CH 39

Question 1

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should suspect a(n):
local reaction to an ant bite.
brown recluse spider bite.
infection caused by a tick.
poorly healed diabetic ulcer.

Answer 1

brown recluse spider bite.

Question 2

In drowning victims, positive end-expiratory pressure is used to:
force fluid from the interstitium back into the alveoli.
increase the rate and depth of the victim’s breathing.
prevent atelectasis and force fluid from the alveoli.
increase cardiac contractility and improve stroke volume.

Answer 2

prevent atelectasis and force fluid from the alveoli.

Question 3

Hypothermia is defined as a decrease in core body temperature, generally starting at:
94 degrees Fahrenheit.
95 degrees Fahrenheit.
93 degrees Fahrenheit.
96 degrees Fahrenheit.

Answer 3

95 degrees Fahrenheit.

Question 4

It is most pertinent to determine if the symptoms of a diving-related emergency began:
after the diver surfaced.
before entering the water.
during ascent or descent.
at the time of water entry.

Answer 4

during ascent or descent.

Question 5

An increase in core temperature causes the:
anterior pituitary gland to send signals via afferent pathways in the sympathetic nervous system to increase the heart rate.
hypothalamus to send signals via afferent pathways in the parasympathetic nervous system, resulting in vasoconstriction and sweat production.
anterior pituitary gland to send signals via efferent pathways in the sympathetic nervous system, causing widespread vasoconstriction.
hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.

Answer 5

hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.

Question 6

Which of the following signs and symptoms is most indicative of acute mountain sickness?
A throbbing headache and fatigue
Chest congestion and dyspnea at rest
Excessive sleeping and abdominal pain
Audible wheezing and chest tightness

Answer 6

A throbbing headache and fatigue

Question 7

Older people are at increased risk for heat-related illnesses because:
they are often taking beta adrenergic agonists, which can decrease the tachycardic response to heat.
they are more likely to have chronic medical conditions that interfere with normal heat regulation.
they have proportionately higher metabolic heat production compared to younger adults.
they acclimatize more rapidly than younger adults, which results in faster heat production.

Answer 7

they are more likely to have chronic medical conditions that interfere with normal heat regulation.

Question 8

In contrast to classic heatstroke, exertional heatstroke:
is associated with diuretic use.
presents with hot, dry skin.
can affect young, healthy people.
causes hyperglycemia.

Answer 8

can affect young, healthy people.

Question 9

If a patient with severe hypothermia is pulseless and apneic, you should:
infuse 4 L of warmed normal saline solution.
avoid placement of an advanced airway device.
perform high-quality CPR at half the normal rate.
attempt a single shock for V-fib or V-tach.

Answer 9

attempt a single shock for V-fib or V-tach.

Question 10

Other than using a Nitrox system, the only effective way to counteract nitrogen narcosis is to:
lower the nitrogen partial pressure through controlled ascent.
increase the nitrogen partial pressure through controlled ascent.
increase the nitrogen partial pressure through controlled descent.
lower the nitrogen partial pressure through controlled descent.

Answer 10

lower the nitrogen partial pressure through controlled ascent.

Question 11

A 45-year-old woman presents with severe cramps in her legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95 degrees Fahrenheit and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. Her blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The most appropriate treatment for this patient involves:
having her chew salt tablets, starting an IV with D5W at a keep-vein-open rate, administering 12.5 mg of promethazine IV, and transporting to the hospital.
giving her a salt-containing solution to drink, applying chemical ice packs to the back of her neck, and discouraging further activity for the day.
administering high-flow oxygen, gently massaging her lower extremities to enhance circulation, administering 1 mg/kg of fentanyl IM, and transporting.
offering her oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.

Answer 11

offering her oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.

Question 12

A 19-year-old man presents with hot, moist skin; confusion; tachycardia; and tachypnea shortly after completing a marathon. According to his marathon registration form, he has no significant medical problems and takes no medications. Which of the following treatments are contraindicated for this patient?
Prostaglandin inhibitors
Immersion in ice water
Ventilation assistance
25 g of 50% dextrose

Answer 12

Prostaglandin inhibitors

Question 13

Which of the following is a form of passive rewarming?
Removing wet clothing
Using forced-air warming blankets
Applying large heat packs
Applying electric heating blankets

Answer 13

Removing wet clothing

Question 14

Other than personal safety, your most immediate concern when caring for a submersion victim should be:
determining what caused the event.
the risk of vomiting and aspiration.
inserting an advanced airway device.
hypothermia-induced dysrhythmias.

Answer 14

the risk of vomiting and aspiration.

Question 15

If a small amount of water is aspirated into the trachea during a submersion event:
resulting hypoxemia causes the body to shift to aerobic metabolism.
permanent laryngeal spasm occurs and requires cricothyrotomy.
the victim asphyxiates, becomes profoundly acidotic, and dies.
laryngospasm occurs and temporarily protects the lower airway.

Answer 15

laryngospasm occurs and temporarily protects the lower airway.

Question 16

A patient with diabetes would most likely experience heat loss secondary to:
insulin use.
acute hyperglycemia.
ketoacidosis.
peripheral neuropathy.

Answer 16

peripheral neuropathy.

Question 17

Approximately 5 minutes following ascent from the water, a 30-year-old diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should suspect:
nitrogen narcosis.
an arterial gas embolism.
decompression sickness.
a tension pneumothorax

Answer 17

an arterial gas embolism.

Question 18

The thermolytic tissues in the hypothalamus are mediated by the:
sympathetic nervous system.
signals of the adrenergic nervous system.
parasympathetic nervous system.
endocrine system.

Answer 18

parasympathetic nervous system.

Question 19

Treatment for a superficial frostbite injury includes:
rewarming with radiant heat.
rewarming the area with hot water.
elevating the frostbitten part.
gently rubbing the frostbitten area.

Answer 19

elevating the frostbitten part.

Question 20

The most important treatment for a patient experiencing heatstroke is:
antipyretic administration and high-flow oxygen.
removal from the hot environment and rapid cooling.
rehydration with IV fluids and ice water submersion.
rapid transport and cooling to the point of shivering.

Answer 20

removal from the hot environment and rapid cooling.

Question 21

Nitrogen causes decompression sickness:
on ascent, because of the bubbles that form on reduction of pressure.
on descent, because of a progressive increase in atmospheric absolute.
on ascent, because of a progressive increase in atmospheric absolute.
on descent, because of the bubbles that form on reduction of pressure.

Answer 21

on ascent, because of the bubbles that form on reduction of pressure.

Question 22

A person blowing on hot food in an attempt to cool it is an example of:
passive cooling.
convection.
conduction.
radiation

Answer 22

convection.

Question 23

Patients with heatstroke:
usually have a low end-tidal carbon dioxide reading.
have a core temperature greater than 106 degrees Fahrenheit.
are typically bradypneic and hypotensive.
should routinely be given 50% dextrose.

Answer 23

usually have a low end-tidal carbon dioxide reading.

Question 24

In mild hypothermia, an older person would likely present with:
stroke.
dysarthria.
sepsis.
shivering

Answer 24

dysarthria.

Question 25

When frozen tissues thaw slowly: partial refreezing of melted water may cause greater tissue damage. the resultant ice crystals are smaller in size and cause less damage. the injured area becomes flushed or pale, but is relatively painless. the risk of gangrene and subsequent amputation is much lower.

Answer 25

partial refreezing of melted water may cause greater tissue damage.

Question 26

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. is the result of prolonged exertion in a hot environment coupled with the excessive intake of hypotonic fluids. is much less likely to occur in a patient who takes diuretic medications for hypertension. usually takes several hours or days to develop and occurs when regular water is used to replenish sodium and water.

Answer 26

occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.

Question 27

Classic heatstroke: is also called active heatstroke and is usually seen in diabetics. presents with a high core body temperature and profuse sweating. typically affects older people and is not associated with exertion. affects young people and is often accompanied by hypoglycemia.

Answer 27

typically affects older people and is not associated with exertion.

Question 28

Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they: are compressible. expand rapidly. do not compress. contain oxygen.

Answer 28

are compressible.

Question 29

In a cold environment, the body produces and conserves heat through: hyperventilation. vasoconstriction. sweating. release of sodium.

Answer 29

vasoconstriction.

Question 30

You are dispatched to the city park on a hot summer day for a 39-year-old man who fainted. When you arrive, you find the patient sitting under a tree. According to his wife, he had been playing softball all day and has consumed a significant amount of alcohol. She further confirms that he did faint and was “out” for about 2 minutes. The patient is conscious and tells you that he does not remember what happened. His skin is cool, moist, and pale, and his pulse is weak and rapid. You should: administer oxygen, apply a cervical collar in case he injured himself when he fainted, start an IV with normal saline, give a 20-mL/kg fluid bolus, and transport. initiate immediate and aggressive cooling measures, begin transport, start two large-bore IV lines en route, and closely monitor his cardiac rhythm. give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm. give oxygen via nasal cannula, start an IV of normal saline at a keep-vein-open rate, administer 50% dextrose IV, and transport with passive cooling en route.

Answer 30

give oxygen, assess his blood glucose level, establish vascular access and give saline fluid boluses as needed, transport, and monitor his cardiac rhythm.

Question 31

In trauma patients with shock, hypothermia: interferes with the coagulation of blood. decreases internal hemorrhage. facilitates the process of hemostasis. enhances the shivering response

Answer 31

interferes with the coagulation of blood.

Question 32

Which of the following locations would provide the best protection from a lightning strike? Curled up in a ball in an open area A car with the windows rolled up An open shed or lean-to A spot at least 5 miles away from the storm

Answer 32

A car with the windows rolled up

Question 33

Law enforcement requests your assistance for a 40-year-old man they found in an alley. According to one police officer, the patient is “probably drunk.” The outside temperature is 37 degrees Fahrenheit with a light wind and drizzle. The patient, who is conscious but confused, is shivering and has slurred speech. His skin is cold and pale, his heart rate is 68 beats/min and regular, and his respirations are 24 breaths/min and regular. After moving the patient into the warmed ambulance, you should: apply warm layered blankets, administer 100 mg of thiamine IM, administer oxygen via nasal cannula, start an IV line with lactated Ringer solution, and administer 25 g of 50% dextrose. assess his blood pressure; apply chemical heat packs to his neck, groin, and axillae; infuse 250 to 500 mL of warm normal saline; and administer one or two tubes of oral glucose. remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline. remove his wet clothing, apply chemical heat packs directly to the groin, assess his blood glucose level and treat with dextrose if it is less than 80 mg/dL, and administer high-flow oxygen.

Answer 33

remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline.

Question 34

The most common and reliable sign of pit viper envenomation is: patient anxiety and a slow, bounding pulse. tachycardia within 30 seconds of the bite. rapidly developing edema around the bite area. swelling of the tongue and marked hypertension.

Answer 34

rapidly developing edema around the bite area.

Question 35

Which of the following clinical findings would you expect to encounter in a patient with heat exhaustion? Abdominal cramping Hypertension upon standing Cool, moist skin Body temperature of 104 degrees Fahrenheit

Answer 35

Abdominal cramping

Question 36

Cold diuresis occurs when: massive systemic vasoconstriction shunts cold body water to the renal system, where it is excreted from the body in an attempt to increase the core body temperature. warmed IV fluids administered during severe hypothermia decrease the viscosity of the blood, resulting in an acute increase in output from the kidneys. the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine. the sympathetic nervous system response in hypothermia increases blood flow to the kidneys, resulting in decreased sodium reabsorption and subsequent water excretion.

Answer 36

the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.

Question 37

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 patient's 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: placing him in a supine position, elevating the affected extremity and applying ice to reduce the swelling, establishing vascular access, and administering fentanyl for pain. applying venous tourniquets proximal and distal to the affected site, elevating the limb no more than 12 inches, applying a splint, and establishing vascular access. administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity. keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.

Answer 37

keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.

Question 38

The venom from a pit viper causes all of the following effects, except: increased vascular permeability. neuromuscular dysfunction. increased blood clotting. local tissue necrosis

Answer 38

increased blood clotting.

Question 39

Shallow water blackout occurs when: cerebral vasodilation causes syncope during ascent. a swimmer hyperventilates prior to entering the water. decreasing partial pressure of oxygen during descent results in syncope. voluntary hypoventilation causes a drop in partial pressure of oxygen.

Answer 39

a swimmer hyperventilates prior to entering the water.

Question 40

The effects of hypothermia are most dramatically apparent in the: integumentary system. central nervous system. cardiovascular system. hematopoietic system.

Answer 40

central nervous system.

Question 41

Rewarming efforts of a patient with severe hypothermia should continue until the core body temperature is at least: 97 degrees Fahrenheit. 99 degrees Fahrenheit. 95 degrees Fahrenheit. 92 degrees Fahrenheit.

Answer 41

95 degrees Fahrenheit.

Question 42

Which of the following statements regarding thermoregulation is correct? Temperature of the brain and thoracoabdominal organs varies widely, depending on the body's needs. The body's metabolic reactions proceed at their optimal level at a constant temperature of 97.6 degrees Fahrenheit. Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation. Thermogenesis is how the human body eliminates excess heat in order to maintain homeostasis.

Answer 42

Skin temperature can fluctuate a great deal, which is why it plays a major role in thermoregulation.

Question 43

The most common clinical finding observed in patients with type I decompression sickness is: pruritus and rashes. joint pain. a cough and dyspnea. unsteadiness.

Answer 43

joint pain.

Question 44

A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient's friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The most effective way to address this situation is to: administer morphine sulfate to promote venous pooling and decreased preload. insert a nasogastric tube and remove any water from the patient's stomach. attach a portable ventilator that provides positive end-expiratory pressure. increase your ventilation rate to 15 breaths/min and provide higher volume.

Answer 44

attach a portable ventilator that provides positive end-expiratory pressure.

Question 45

Alcohol predisposes a patient to hypothermia due to: brain atrophy and impaired thermolysis. increased liver glycogen storage. widespread cutaneous vasoconstriction. impaired shivering thermogenesis.

Answer 45

impaired shivering thermogenesis.

Question 46

Which of the following contributes to heat cramps? Dehydration Time of day Mental status Gender

Answer 46

Dehydration

Question 47

When a person experiences a crisis in the water, the amount of time the person can hold their breath depends on: the victim's level of panic. the water's tonicity. the victim's age. the depth of the water.

Answer 47

the victim's level of panic.

Question 48

On the ECG, an Osborn wave can be recognized as: a positive deflection immediately after the QRS complex. an upward slurring at the beginning of the QRS complex. acute widening of the QRS complex during the R wave. a negative deflection that produces a biphasic P wave.

Answer 48

a positive deflection immediately after the QRS complex.

Question 49

Which of the following clinical findings suggests a cause of a patient's hyperthermia other than heatstroke? Pupillary constriction Moist, pale, hot skin Intermittent chills Dehydration

Answer 49

Intermittent chills

Question 50

Mortality and morbidity are greatest following the bite of a: cottonmouth. rattlesnake. coral snake. copperhead.

Answer 50

rattlesnake.

Question 51

At a core body temperature of 90 degrees Fahrenheit: ventricular fibrillation is likely. hyperventilation is profound. oxygen consumption decreases. shivering becomes involuntary.

Answer 51

oxygen consumption decreases.

Question 52

A 39-year-old woman's car broke down, stranding her out in the country for approximately 18 hours. The outside temperature is 23 degrees Fahrenheit. When you arrive and assess the woman, you determine that she is pulseless and apneic; her core body temperature is estimated to be below 86 degrees Fahrenheit. CPR is immediately initiated and the woman is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient? Perform CPR for 2 minutes, give up to three stacked shocks, immediately resume CPR, reassess in 30 seconds, place an advanced airway, ventilate at 10 breaths/min, establish vascular access, give a saline bolus, and provide rapid transport. Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport. Provide immediate defibrillation with maximum energy, reassess the rhythm and pulse, continue CPR, place an advanced airway, give one breath every 3 to 5 seconds, establish vascular access, administer a vasopressor, and provide rapid transport. Give a single monophasic shock at 360 joules, reassess the rhythm and pulse, continue CPR, place an advanced airway, hyperventilate at 20 breaths/min, establish vascular access, give 300 mg of amiodarone, and provide rapid transport.

Answer 52

Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport.

Question 53

When the outside temperature approaches or exceeds skin surface temperature, heat loss by which of the following diminishes and eventually ceases? Evaporation and radiation Convection and conduction Radiation and convection Conduction and evaporation

Answer 53

Radiation and convection

Question 54

If you are unsure if a patient became hypothermic prior to developing cardiac arrest, you should: contact medical control. transport with BLS only. begin resuscitative efforts. withhold resuscitation.

Answer 54

begin resuscitative efforts.

Question 55

Any diver who loses consciousness immediately following a dive should be assumed to have experienced: an air embolism. barotrauma. decompression sickness. nitrogen narcosis.

Answer 55

an air embolism.

Question 56

The first step in treating a patient with a heat cramps is to: assess core body temperature. move the patient to a cooler area. employ active cooling measures. ensure that the airway is patent.

Answer 56

move the patient to a cooler area.

Question 57

The bite of a brown recluse spider: manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia. results in a local reaction only because the spider's venom is cytotoxic and spreads slowly throughout the bloodstream. may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister. most often causes severe central nervous system depression because its venom contains a powerful neurotoxin.

Answer 57

may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.

Question 58

Which of the following medications would most likely cause malignant hyperthermia? Promethazine Amitriptyline Succinylcholine Vecuronium

Answer 58

Succinylcholine

Question 59

Liver disease predisposes a patient to hypothermia secondary to: inadequate glycogen stores. severe portal hypertension. decreased glucagon uptake. increased bilirubin production.

Answer 59

inadequate glycogen stores.

Question 60

Which of the following statements regarding the black widow spider is correct? Following a black widow spider bite, the patient's abdomen is often rigid due to severe muscle spasms. The venom of a black widow spider contains a necrotoxin, which results in local tissue necrosis. Because the mortality rate from a black widow spider bite is about 40%, a prehospital antidote is crucial. The male black widow spider, which is the sex that poses a danger to humans, contains a red hourglass on its back.

Answer 60

Following a black widow spider bite, the patient's abdomen is often rigid due to severe muscle spasms.