism - the length of myocardial fibers determines the force of cardiac contraction. 27 A characteristic sign of neurogenic shock caused by a spinal injury is - an absence of sweating below the level of the injury.

REVIEW 1. Unless the fluid level is low, you should NOT uncap the brake fluid reservoir because D. Brake fluid absorbs moisture from the atmosphere 2. Safe practices when parking your emergency vehicle on a roadway at night include all of the following, EXCEPT B. Leaving the headlights on. 3. The paramedic should NOT operate an emergency vehicle if he or she is taking a cold remedy or an analgesic. 4. Air ambulances are advantageous for all of the following reasons, EXCEPT D. the more experience of the flight paramedics. 5. 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. 6. Which of the following pieces of equipment typically does not require calibration? B. Cardiac monitor. 7. The motor oil level of the ambulance : should be checked prior to starting the engine. 8. When checking the ambulance engine, you note the odor of sewer gas. What should you do? Close the hood and take the ambulance out of service. 9. An ambulance should be remove from service immediately if you feel or hear: B. Brake fade. 10. 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. 11. A third service EMS system is one in which A public agency not affiliated with the fire department provides EMS service. 12. the goal of system status management is to: Minimize response times by deploying EMS resources strategically. 13. Upon arriving at a motor vehicle crash, the paramedic should look for safety hazards and then: evaluate the need for additional resources. 14. With respect to emergency driving, due regard means that: D. the use of lights and siren does not exempt you from operating the ambulance with concern for the safety of others. 15. The decision to use lights and siren when transporting a patient to the hospital is MOST dependent upon: C judgment on the part of the paramedic. 16. When parking the ambulance off the side of the highway in dry weather: the heat from underneath the vehicle could start a grass fire. 17. General principles for backing up an ambulance include: stopping the vehicle if you lose sight of your spotter. 18. Which of the following disadvantages of using an air ambulance should concern you the LEAST when utilizing it for a critically injured patient? The cost that will be incurred. 19. When assisting with a helicopter landing at night, you should: avoid shining a spotlight up at the descending aircraft. 20. The killing of pathogenic agents by directly applying a chemical made for that purpose is called disinfection. 21. 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 : remain behind the vehicle and anticipate that the driver may slam on the brakes. 22. 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: Advise him to drive at normal speeds and ensure that he knows where the hospital is. 23. You are driving in the right hand lane while transporting a patient to the hospital in non-emergency mode. In your side view mirror, you notice that a small truck is tailgating you. What should you do? Maintain your current speed and advise the dispatcher to contact the police. 24. 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: Come to a complete stop and then proceed after looking in all directions. 25. 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 front. 26. The use of lights and siren on an ambulance: is a request for the right of way. 27. When you are dispatched to an emergency, it is MOST important to determine which route will be used to arrive safely.' 28. When transporting a small child on the stretcher, you should: use a pediatric transport securing device whenever possible. 29. When responding to an emergency scene, you approach a sharp turn in the road. What should you do? Slow the vehicle to the posted speed limit and avoid braking during the turn. 30. 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? 100 feet past the crash site on the right side of the road. 31. command functions include all of the following EXCEPT the triage officer. 32. Which of the following duties is NOT a responsibility of the incident commander? Authorizing medical treatment. 33. Which of the following statements regarding the unified command system is correct? In a unified command system, multiple agencies from multiple jurisdictions work together to develop a plan that involves shared responsibilities. 34. Prior to implementing any plans or operations at the scene of a multiple casualty incident, you should FIRST: notify your supervisor or the incident commander. 35. Broadly speaking, the finance section chief is responsible for: documenting all expenditures at an incident and seeking reimbursement. 36. At a very large incident, the operations section is responsible for managing the tactical operations job usually handled by the incident commander on routine EMS calls. 37. Multiple-casualty equipment and supplies needed for airway control include all of the following, EXCEPT Large bore IV catheters for thoracic decompression. 38. the safety officer has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. 39. When functioning at the scene of a major incident, communication should; be face to face to minimize radio traffic. 40. If an emergency physician is present at the scene of a mass casualty incident, He or she would be the LEAST likely to Assume control over complex rescuer operations. 41. Which of the following statements regarding the rehabilitation group is correct? In addition to meeting the responder's needs for rest, fluids and food, the rehabilitation officer must be prepared to conduct a defusing session if a responder shows signs of stress. 42. Because extrication and rescue are medically complex : the officers responsible for these functions usually function under a specialty branch of the incident command. 43. if a disaster requires a morgue unit leader, it is MOST important for the person who is assigned that function to be aware that some mass casualty incidents involving multiple fatalities may be crime scenes. 44. Which of the following injuries or conditions should be assigned the highest priority? Respiratory distress.' 45. According to the START triage system, a nonbreathing patient should be triaged as immediate if a manual airway maneuver restores breathing. 46. According to the JUMPSTART triage system, if an infant or child is not breathing, you should immediately assess for a pulse. 47. Which of the following statements regarding critical incident stress management at the scene of a mass casualty incident is correct? Rescuers should be encouraged, but not forced to report to the rehabilitation sector for a stress debriefing. 48. During an incident involving a building collapse, a paramedic is assigned eight rescuers under his authority. However, as the incident progresses, the paramedic finds that he is unable to effectively manage the personnel assigned to him. He should: divide tasks and delegate supervision of some tasks to one or more of the rescuers assigned to him. 49. you are caring for a patient with non-life threatening injuries in the treatment section of a multiple- casualty incident when you are approached by several TV reporters who are seeking details regarding the incident. You should: direct the reporters to the public information officer. 50. During an incident involving an explosion, you determine that two critically injured patients should be transported to a trauma center by air. After stabilizing the patients conditions to the best of your ability, you should notify the transportation supervisor and request that he or she establish a landing zone. 51. Upon arriving at the scene of a major incident, you can clearly see that there are numerous patients, some of whom are receiving care and other whom are walking around unattended. Your MOST appropriate action should be to: report to the staging area for further instructions 52. While triaging patients at a multiple casualty incident, you rapidly assess a patient and determine that she is conscious and alert, bit cannot feel or move anything below her umbilicus. You should place a yellow tag on her and move on the next patient. 53. Upon arriving at the scene of a multiple vehicle crash, you call for additional resources and begin triaging patients using the START triage system. The first patient you assess is a young male who is unconscious and apneic. After manually opening his airway, you note that he starts breathing shallowly. You should: categorize him as an immediate patient. 54. a man stormed into a daycare center and opened fire with a semiautomatic rifle. The scene has been secured by law enforcement, and you are in the process of triaging the injured children. The first child you assess, a 4 year old boy, is responsive and apneic but has a pulse. After manually opening the airway, he remains apneic. You should: provide five rescue breaths and reassess his respiratory status. 55. Which of the following interventions would MOST likely be performed while triaging patients with the SALT method? Needle chest decompression. 56. A single command system is one in which a single person is in charge, even if multiple agencies respond to the incident. 57. The transfer of command should occur. D. face to face, if possible, and in an orderly manner. 58. Occlusive dressings and large bore IV catheters for thoracic decompression are supplies used to address breathing issues at a multiple-casualty incident. 59. The FIRST step in START triage system involves directing all the walking wounded to an easily identifiable landmark. 60. Your unit is the first to arrive at the scene of a bus crash. As you approach the scene, you see multiple patients, some of them lying on the ground not moving and others walking around in a dazed state. You should: remain aware of the potential for hazards. 61. the most difficult part of any rescue is the simultaneous coordination of rescue and treatment. 62. with regards to rescue, it is MOST important for the paramedic to be able to understand and identify potential hazards and determine whether it is safe to gain access to the patient. 63. after the warm zone has been established, it should be demarcated with orange police or fire line tape. 64. Unique dangers associated with confirmed with confined spaces include limited ventilation. 65. Which of the following statements regarding the hot zone at a rescue scene is correct? The hot zone immediately surrounds the dangers of the rescue site and is only accessible by entry and rescue teams. 66. The scope and magnitude of a rescue incident should be reassessed frequently. 67. After a vehicle has been properly stabilized, the simplest way to gain access to a crash victim is to attempt to open the least damaged door. 68. During extrication of a seriously injured patient from his or her crashed vehicle, it is most important to provide emergency care while extrication is in progress if it is safe to do so. 69. Carbon monoxide binds to red blood cells and prevents them from transporting oxygen to all parts of the body. 70. Which of the following statements regarding an EMS provider's role during a trench rescue is correct? EMS providers should attempt to make contact with the patient, but should not enter the trench and attempt rescue. 71. Which of the following situations des NOT depict a technical rescue? Moving a 180 pound man from his living room to the ambulance. 72. Once the patient has been disentangled, your primary focus should be to safely remove the patient. 73. Packaging a patient is MOST accurately defined as preparing the patient for movement as a unit. 74. Which of the following items of personal protective equipment is not always required when performing a water rescue? Contamination protection. 75. When heavy extrication tools are required to force a damaged door open, you should avoid trying to force a door open if the patient is leaning against it. 76. The preferred initial method for disentangling a patient who is trapped between the seat and the steering wheel involves, trying to slide the seat back on its track. 77. The objective of dash displacement is to lift the dash up and move it forward. 78. As the first responding unit to arrive at the scene of a confined space rescue, what is the MOST important information to share with the technical rescue team when they arrive? Whether the incident has changed significantly since your arrival 79. The FIRST step in assuming the self-rescue position if suddenly immersed in fast moving water involves: rolling into a face up arched position with the lower back higher than the feet. 80. The MOST common swift rescue scenario involves: people who attempt to drive their vehicles across a flooded bridge. 81. Your initial attempt to rescue a person from the water should involve reaching out to the victim using any readily available object. 82. in contrast to low-angle rope rescues, high-angle rescues involve situations where the slope of the ground is greater than 45* and rescuers or patients are dependent on a life safety rope. 83. Descending on a fixed rope from a severe angle is called rappelling, 84. A 7 year old child was playing near a large pile of sand when the ground underneath her collapsed. You can hear her crying and asking for her mother. Until the technical rescue team arrives at the scene, you should: maintain verbal contact with the child, but avoid going near the edge of the trench. 85. You and your partner are standing by at the scene of a residential fire when you hear that a badly burned woman has been located by fire fighters on the side of the house opposite your ambulance. you should: stay where you are and have fire fighters bring the patient to you. 86. Upon arriving at the scene of an overturned tanker truck or train derailment. You should be MOST suspicious that a hazardous material is involved if: multiple patients are unconscious or are experiencing respiratory distress. 87. Which of the following would be of LEAST value when trying to determine the type of hazardous material a commercial tanker truck is carrying? Waybill 88. Department of Transportation (DOT) Class 8 chemicals are: corrosive. 89. Which of the following statements regarding the warm zone at a hazardous materials incident is correct? It may be necessary to perform urgent lifesaving care in the warm zone before a patient is fully decontaminated. 90. Level C personal protective equipment would be MOST likely be worn during transport of patients with the potential of secondary contamination. 91. The local effects of a hazardous material may present with blister formation. 92. The temperature at which a liquid fuel gives off sufficient vapors to cause a fire when an ignition source is present is called the flashpoint. 93. It is MOST important to park your ambulance upwind and uphill from a hazardous materials incident scene because: the vapor density of many chemicals is less than that of the air, causing the vapor to rise and dissipate as it travels with the wind. 94. In contrast to the lethal concentration of a chemical, the lethal dose is a single dose that causes death when exposure occurs by any other route other than inhalation. 95. Medical monitoring and rehabilitation of rescuers at the scene of a hazardous materials incident should routinely include all of the following, EXCEPT prophylactic IV boluses of an isotonic crystalloid. 96. When approaching an overturned tanker truck that is not displaying a warning placard, it is MOST important for the paramedic to maintain a high index of suspicion because tankers carrying small amounts of a hazardous material may not be required by law to display a warning placard. 97. Systemic effects following exposure to a hazardous material may be delayed for hours or even years. 98. Cyanide is a chemical asphyxiant, which means that it interferes with the utilization of oxygen at the cellular level. 99. You are one of the paramedics staffing the rehabilitation section at a hazardous materials incident when a hazardous materials technician brings you one of his coworkers, whose mental status is altered. According to the technician. His coworker was appropriately decontaminated in the warm zone. The patients skin is hot and moist, and he is confused and nauseated. You should suspect that he is suffering from heatstroke, administer high flow oxygen, and begin rapid transport. 100. After ensuring your own safety, which of the following is your next priority at the scene of a hazardous materials incident? Identify the hazardous material involved. 101. Which of the following statements regarding the transport of a hazardous material is correct? Even if the law does not require a truck to display a placard, the driver of the truck is required to carry documentation of the chemical being transported. 102. If you are the first unit to arrive at a scene and observe any signs suggesting that a hazardous materials incident has occurred, you should remain upwind from the scene if possible and immediately call the hazardous materials team. 103. When staging at an appropriate distance from the scene until the hazardous materials team arrives to investigate the chemical leaking from an overturned tanker, you should check the wind direction periodically and be prepared to relocate. 104. Department of Transportation (DOT) class 1 chemicals are: explosive. 105. Triage and emergency medical treatment should be performed in the cold zone 106. What level of personal protective equipment is typically worn by the hazardous materials decontamination team in the warm zone? Level B. 107. Secondary contamination with a hazardous material occurs when toxins are transferred to another person by contaminated objects. 108. The threshold limit/value of a chemical is the concentration that A person should never be exposed to. 109. If a sufficient concentration of a hazardous material mixes with air and reaches its lower flammable limit: the material can burn in the air or explode. 110. Patients showing signs of pulmonary edema secondary to inhalation exposure to a corrosive chemical, may need to be treated with a diuretic. 111. Following exposure to an industrial pesticide, a patient is responsive to pain only, is coughing up copious secretions, and has a heart rate of 40 beats/min. priority treatment for this patient includes: oral suctioning. 112. A commercial truck was involved in a wreck and is spilling anhydrous ammonia on the roadway. The incident commander has already established the hot, warm and cold zones as dictated by the chemicals involved. As one of the paramedics at the scene, you should anticipate that your role will MOST likely involve: performing triage and treatment in the cold zone. 113. You and another paramedic are transporting an unresponsive, apneic patient from a hazardous materials incident to the hospital. Because of her condition, she was only partially decontaminated at the scene. You will arrive at the hospital in approximately 10 minutes. The MOST appropriate treatment for this patient involves. Avoiding intubation if possible, as this may expose the patients airway to contamination. 114. Following decontamination, a patient is presented to you by rescue personnel for transport. The patient is conscious and alert, and is in no obvious respiratory distress. The patient is emitting a pungent odor and has an orange chemical on her clothing. You should advise rescuers that the patient has not been adequately decontaminated. 115. the threshold limit value (TLV) is the maximum concentration of a toxin that someone can be exposed to for a 40 hour workweek over a typical 30-year career. 116. Sarin has an LD50 of 1,700 mg/70 kg. this means that this dose will kill 50% of people who are exposed to it. 117. Which of the following statements regarding radiation is correct? It is impossible to recognize the type of radiation emitted from a given source. 118. Bubonic plague is characterized by lymph node enlargement. 119. You were at the scene of an explosion at an office complex. There are a total of 15 casualties, including 2 deaths. In addition to injuries experienced by the explosion, most of the victims are complaining od nausea, vomiting and diarrhea. You must ensure that they have been properly decontaminated first. 120. What do tabun, sarin, soman, and VX agent all have in common? The onset of symptoms following exposure is immediate 121. All of the following are examples of domestic terrorism, EXCEPT the world trade center attack. 122. Which of the following statements regarding terrorism is not correct? the majority of terrorist attacks are impulsive and unplanned. 123. When triaging patients at the scene of an explosion, you should be especially aware of the fact that a secondary explosive device may be present. 124. You and your partner arrive at the scene of a building explosion. As you stage your ambulance, you can see that members of the FBI are present. You also see numerous victims lying on the ground outside the building. You should: stay where you are until you receive instructions from the staging officer. 125. The seizures associated with nerve agent exposure will continue until a MARK 1 antidote is administered. 126. While at the scene of an incident in which several patients were possibly exposed to lewisite, you are informed that an unresponsive patient with multiple blisters on his body and inadequate breathing is being brought to you for treatment. You should: ensure the patient has been decontaminated before initiating any treatment. 127. Radiation exposure that occurs through the body is most appropriately termed irradiation. 128. Ricin is derived from mash that is left from the castor bean. 129. The BEST way to protect yourself from the effects of radiation is to use time, distance, and shielding to your advantage. 130. in contrast to Sulphur mustard, lewisite and phosgene oxime exposures cause a rapid onset of signs and symptoms. 131. Whether ingested or inhaled, ricin poisoning causes fever, chills, and a headache. 132. A young woman presents with severe respiratory distress. She is conscious, but confused, and smells of freshly cut grass. Auscultation of her breath sounds reveals coarse crackles in all lung fields. And she is coughing up copious secretions. This patients clinical presentation is MOST consistent with exposure to phosgene. 133. which of the following statements regarding tabun is correct? tabun is half as lethal as sarin and 30 to 40 times more persistent. 134. The hazardous materials team has deemed it safe for you to enter and remove patients from an office building that has exploded. As you are moving the patients, it is most important to remain alert to the possibilities of a secondary explosive device. 135. Upon arriving at a scene in which the incident command system has already been established, you should. Locate the medical staging supervisor to receive your assignment. 136. A 21 year old woman presents with a severe headache, body aches, and a fever of 102.8 F. She tells you that she has returned from a humanitarian aid mission overseas a week and a half ago and began feeling ill yesterday morning. Given this patient's travel history and clinical presentation, you should expect her to develop a rash and blisters on her face. 137. Which of the following statements regarding a radiological dispersal device (RDD) is correct? An RDD is any container designed to disperse radioactive material and requires the use of an explosive device. 138. Which of the following chemical agents has the smell of freshly cut grass? Phosgene. 139. Viral hemorrhagic fevers include all of the following EXCEPT the plague. 140. Signs and symptoms of significant cyanide exposure include tachypnea. 141. You are caring for a 40 year old man who was exposed to an unknown chemical and has been appropriately decontaminated by the hazardous material team. The patient responds to pain only, is incontinent of urine and feces, and has a heart rate of 40 beats per minute and weak. Further assessment reveals that his breathing effort is poor and his blood pressure is low. After taking standard precautions, the MOST appropriate treatment for this patient involves: assisting his ventilations with a bag-mask device and 100% oxygen, performing intubation if necessary, establishing vascular access, applying the cardiac monitor, and administering atropine and pralidoxime. 142. Which of the following is a pre-incident indicator of terrorism? Increase in violent political activism. 143. Nerve agents block cholinesterase an essential enzyme of the nervous system. 144. Signs and symptoms of nerve agent exposure include all of the following EXCEPT tachycardia. 145. All of the following chemicals are vesicant agents, EXCEPT chlorine. 146. The "hazards approach to disaster planning involves: conducting comprehensive preplanning for all types of disasters. 147. A mutual aid agreement formally defines: the relationship between two or more agencies and the support that those agencies will provide to eachother when requested. 148. An EMS agency's public information officer should be trained to. Use the media to the agency's advantage. 149. What is the purpose of an ICS-211 form during the mobilization of personnel when a disaster occurs? To track who was mobilized and when and where they were assigned. 150. Which of the following would be the MOST likely reason that transport of patients via helicopter would not be an option during the initial aftermath of a tornado? Changes in temperature and wind speed in the air? 151. A category 1 hurricane has sustained winds that are between 74 and 95 mph. 152. The primary emergencies during a volcanic eruption come from explosions in bubbling magma. 153. The number one killer of firefighters at the scene of a fire scene of a fire is/are cardiac events. 154. A lock out/tag out information sheet at the site of a new building being constructed contains information regarding the number of people and conditions in the danger zone. 155. If an EMS agency is providing relief to a neighboring community during a disaster, it is important to ensure that it has enough coverage in its home area of responsibility. 156. Which of the following is the MOST important consideration after an event? All personnel are accounted for. 157. While providing care to victims following an earthquake, you note that many of them are experiencing respiratory distress. This is MOST likely due to dust suffocation. 158. The intense heat of brush fires seals the soil surface, which makes mudslide, avalanches or landslides; Move even faster over terrain. 159. Which of the following injuries or conditions would you most likely encounter following a cave-in? hypoxia and hypothermia. 160. When functioning during a flash flood, tag lines should be used, which are: safety ropes tied around rescuers so they can be pulled to safety. 161. For the EMS provider, most of the problems associated with sandstorms and dust storms are directly related to the abrasive and visual effects. 162. When functioning during a heat wave, the paramedic should take small constant sips of water throughout the day. 163. Which of the following is the MOST important consideration during a pandemic? Personal protective equipment. 164. While staging at a sniper shooting, you hear of a police officer who has been shot in the leg and is bleeding profusely. You should: attempt to make verbal contact with the swat team and instruct them to apply a tourniquet 165. The unified command system allows representatives from multiple jurisdictions and agencies to share command authority and responsibility. 166. During a disaster, all patients who are transported to the hospital should have: a patient care report written, in addition to a triage tag. 167. Fast moving water as low as 2 inches can easily move a car. 168. When functioning during cold weather, the paramedic should wear. Layered clothing. 169. During a pandemic, your agency has been called upon to be a point of distribution this means that you will house temporary supplies and provide inoculations and medications. 170. Which of the following statements regarding violence is correct? violence is not isolated to a particular socioeconomic class 171. All of the following are indicators of the potential of violence, Except. A large body build. 172. How should you position your ambulance upon arriving at the scene at the scene of a victim who was found slumped over the steering wheel of his or her car. At least 21 feet behind the parked vehicle, at a 10 angle to the drivers side, facing the shoulder. 173. If you unexpectedly find yourself in the middle of a domestic dispute, the situation would MOST likely deteriorate if you use an authoritative voice. 174. Youths usually join a gang for all of the following reasons, EXCEPT a psychiatric illness. 175. After concealing yourself and reassessing your position, you should: seek adequate cover 176. If you are under fire from a sniper who is on the roof of a building, and you are using a vehicle as cover, the MOST effective way of protecting yourself is to position yourself next to the front wheel so that the engine block and tire can both protect you. 177. If someone continues to intentionally block you from reaching a critically injured patient despite your initial request that he or she move, you should; take a side step and state, "if you don't get out of my way I'm calling the police." 178. Proper documentation of an incident in which a patient was injured during a crime should include all of the following, EXCEPT your estimate of when the injury occurred. 179. You are at the scene of a drive-by shooting in which a 19 year old man was shot in the chest. Law enforcement personnel are at the scene. The patient conscious, has an actively bleeding entry wound to his left anterolateral chest, and is breathing with difficulty, you should provide only the amount of care needed to prevent his condition from deteriorating 180. You and your partner respond to a call for a domestic disturbance. You are both wearing high-level body armor. There are no indications of any weapons on premises. What should you do? Wait for law enforcement personnel to arrive and secure the scene. 181. When approaching a parked vehicle that is occupied by an apparently sick person, you should: determine how many people are in the vehicle, paying particular attention to the location of their hands. 182. When approaching a van at night to determine the driver, who is reportedly unconscious, is in need of medical assistance, you should: move 10 to 15 feet away from the passenger side and walk parallel to the van. 183. Your EMS systems' standard procedure for responding to any call involving violence, should be to: allow law enforcement to secure the scene prior to your entry. 184. Which of the following is the safest method for preparing to enter a residence? stand to the doorknob side of the door, knock, and announce that you are a paremedic. 185. One aspect of the technique of contact and cover involves: one paramedic making contact with the patient to provide care while the second paramedic obtains patient information from another person while gauging his or her level of tension. 186. Which of the following statements regarding clandestine drug labs is correct? some drug producers use fragmentation and incendiary devices and animal traps to protect their operations. 187. Gangs predominantly survive through selling drugs. 188. Which of the following objects or locations would NOT provide adequate cover from gunfire? Shrubbery. 189. If you are taken hostage, it is most important to control the instinctive anger that occurs when you are physically abused. 190. Which of the following statements regarding cover and concealment is correct? you have more options for concealment in the dark than during daylight hours. 191. the primary function of the tactical paramedic is to provide: care for law enforcement teams who make entry into violent situations. 192. If you believe that your life is in imminent danger, any action that gets you out of the situation is a reasonable level of force. 193. All of the following are examples of real or physical evidence, EXCEPT oral documentation left by a witness. 194. You receive a call to a residence in a rural area of your jurisdiction for a patient with an accure COPD exacerbation. Upon arriving at the scene, you knock on the door nd identify yourself. The patient , an elderly sounding man, tells you that you took to long to get to him and that you took too long to get to him and that he has a shotgun. You should immediately retreat to the ambulance and notify law enforcement. 195. At 10:20 PM, you are dispatched for a woman reportedly slumped over the steering wheel of her car alongside the highway, Upon arriving at the scene, you should park your ambulance at least 21 feet behind the patient's vehicle. 196. Upon arriving at the scene of a woman with chest pain, you enter the residence and begin to assess the patient. The patients husband, who is angry because of your response time, is standing in the corner clenching his fists. You should: quickly scan the area for the quickest escape route. 197. You are dispatched to recreational vehicle (RV) park for an unconscious patient, when you arrive at the scene, another resident of the park tells you that the patient, a young man, is in his RV and will not answer the door. After safely entering the RV, you find the patient lying supine near the rear of the vehicle. From a distance, you can tell that he is not breathing as you approach him, you see several bottles of Sudafed, a container of camping fuel, and a variety of glass containers with an unknown liquid in them. What should you do? Quickly remove the patient from the vehicle if it is safe to do so, begin CPR away from the RV and ask the resident to call the police. 198. Upon entering the residence of a man with a supposed heart attack, you find that you have been taken hostage by a young man who has a deer rifle. He orders you to sit down in the corner of the room, where other people have been taken hostage as well. You should do as your captor orders try to remain calm, and avoid doing anything to attract attention to yourself. 199. While interviewing a severely depressed woman, the patient suddenly lunges at you with her hands, it is not known if the patient has any weapons. Your MOST appropriate action should be to throw your patient care form directly at the patient's nose and egress rapidly. 200. Which of the following statements regarding the EMS system is correct? the paramedic is a public servant who often responds to non-emergency calls 201. A paramedic who is licensed in a particular state: is required to function under the guidance of a licensed physician. 202. The main purpose of conditioning education is to remain current with the latest treatment guidelines. 203. Openness, honesty, and truthfulness are attributes that demonstrate integrity. 204. As an advocate for your patient, you must Act in the patients best interest and remain respectful of his or her wishes and beliefs. 205. you should prioritize the needs of your patient based on the injury or illness that requires the most urgent treatment. 206. When you transfer care of your patient to the hospital staff, it is most important to use discretion and protect the patients privacy. 207. When educating citizens who live in an area where EMS response times will be lengthy, the MOST important skill to teach them is rescue breathing and chest compressions. 208. a protocol is MOST accurately defined as a(n) treatment plan for a specific illness or injury. 209. Which of the following statements regarding protocols is correct? protocols are usually developed in conjunction with national standards. 210. the main purpose of research in EMS is to determine whether treatment is effective or ineffective. 211. 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 experimental research. 212. the LEAST preferable and reliable method of selecting people to participate in a research study is convenience sampling 213. 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: instruct the caller on how to perform CPR until you arrive at the scene. 214. You and your team are attempting to resuscitate a 50 year old woman in traumatic cardiac arrest. Your team consists of two EMT's and an AEMT. Which of the following tasks would be MOST appropriate to assign to the AEMT? IV therapy and fluid boluses. 215. If the receiving facility does not have adequate resources to take care of your patient, you should determine whether: there is an appropriate facility within a reasonable distance. 216. Common actions performed by the dispatcher after receiving an emergency call include all of the following. EXCEPT: determining if an ambulance should be dispatched. 217. Compared to an EMT, an AEMT has a more advanced knowledge of pathophysiology. 218. Being empathetic towards a patient means that you acknowledge the patients feelings. 219. if a paramedic is self motivated, he or she should NOT require maximum supervision at work. 220. All of the following are examples of injury prevention EXCEPT teaching rescue breathing and CPR to a group of citizens. 221. When faced with a situation that is not addressed in your EMS system's protocols, you should: radio your medical director to obtain orders. 222. When deciding which medical facility is most appropriate for your patients needs, it is MOST important to: know the capabilities of all the hospitals in your area. 223. When educating the public regarding your EMS system, you should do all of the following, EXCEPT. Liken your job to EMS-related TV shows. 224. Which of the following is NOT a typical function of the EMS medical director? Responding to an emergency scene with paramedics. 225. Specific functions that the paramedic should perform prior to contacting medical control are called standing orders. 226. Which of the following statements regarding peer review is correct? peer review is not a tool to demean or belittle a fellow paramedic. 227. 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: personal finance issues. 228. the first part of EMS research is to identify a specific problem or question. 229. Research that is based on observation only, without an attempt to alter or change an event is called descriptive research. 230. Research that is based on a group of individuals at one point in time is called cross sectional research. 231. When research participants are advised of all the aspects of the project, the research project is said to be unblinded. 232. The qualitative method of gathering data for a research project: does not use numerical information and is the least accurate. 233. When using a group of subjects who range in age of 30 to 40 years, 3 years of age would be considered the midpoint. 234. In order to link research and evidence to patient care, one must: ensure that the quality of the evidence is sufficient to justify changing patient care protocols. 235. An unblinded research study is one in which: all research participants are advised of all aspects of the project. 236. 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 educate the patient and tactfully discuss why a cold is not an emergency. 237. A patient has requested to be transported to a specific hospital, however the hospital does not have the proper resources to meet the patients needs. You should determine if there is a more appropriate medical facility within a reasonable distance. 238. Upon arriving at a scene of a motorcycle crash, you are approached by an EMR. What is the MOST important the EMR should provide to you? Initial scene and patient assessment findings and any basic care that was provided to the patient. 239. 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? you should maintain a professional attitude and care for the patient to the best of your ability. 240. 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 have integrity. 241. 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 be respectful of the patient's wishes and give her the time she needs. 242. You arrive at a convenience store to find a middle aged male in cardiac arrest. Your protocols provide for standing orders in this scenarios. This means that you should perform certain interventions, prior to contacting medical control. 243. What instructions or guidance would an emergency medical dispatcher MOST likely provide to a caller? How to control bleeding and perform CPR. 244. If an emergency medical responder is appropriately trained and competent, he or she should be able to recognize the seriousness of a patient's condition, provide basic life support care. 245. A major recommendation made by the 2009 national EMS education standards for paramedic training was the inclusion of a college level anatomy and physiology course as part pf the training program. 246. Performing the functions of a paramedic prior to licensure is unlawful. 247. A paramedic is considered a health care professional, and as such should: meet societal expectations whether he or she is off duty. 248. When responding to an emergency scene, it is MOST important to proceed in a manner that is timely and safe. 249. A major distinction between a paramedic and an EMT is that the paramedic carries out advanced pharmacologic skills 250. The fight or flight response is characterized by all of the following physiologic responses EXCEPT decreased sympathetic tone and pupil constriction. 251. Consequences of poor nutrition include all of the following EXCEPT: hair loss 252. Common signs of PTSD include all of the following, EXCEPT: feelings of guilt that you performed inadequately. 253. Which of the following is NOT a component of well being that is essential for a healthy life? Financial. 254. Burnout is a consequence of chronic, unrelieved stress. 255. The first thing you should do if you think you are beginning to experience symptoms of burnout is reexamine your beliefs and your ways of responding to stress. 256. All of the following are common triggers of distress, except planning a lengthy vacation. 257. At the scene of an incident involving multiple patients, an obviously depressed bystander needs to be brought back to reality and removed from the scene. 258. What is the recommended exercise for most adults? At least 30 minutes a day of moderate to vigorous exercise. 259. In which order do MOST people progress through the stages of grief? Denial, anger, bargaining, depression, acceptance. 260. Which of the following is NOT a symptom of impending burnout? Requesting additional shifts. 261. Which of the following statements regarding a patient's reaction to an illness or injury and his or her cultural background is MOST correct? you will not be able to manage patient care well if you do not respect the culture of your patient. 262. It is most important for you to remember that an angry or resentful patient. Is acting in a manner due to fear of the situation. 263. The MOST effective way to deal with stress is to identify the stress triggers and take action to minimize their effects. 264. When attempting to control your own anxiety through controlled breathing, you should take deep breaths in throught the nose and out through the mouth 265. Which of the following habits will increase your exposure to injury from lifting your maximum weight? Routinely lowering the ambulance stretcher all the way to the ground. 266. Which of the following statements regarding distress is correct? distress is a learned reaction, based on the way the paramedic perceives and interprets a given situation. 267. People who overreact at the scene of an emergency, such as an incident with multiple casualties, will most likely Be compulsively talkative 268. Part of your therapeutic role as a paramedic includes: maintaining a calm and confident attitude. 269. When caring for a confused elderly patient, it is MOST important for the paramedic to: explain what he or she is doing at all times. 270. The BEST way for a paramedic to sustain energy is to carry numerous small snacks that can be eaten slowly. 271. A patient with different cultural beliefs will not maintain eye contact with you. He is very pleasant, but looks down when answering your questions. What does this indicate? He is showing respect for your authority. 272. You arrive at the scene of an injured person. As you and your partner approach the patient , You see that he is bleeding profusely from a large laceration to his neck. As you are about to begin patient care, a man walks up and states and "I cut him!" you should; retreat from the scene to a safe area and immediately notify law enforcement. 273. When managing stress, it is important to avoid taking sleeping aids after a stressful event. 274. Foods made from eggs are considered part of what food group? Protein. 275. While caring for a woman with acute shortness of breath, your partner, a dedicated paramedic for many years, tells the patient that she should have driven herself to the hospital instead of calling EMS. Your partners behavior is MOST consistent with impending burnout. 276. You and your partner are caring for an 82- year old woman who is obviously confused at the situation. It is MOST important for you to carefully explain what you are doing and frequently talk to the patient. 277. When dealing with a grieving child, it is important to remember that children 9 to 12 years to age may want to know details of the incident. 278. The ability to remain calm and think clearly when everything else is in disarray is a trait of professionalism 279. Which of the following statements regarding stress is correct? the specific event that triggers a stress reaction varies from person to person. 280. When a patient calls for EMS for an apparent non-life-threatening condition, the paramedic should: recall that what he or she considered to be a nonemergency may be very emergent to the patient. 281. During a crisis the paramedic is able to focus and function, but afterwards, he or she may be left with nervous, excited energy that continues to build. This is indicative of a delayed stress reaction. 282. The ECG of a patient clearly indicates that he is experiencing a heart attack. The paramedic advises the patient of this, but the patient states, "no, I don't care what your machine says; its not my heart" this Is an example of denial. 283. As part of your personal health assessment, you should consider hereditary factors that can impact your health. 284. You have loaded a cardiac arrest patient onto the stretcher and are preparing to lift the stretcher. When doing so, you should take unnecessary equipment off the stretcher. 285. You should know your target heart rate ad attempt to achieve it every time you exercise. 286. When you enter a situation in which everyone is under stress, it is important to remember that: there is no guarantee that people are going to behave appropriately. 287. When a patient minimizes his or her symptoms by stating, "im fine", the paramedic should. Find a reliable informant among the patient's family or friends. 288. You and your team are attempting to resuscitate a 50-year-old man in cardiac arrest when his wife returns home. She immediately goes into a blind panic and begins screaming and crying. You should: separate her from the area and place her under the supervision of a calmer person. 289. Regardless of a paramedic's circadian rhythms, he or she should not overlook the need for rest. 290. In general, paramedics who do not experience burnout are those who have learned to value and respect themselves. 291. If you are approached by a coworker who has noticed a negative change in your behavior, you should: keep an open mind regarding what the coworker has noticed. 292. If a 30 year old man has a resting heart rate of 60 Beats/min and a maximum heart rate of 190 beats/min, his target heart rate is 151 beats/min 293. The statement "if I can just live long enough to see my son's wedding, I can die in peace" is indicative of the bargaining stage of the grieving process. 294. Any time you need to move a patient who cannot or should not walk, it is MOST important to consider: the need for extra help. 295. Chronic stress: Dry irritated skin. 296. Some health care professionals are reluctant to discuss death with patients because of their own anxiety about the subject. 297. Family members who are depressed following the loss of a loved one: typically do not want to be cheered up 298. A critical incident is MOST accurately defined as an incident that overwhelms the ability of the EMS worker or system to cope with the experience, either at the scene, or later. 299. Prolonged or excessive stress has been proven to lead to depression. 300. From an injury prevention standpoint, the term "intervention" is define as: specific prevention measures or activities designed to increase positive health and safety outcomes. 301. Which of the following is an example of a secondary injury prevention? Administering epinephrine to a patient in anaphylactic shock. 302. With regard to injury prevention, effective educational techniques include all of the following, EXCEPT penalties. 303. A specific action intended to improve health and safety outcomes is called an intervention. 304. 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? Avoid driving during high risk times. 305. Compared to adults, children have thinner skin. 306. The leading cause of kidney failure in Americans 20 years of age and older is diabetes. 307. When defining an injury problem in your community, it is MOST important to determine the most frequent causes of fatal and nonfatal injuries. 308. Which of the following is the BEST example of a teachable moment? Advising the unrestrained passenger with minor injuries following a motor vehicle accident that she easily could have been killed. 309. When organizing a community illness or injury program, you should FIRST: identify a lead person to coordinate the effort. 310. Which of the following results in the MOST years of potential life lost? Traumatic injury. 311. Air bags installed in an automobile are more likely to reduce injuries than educating people to wear their seat belts because air bags do not require a conscious effort on a person's part. 312. Which of the following statements regarding unintentional injuries and death is correct? they occur without the intent to cause harm. 313. Children are at higher risk for serious injury than adults because of proportionately larger head. 314. if a 16-year old child is killed in a car crash, how many years of potential life are lost? 49 315. 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) outcome objective 316. in the next 18 months, 500 older adult community members will be offered the flu vaccine. This is an example of a/an process objective 317. according to the Haddon matrix, which of the following is a post event strategy to reduce the severity of an injury? the ambulance is outfitted with up-to-date equipment. 318. One of the MOST visible ways in which EMS professionals have interacted with public health agencies is through the provision of immunizations. 319. Which of the following is NOT a reason why EMS providers are in the ideal position to serve as advocates for injury prevention? Most EMS systems require their personnel to participate actively in injury prevention programs. 320. In 2016 the leading cause of death by unintentional injury was: poisoning 321. Which of the following is NOT an example of a passive injury intervention? Providing public education on the use of AED'S 322. An effective injury prevention program should focus on all of the following data, EXCEPT: current EMS call volumes. 323. Factors that can influence injury patterns in a child include all of the following, EXCEPT: number of relatives. 324. Which of the following is the MOST common cause of injuries that occur at school? Sports-related incidents. 325. The wrongful act that gives rise to a civil suit is called: a tort 326. In a medical liability suit involving a paramedic, the plaintiff: usually seeks compensation for the injury he or she sustained. 327. Criminal laws that most likely apply to paramedics include all of the following EXCEPT inadequate patient care. 328. Assault on a patient occurs when the EMS provider instills the fear of immediate bodily harm in a patient. 329. Documenting a false statement that injures a person's good name or reputation constitutes: libel and defamation. 330. Which of the following is an example of slander? Telling the receiving facility that a patient is drunk. 331. The initial complaint filed against a paramedic or EMS system by a dissatisfied patient may not contain specific information about what the patient thinks went wrong. 332. Because a lawsuit may not begin until several years after the paramedic cares for a patient: it is essential to maintain good documentation on any call. 333. Most civil cases are resolved during a settlement process because: it is expensive and time consuming to take the case to trial. 334. Generally, the paramedic is not at liberty to disregard a physician's order unless: carrying out the order will cause harm to the patient. 335. Which of the following is an example of a protocol? Standing orders. 336. If a conflict arises between a paramedic and a physician bystander in the field, the paramedic should contact medical control to seek resolution 337. A reasonable paramedic should follow the same standard of care that a paramedic in a similar situation would. 338. Provisions of the medical practice act include all of the following, EXCEPT assigning medical directors to EMS systems. 339. Which of the following is an example of a quid pro quo type of sexual harassment? An employer promises an employee a raise if he or she engages in sexual intercourse. 340. If your EMS system receives a subpoena for a patient's protected health information, it would be MOST appropriate to notify legal council before releasing any information. 341. Which of the following is addressed in the EMTALA? Preventing medical facilities from denying medical screening and stabilization. 342. Historically, most EMTALA violations occurred when the patient did not have medical insurance. 343. When transferring a patient between medical facilities, it is MOST important for the paramedic to ensure that a physician or nurse accompanies the patient if the patient requires care beyond the paramedic's scope of practice. 344. Which of the following statement regarding emergency vehicle laws is correct? all state statutes require emergency vehicles to be operated in a safe and prudent manner. 345. When an ambulance collides with a citizen's vehicle at an intersection: the driver of the ambulance may be charged criminally. 346. Which of the following is NOT a required element needed to prove negligence? The patients condition was life threatening. 347. When determining whether or not a paramedic's actions were consistent with the standard of care, the court would be LEAST likely to: talk to patients to whom the paramedic has provided care in the past. 348. A paramedic's actions are considered to be grossly negligent if he or she willfully or wantonly deviates from the standard of care 349. Which of the following statements regarding the harm element of a negligence lawsuit is correct? A loss of earning capacity is a form of harm that the patient may claim 350. Abandonment occurs when: care of a patient was terminated without his or her consent. 351. What is the main legal risk of providing a tiered-response EMS system? Exposure to liability if the BLS crew makes an improper determination that a patient does not need ALS care. 352. The concept of consent refers to all of the following EXCEPT the severity of the patient's injury 353. Implied consent is based on the premise that a patient would consent to care because of the seriousness of his or her injury 354. Which of the following patients is NOT an emancipated minor? 17 year old woman who goes to college and lives with her parents. 355. The BEST way for the paramedic to evaluate a patient's decision-making capacity is to: talk to the patient to determine if he or she understands what is happening 356. If a conscious patient with decision-making capacity refuses care for a potentially life threatening condition he or she cannot be treated without a court order. 357. Before asking a patient to sign a refusal form, the paramedic must: ensure the patient is aware of the risks of his or her refusal. 358. General criteria for determining a patient's mental competence include all of the following EXCEPT the absence of cardiac dysrhythmias 359. 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 treat and transport, even if it is against the patient's will. 360. Which of the following statements regarding a psychiatric patient who is refusing transport is correct? if the patient's life is not in danger, only a police officer can authorize paramedics to restrain and transport the patient. 361. When determining the most appropriate hospital to which to transport a patient, the paramedic's FIRST consideration should be: the patient's clinical condition. 362. When functioning at a crime scene, it is important for the paramedic to: use caution and not disturb the scene unnecessarily. 363. 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 battery 364. Which of the following statements would be inappropriate when documenting your care with an emotional problem? "the patient's actions suggest the use of illicit drugs." 365. 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: Tell the media representative that you cannot disclose any information. 366. 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 remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so. 367. 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 is correct? 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. 368. 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: Remain professional and advise the patient that he is not legally capable of refusing EMS treatment. 369. You arrive at the scene of a shooting. The patient, a 19 year old woman, has a gunshot wound to the side of her head with a large amount of exposed brain matter. Further assessment reveals that the patient is apneic and pulseless. Law enforcement personnel advise you that the person who shot the patient is in their custody. You should: avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene. 370. A DNR order is MOST accurately defined as a written order designed to tell health care providers when resuscitation is or is not appropriate. 371. The surrogate decision maker: is legally obligated to make decisions as the patient would want. 372. A person wishes to be an organ donor. He or she must have witnessed informed consent, usually in writing. 373. A medical order for life-sustaining treatment, (MOLST) would MOST likely apply to a patient: With impending pulmonary failure but who is not in cardiac arrest. 374. 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 respect the patient's wishes and ask him if he wants to be transported to the hospital. 375. 1-Compared to lower frequency bands, higher frequency bands: generally have less interference 376. 2-Biotelemetry is MOST accurately defined as: the capability to measure vital signs and ECG tracings and transmit them to a distant terminal 377. 3-At minimum, sending a 12-lead ECG of a patient with chest pain to the emergency department physician via telemetry would: decrease the time from diagnosis to treatment. 378. 4-Cellular telephones are more advantageous than regular two-way radios because cellular cellphones: incorporate GPS technology to help rescuers find the patient 379. 5-Mobile Transceivers: can have a line of sight range up to 15 miles 380. 6-A(n)_______receives a weak signal and retransmits it at a higher power on another frequency. Repeater 381. 7-Automatic crash notifications (ACN) systems can provide all of the following information about a car crash, EXCEPT: the principle direction of force at the impact point 382. 8-When transmitting the data over the radio, you should not disclose the patient's: date of birth 383. 9-Which of the following is a drawback of using the ten-code system when communicating by radio? The codes' meanings vary by jurisdiction 384. 10-When relaying medical information to a physician in person, you should: Include information that you did not provide during your radio report

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1. Women who experience hyperemesis gravidarum - have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition. 2. a woman has been pregnant three times, has had two spontaneous abortions, and has carried one baby to term. You should document her obstetric history as - G3A2P1 3. which of the following statements regarding abdominal trauma during pregnancy is correct ? - use of a lap belt increases the risk of uterine injury. 4. The risk of aspiration in the pregnant woman is increased significantly because - decreased digestion causes a delay in gastric emptying. 5. If a pregnant woman is injured and is bleeding severely - blood flow will be diverted away from the uterus. 6. If a woman who is 35 weeks pregnant is placed in a supine position - atrial preload may be reduced markedly. 7. Premonitory signs of labor include all of the following EXCEPT - contractions at 5 to 15 minute intervals. 8. During the second stage of labour - contractions become more intense and more frequent. 9. Crowning is MOST accurately defined as - the presenting of the baby at the vaginal opening. 10. A woman is in the second stage of labour when - she feels a strong urge to move her bowels. 11. Which of the following events occur during the third stage of labour ? - placental delivery . 12. During the labour - the interval between contractions gradually shortens. 13. The MOST important prehospital intervention for a footling breech or transverse presentation of the baby is - rapid transport to the hospital. 14. When caring for a prolapsed umbilical cord, you should - keep the presenting part of the baby off the umbilical cord during rapid transport to the hospital. 15. Appropriate care for postpartum bleeding in the prehospital setting includes all of the following EXCEPT - carefully placing sanitary pads in the vagina. 16. Uterine inversion occurs when - the placenta fails to detach proprerly and adheres to the uterine wall when it is expelled. 17. After delivering a baby and clamping and cutting the umbilical cord you not that the end of the unbilical cord attached to the baby is bleeding, you should- tie or clamp the cord proximal to the first clamp and reexamine it . 18. The initial drug of choice for a pregnant patient who is experiencing seizures is - magnesium sulfate. CHAPTER 42 1. all of the following are antepartum risk factors that increase the potential that a newborn may require resuscitation EXCEPT- prolapsed cord. 2. Causes of delayed fetal transition include all of the following EXCEPT - birth at 41 weeks 3. While preparing equipment for newborn resuscitation which of the following items is/are NOT considered optional ? - endotracheal tubes. 4. According to the apgar score a new born with a heart rate of 80 beats/min and slow irregular breathing should receive a combines score of - 2. 5. If a newborn does not respond to the initial steps of resuscitation the need for further intervention is based upon - respiratory effort, pulse rate and colour. 6. If you feel 13 pulsations in a 6 second time frame the newborns heart rate is approximately - 130 beats/min 7. The MOST common devce used to provide positive pressure ventilation to a newborn in the prehospital setting is a - self inflating bag mask device. 8. The MOST common reasons for ineffective bag mask ventilations in the newborn are - inadequate mask to face seal and incorrect head position. 9. What size and type of laryngoscope blade is recommended for use in a full term newborn ? - no, 1 straight. 10. Signs of a diaphragmatic hernia include all of the following EXCEPT - bilaterally absent breath sounds. 11. After inserting an orogastric tube in a newborn you should - leave the tube open to allow air to vent. 12. Chest compressions are indicated in the newborn if its heart rate remains less than ___beats/min despite effective positive pressure ventilations for ____ - 60 ,30. 13. When performing chest compressions on a newborn, you should - compress the chest one third the anteroposterior depth of the chest. 14. If a new born requires epinephrine and peripheral venous access is unsuccessful you should - cannulate the umbilical vein. 15. To assess a newborns preductal oxygen saturation you should place the pulse oximeter prone on the - right hand. 16. Signs of hypovolemia in the newborn include all of the following EXCEPT - persistent acrocyanosis. 17. Naloxone is NOT indicated for use in newborns - who are born to narcotic addicted mothers. 18. A newborn is at GREATEST risk for meconium aspiration if he or she - is born at more than 42 weeks gestation. 19. Respiratory distress in a premature infant is MOST often the result of - surfactant deficiency. 20. A subtle seizure in the newborn is characterized by - eye deviations. 21. The single most common cause of seizures in both term and preterm infants is - hypoxic ischemic encephalopathy. 22. Severely hypotermic newborns may present with sclerema, which is defined as - hardening of the skin associated with reddening and edema. 23. Which of the following factors is associated with the HIGHEST risk of newborn hypoglycemia ? - morbid obesity in the mother. 24. Which of the following disorders or conditions is related to decreased glycogen stores in the newborn ? - small for gestational age. 25. Most newborns with hypoglycemia remain asymptomatic until the glucose level fails below ____ mg/dl for a significant period of time - 20. 26. In addition to an IV dextrose bolus, the MOST important treatment for newborn hypoglycemia is - proper thermal management. 27. You have just delivered a little boy who was born 4 weeks premature, there is no evidence of meconium in the amniotic fluid after drying warming, suctioning, positioning and stimulating the infant, he remains acrocyanotic and is not crying, you should - open his airway and assess respirations. 28. During your rapid assessment of a newborns cardiopulmonary status you note that its respirations are adequate you feel8 pulsations in a 6 second time frame and the newborn is centrally pink but peripherally cyanotic, the MOST appropriate next action should be to - administer positive pressure ventilations. 29. After performing the initial steps of resuscitation you assess a new born and note that its respirations are poor and its pulse rate is 50 beats/min you should - begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive pressure ventilation. 30. You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia your estimated time of arrival at the hospital is 45 minutes air medical transport was unavailable due to severe weather a peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation approximately 10 seconds into your intubation attempt the newborn's heart rate suddenly drops more you should - abort the intubation attempt and continue ventilations. 31. You have been providing bag mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes the infants abdomen is markedly distended although you are properly trained your protocols do not allow you to intubate newborns the MOST appropriate intervention involves - inserting an orogastric tube. 32. You and your partner are caring for a 5 pound distressed newborn, after providing 30 seconds of effective bag mask ventilations, the newborns heart rate remains below 60 beats/min, you should - continue bag mask ventilations and intiate chest compressions. 33. During the delivery of a post term baby you note presence of particulate meconium in the amniotic fluid, your post delivery assessment of the newborn reveals that it is active, has a strong cry and has a heart rate of 110 beats/min- ensure that the infant is warm and dry administer free flow oxygen if needed and provide continuous monitoring. 34. Your assessment of a depressed 7 pound newborn reveals tachypnea, pallor, weak peripheral pulses a heart rate of 120 beats/min and a blood glucose level of 58 g/dl which of the following interventions will MOST likely cause improvement in this newborn's condition ? - normal saline. 35. Total anomalous pulmonary venous return is a rare congenited defect in which - the four pulmonary veins connect to the right atrium. 36. Which of the following statements regarding the apgar score is correct ? - if resusciatations is necessary the apgar score is completed to determine the result of the resuscitation. 37. An infant born with a pink body and blue extremities a pulse rate of 90 beats/min a strong cry and active movement should be assigned an initial apgar score of - 8. 38. The initial steps of newborn resuscitation include - proper positioning. 39. The MOST common etiology for bradycardia in a newborn is - severe hypoxia. 40. Common causes of respiratory distress in the newborn include - mucous obstruction of the nose. 41. The correct positive pressure ventilation rate for an apneic newborn is - 40 to 60 beats/min. 42. Endotracheal intubation is clearly indicated in the newborn if - meconium is present in the amniotic fluid and the newborn is limp and has a heart rate of 70 beats/min. 43. When suctioning the newborn's oropharynx to clear secretions prior to intubation it is MOST important to - monitor the newborns heart rate. 44. Naloxone may be indicated for a newborn with respiratory depression if - the mother is not a chronic narcotic user. 45. A shift of heart tones and severe respiratory distress despite positive pressure ventilations is indicative of - a pneumothorax 46. In contrast to primary apnea, secondary apnea - is usually unresponsive to stimulation alone. 47. Which of the following anticonvulsant medications would MOST likely be administered to a newborn with seizures in the prehospital setting ? - lorazepam. 48. When fever is suspected in the newborn you should - observe for the presence of a rash. 49. Newborn hypoglycemia is defines as a blood glucose of ___ mg/dl or lower - 45 50. You are assisting in the delivery of a baby after the baby's head emerges from the vagina you should quickly assess for the presence of a nuchal cord and then - suction its mouth and nose. CHAPTER 43 1. which of the following statements regarding a child's chest wall is correct ? - children are belly breathers because they rely heavily on their diaphragms. 2. The pediatric assessment triangle will help answer all of the following questions EXCEPT - will the child cooperate during my exam ? 3. The work of breathing component of the pediatric assessment triangle includes all of the following EXCEPT - auscultating the lungs for adventitious sounds. 4. When assessing a childs circulation by looking at his or her skin, pallor is MOST indicative of - peripheral vasoconstriction and compensated shock. 5. Which of the following statements regarding acrocyanosis is correct ? - acrocyanosis is cyanosis of the hand and feet and is a normal finding in infants younger than 2 months of age who are cold. 6. A normal respiratory rate in a child - may be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued. 7. Early hypoxia in a child would MOST likely present with - tachycardia. 8. Assessment of a child in a cold environment would MOST likely yield - delayed capillary refill 9. To evaluate function of an infants or childs cerebral cortex you should - use the AVPU scale. 10. When a child who is too young to verbalize is in significant pain - your ability to assess accurately for physiologic abnormalities is impaired. 11. In contrast to adults, cardiac arrest in children is usually caused by - respiratory failure. 12. Treatment for a child with respiratory distress should include - a position of comfort and supplemental oxygen. 13. If a 2 year old child with a foreign body airway obstruction becomes unresponsive you should position him or her supine and then - perform chest compressions. 14. Epiglottitis in children - is uncommon because children are vaccinated against haemophilus influenza type b. 15. The goal in treating a child with epiglottitis is to - transport him or her to the hospital with a maintainable airway. 16. A child who is experiencing a moderate asthma attack would MOST likely present with - wheezing during inspiration and expiration. 17. Medications used to prevent an asthma attack include - inhaled steroids. 18. Which of the following represents the correct drug, dose, and delivery route for an 18 kg child experiencing severe respiratory distress due to bronchospasm ? - ipratropium 0.5 mg nebulized. 19. Which of the following statements regarding bronchiolitis is correct ? - bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age. 20. Appropriate bag mask ventilation for an apneic 3 year old child involves - delivering each breath over 1 second until the chest rises visibly. 21. The MOST appropriate ET tube for a 6 year old child is - 5.5 mm uncuffed. 22. Signs of compensated shock in the infant or child include all of the following EXCEPT - abnormal mentation. 23. A child in decompensated shock with hypotension should - receive initial fluid resuscitation at the scene. 24. Distributive shock in children is MOST often the result - sepsis. 25. Vasopressor support to improve vascular tone in a child In septic shock should be considered - if hypotension persists despite 60 ml/kg of isotonic fluid. 26. The first line treatment of pediatric patients in distributive shock is - volume resuscitation. 27. First degree heart block in children - is typically asymptomatic and does not require special treatment. 28. Which of the following is the first line treatment for a hemodynamically unstable child with bradycardia ? - ventilatory support. 29. If an initial cardioversion attempt is unsuccessful in a 33 pound child you should repeat the procedure using ____ joules - 30. 30. Adenosine may be considered for a hemodynamically stable child with a wide complex tachycardia if - the ventricular rhythm is regular and monomorphic. 31. Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia the paramedic should perform - defibrillation. 32. Dilated cardiomyopathy is a condition in which the heart is - weakened and enlarged making it a less efficient pump. 33. Common signs and symptoms of meningitis in young children include all of the following EXCEPT - nuchal rigidity. 34. In children complex partial seizures would MOST likely manifest with - focal motor jerking with loss of consciousness. 35. In contrast to a complex febrile seizure a simple febrile seizure - lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities. 36. When treating a child who is seizing with diazepam, the paramedic should remember that - the half life is short and breakthrough seizures may occur during long transports. 37. Bruises that occur _____ are rarely incurred accidentally - in a straight line. 38. In contrast to adults young children are more prone to liver and spleen injuries because the organs - extend well below the rib cage. 39. Ventricular shunts are typically placed in children who - have impaired circulation and absorption of cerebrospinal fluid leading to increased size of the ventricles of the brain and increased intracranial pressure. 40. When caring for a child with a ventricular shunt or gastrotomy tube it is important to - recognize that the caregiver is a key resource and that his or her expertise should be utilized to assist in the care of the child. 41. A 7 year old conscious boy presents with marked respiratory distress your assessment reveals the presence of intercoastal and supraclavicular retractions and nasal flaring his oxygen saturation is 93 % on room air and his heart rate is rapid the MOST appropriate initial treatment for this child involves - administering oxygen as tolerated auscultating his lung sounds and being prepared to assist his ventilations. 42. Rapid IV fluid administration in a child with diabetic ketoacidosis increases the risk of - cerebral edema. 43. A childs vocal cords can be difficult to visualize during intubation because - the epiglottis is floppy and u shaped. 44. A child who is disinterested in your presence and has a blank star and poor muscle tone - requires immediate intervention and transport. 45. Common signs of impending respiratory failure in infants and children include - a falling oxygen saturation despite high flow oxygen administration. 46. When caring for an infant or child who is in compensated shock you should - establish IV or IO access en route to the hospital. 47. The management for any potentially toxic exposure is children begins by - ensuring a patent airway. 48. What forms of child maltreatment are often difficult to identify and may be unreported ? - motional abuse and neglect. 49. Most injuries in pediatric patients - are predictable and preventable events. 50. After administering glucagon to a child with hypoglycemia you should - position the child on his or her side CHAPTER 44 1. An increase in blood pressure that commonly occurs with aging is physiologically exacerbated by - an overproduction of collagen and decreased quantities of elastin. 2. Decreased elasticity of the lungs and calcification of the costochondral cartilage results in - an increase in residual lung volume. 3. An elderly person is at increased risk for aspiration primarily from - decreased cough and gag reflexes. 4. Aging kidneys have a decreased glomerular filtration rate, which predisposes an older person to all of the following conditions, EXCEPT - profound dehydration. 5. Which of the following may you be the LEAST likely to observe in a 90 year old patient with a severe infection? - Fever 6. When assessing an unresponsive older person's airway it is MOST important to remember that - delayed gastric emptying increases the risk of aspiration. 7. Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the - liver 8. Aging brings a widespread decrease in bone mass, especially - in postmenopausal women. 9. Which of the following central nervous system functions does NOT change a person ages ? -intelligence level 10. When assessing an older person you should remember that it is common for him or her to - espond slowly to questions. 11. MOST age related visual disturbances are the result of - cataracts or glaucoma. 12. Presbycusis is defined as - loss of high energy frequency sounds and the inability to differentiate a particular sound from background noise. 13. Typical signs and symptoms of meniere disease include all of the following EXCEPT - otorrhea. 14. Physiologic age related decreases in skin elasticity are the result of - decreased collagen and elastin production. 15. Failure of the hearts primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in - atrial fibrillation. 16. Which of the following cardiac dysrhythmias is associated with the highest risk of stroke ? - atrial fibrillation. 17. Which of the following conditions would MOST likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure ? - kyphosis. 18. Which of the following statements regarding Alzheimer's disease is NOT correct ? - age alone is thought to be the underlying cause of Alzheimer disease. 19. Resting tumor of an extremity and bradykinesia are associated with - Parkinson disease. 20. Hypotension and orthostatic vital sign changes would MOST likely occur in elderly people who take - diuretics. 21. In contrast to a 30 year old man , if a 70 year old man were to consume an excessive amount of alcohol - he would experience a higher alcohol concentration due to decreases in body mass and total body water . 22. Heat gain or loss in response to environmental changes is delayed in elderly people for all of the following reasons EXCEPT - chronic hyperthyroidism 23. Which of the following is NOT a predisposing risk factor for trauma in the elderly ? - creased body water . 24. After falls, _____ is/are the second leading cause of accidental death among elderly people - motor vehicle crashes. 25. Cervical spondylosis is a degeneration change in the cervical spine that causes - narrowing of the spinal canal and pressure on the spinal cord. 26. Which of the following risk factors is associated with the HIGHEST rate of mortality following a burn injury in an elderly person ? - preexisting medical condition. 27. A key element of the "G" in the GEMS diamond includes - recalling that elderly patients often present atypically . 28. Components of the environmental assessment of an elderly patient include all of the following EXCEPT - inquiring about any delays in obtaining food. 29. The medical assessment of an elderly patient can be complex because - he or she often has more than one medical condtion. 30. After obtaining an elderly patients chief complaint gathering additional information about the history of present illness would MOST likely be complicated because - chronic problems may affect the acute problem. 31. You are called to a residence for a 74 year old woman who fainted during your assessment the patient's son tells you that he was standing next to his mother when she fainted and that he caught her before she fell to the floor, he further tells you that his mother has angina and kidney disease, the patient is now conscious but confused, her blood pressure is 80/50 mm hg, pulse is 110 beats/min and weak, and respirations are 22 breaths/min and regular, as your partner administers supplemental oxygen to the patient you should - assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one. 32. you are assessing an 80 year old man who complains of generalized weakness, he denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days , his medical history is significant for two prior heart attacks , hypertension, chronic renal insufficiency and atrial fibrillation, his blood pressure eis 108/60 mm hg pulse rate is 94 /min and irregular and respirations are 20 breaths/min and unlabored, auscultation of his lungs reveals scattered crackles and the ECG reveals atrial fibrillation, in addition to administering supplemental oxygen you should - obtain a 12 lead ECG tracing, assess his blood glucose level establish vascular access and set the rate to keep vein open and transport to the hospital 33. a 71 year old man with a history of emphysema, coronary artery disease and hypertension presents with increased shortness of breath and fatigue, his oxygen saturation is 80 % on home oxygen at 2 l/min via nasal cannula , his blood pressure is 140/76 mm hg pulse rate i104 beats/min and respirations are 28 breaths/min and labored, his medications include an albuterol inhaler prednisone hydrochlorotiazide and lisinopril auscultation of his lungs reveals scattered wheezing in all fields, which of the following prehospital interventions is NOT indicated for this patient ? subcutaneous epinephrine. 34. An 82 year old man presents with confusion that has worsened progressively over the past 2 weeks, because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter, she tells you that her father has high blood pressure but refuses to take medication for it, she also tells you that she thinks he fell about 3 weeks ago although he denies falling , the patient's blood pressure is 168/98 mmhg pulse rate is 60 beats /min and occasionally irregular and respirations are 22 breaths/min and regular , this patient MOST likely - is experiencing a subdural hematoma. 35. The son of a 76 year old woman called 911 because his mother is ill, the patient presents with mild confusion, poor skin tugor, and tachycardia , she is incontinent of urine and asks you for a glass of water, her son tells you that she had not been feeling well for the past several weeks , but would not allow him to take her to the doctor, which of the following assessment parametera will MOST likely reinforce your suspicion regarding the underlying cause of this patients's condition - blood glucose. 36. Hypertension emergencies in the geriatric population - require a controlled decline in blood pressure that often cannot be achieved in the prehospital setting. 37. The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to - peptic ulcer disease 38. Kyphosis is characterized by - a hunchback appearance. 39. delirium is MOST accurately defined as - an acute alteration in mentation that indicates an underlying condition 40. Adverse drug reactions in elderly people are the - changes in drug metabolism due to diminished hepatic function. 41. the heart hypertrophies with age MOST likely in response to - a chronically increased afterload caused by arteriosclerotic blood vessels . 42. a decreased number of pacemaker cells in the sinoatrial node would MOST likely contribute to a decline in cardiac output secondary to - bradycardia. 43. Elderly patient experience a slower physiologic response to hypoxemia and hypercarbia because of - decreased sensitivity to changes in arterial blood content. 44. When elderly patients are prescribed medications, the risk for drug toxicity increases because of - age related changes in hepatic enzyme systems. 45. Impaired proprioception predisposes an elderly person to - falls 46. Due to the process of aging an elderly person commonly experiences - moderate hyperglycemia 47. Elderly people are more susceptible to intracranial bleeding because of - enlargement of the subdural space. 48. Fall related fractures in the elderly occur MOST often to the ____ usually in patient with underlying _____ - hip , osteoporosis 49. Considering the physiologic changes that occur with age which of the following interventions would pose the GREATEST potential for further harm when caring for an elderly patient with a severe burn that is complicated by a spinal injury ? - fluid replacement 50. The social assessment component of the GEMS diamond includes - determining if activities of daily living are being provided by another person CHAPTER 45 1. which of the following injury patterns is MOST suggestive of child abuse ? - bruises on the abdomen . 2. you are assessing a 6 year old Asian child who presents with a fever, during your assessment you note red, flat, rounded lesions on the child's torso this finding is MOST indicative of - cupping. 3. During your assessment of a 4 year old female you find injury patterns that are highly suggestive of abuse, the child's mother is present she is apprehensive and is hesitant to allow you to transport her daughter , you should - ask your partner to retrieve an extra set of latex free gloves the ambulance as this will enable him or her to discreetly call the police . 4. When caring for a patient with suspected abuse or neglect your FIRST priority should be to - take deliberate action to ensure your own safety. 5. Your assessment of an elderly man gives you reason to suspect that he has been abused the patient does not appear to have any life threatening injuries his son who is the only family member present at the scene asks you if he can accompany his father in the back of the ambulance during transport, you should - allow the son to accompany his father in the back of the ambulance. 6. which of the following statements would be appropriate when documenting a case of suspected abuse ? - the injury was reported to have occurred at 1420 hours. 7. Which of the following are often the primary tasks for paramedics who are caring for a patient with a terminal illness ? - pain assessment and management 8. Which of the following interventions is especially important when caring for a patient with a tracheostomy tube ? - suctioning. 9. Phrenic nevre stimulates function by - sending electricl impulses to the diaphragm causing it to contract and passively relax. 10. You would MOST likely encounter the presence of a ventricular assist device in a patient who - is awaiting a heart transplant 11. A patient with a long term vascular access device is in cardiac arrest and requires epinephrine in order to remove any heparin from the device the paramedic should - withdraw up to 10 ml of blood and discard it . 12. Triple lumen central catheters are usually placed in the - subclavian or femoral vein. 13. Which of the following vascular access devices is tunneled under the skin and placed into the superior vena cava / - broviac catheter 14. Which of the following is a proper technique when accessing an implantable venous access device ? - aspirate 5 ml of blood and then block the flow in the line with the crimping device . 15. A 66 year old man with sever left heart failure is receiving an inotropic medication via an infusion pump he presents with an altered mental status increased breathing difficulty and hypotension you should - support his breathing continue his medication and contact medical control. 16. Prior to replacing an ostomy device in a patient it is MOST important to - wash your hands and apply personal protective equipment. 17. The purpose of the wafer that is included in an ostomy kit is to - protect the skin from irritation. 18. When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male you should - continue inserting the catheter until the y between the drainage port and the balloon port is at the penis. 19. The female urinary meatus is located - just above the vaginal opening. 20. The fistula is used for hemodialysis is a surgical connection between - an arytery and a vein. 21. Which of the following drugs should be avoided in a patient with renal failure ? - succinylcholine. 22. When treating a dialysis patient it is especially important to - carefully titrate any IV fluids given. 23. A dialysis patient requires pharmacologically assisted intubation which of the following medications should be avoided ? - Succinylcholine 24. You respond to a dialysis center for a patient with shortness of breath when you arrive you find the patient an older female still receiving dialysis she is conscious and alert and is experiencing mild respiratory distress as your partner administers oxygen you should - ask the dialysis technician how long the patient has been on the dialysis machine. 25. Hydrocephalus may occur if - cerebrospinal fluid absorption into the bloodstream is reduced. 26. The outflow catheter of a cerebrospinal fluid shunt is MOST commonly placed into the patient's - peritoneal cavity. 27. Which of the following clinical presentations is MOST consistent with a malfunctioning cerebrospinal fluid shunt ? - visual disturbances headache and altered mental status. 28. The transducer or drainage system of an intracranial pressure monitor is typically aligned at the same height as the patients - ear canal 29. Intellectual disability is MOST accurately defined as - insufficient development of the brain that results in the inability to learn and socially adapt at the usual rate. 30. The majority of acquired hearing loss in children and adults is the results of - excessive exposure to loud noise 31. Sensorineural hearing loss is caused by - decreased sound uptake through tiny hairs within the cochlea. 32. A person is able to hear but us unable to interpret speech when other background noises are present this is consistent with - central auditory processing disorder. 33. When troubleshooting a hearing aid that is not working you should - avoid tempting to clean the device. 34. By placing one hand on your forehead and your other hand over your abdomen you are asking a hearing impaired person if he or she - feels sick. 35. A person with amblyopia has - partial or complete vision loss in one eye 36. Dysarthria is - the inability to make speech sounds correctly. 37. Which of the following statements regarding paralysis is correct ? - paralyzed patient has lost the ability to voluntarily move a body part. 38. During your assessment of a patient with paraplegia you touch the patients leg and he screams in pain this is an example of - hyperesthesia. 39. Common complications associated with cerebral palsy include all of the following EXCEPT - cardiovascular disease 40. What s the pathophysiology of cystic fibrosis ? - defective gene that makes it difficult for chloride to move through the cells which causes unusually high sodium loss and abnormally thick mucous secretion. 41. Multiple sclerosis is - a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord 42. Spina bifida occurs when - the fetus spinal column does not close properly or completely and vertebrae do not develop leaving a portion of the spinal cord exposed. 43. Which of the following statements regarding poliomyelitis (polio) is correct ? - polio initially presents with a headache sore throat fever and vomiting . 44. You are caring for an elderly woman with terminal sarcoma she is conscious extremely weak and in severe pain her son tells you that she has a living will and an out of hospital DNR and produces the appropriate documentation the patient is on home oxygen at 2 l/min via nasal cannula you should - administer an appropriate dose of morphine or fentanyl to the patient and provide emotional support to the son. 45. A terminal illness is MOST accurately defines as a (n) - disease process that is expected toc ause death within 6 months verified by a physician 46. Down syndrome is a condition in which - a triplication of chromosome 21 occurs. 47. The signs symptoms clinical presentation and treatment for cancer largely depends on - the present location of the cancer. 48. An intra aortic balloon pump functions by - inflating a balloon during diastole which pushes blood into the system circulation. 49. Cerebral palsy - nonprogressive bilateral neuromuscular disorder in which c=voluntary muscles are poorly controlled. 50. Muscular dystrophy can be defines as a (n) - genetic disease that causes a slow progressive degeneration of muscles fibers

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