Chapter 12: Critical Thinking

Question 1

After gathering information from the patient, scene, and any bystanders, you must next:
A) formulate a care plan based on the information.
B) determine which information is valid and which may be invalid.
C) synthesize the information to form a thought process.
D) determine the most likely cause of the patient’s problem.

Answer 1

B) determine which information is valid and which may be invalid.

Question 2

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

Answer 2

D) assessing each condition’s potential for having a life-threatening impact.

Question 3

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

Answer 3

A) your EMS system’s patient care protocols or standing orders.

Question 4

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

Answer 4

D) define what the paramedic can or cannot do without direct medical control.

Question 5

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

Answer 5

C) only address classic patient presentations.

Question 6

If a patient’s clinical presentation is not addressed in a specific algorithm, the paramedic must:
A) focus exclusively on the patient’s ABCs.
B) determine what is in the patient’s best interest.
C) perform a comprehensive head-to-toe exam.
D) provide supportive care and transport promptly.

Answer 6

B) determine what is in the patient’s best interest.

Question 7

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

Answer 7

C) will help justify the patient care decisions you make.

Question 8

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

Answer 8

A) Controlling severe bleeding from an open wound, establishing an IV to maintain perfusion, and contacting medical control en route to the hospital

Question 9

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

Answer 9

D) think and perform quickly and effectively under pressure.

Question 10

Once you determine that your patient is sick, you must next:
A) provide aggressive care.
B) quantify how sick he or she is.
C) contact online medical control.
D) transport him or her immediately.

Answer 10

B) quantify how sick he or she is.

Question 11

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

Answer 11

C) Acute presentation of a chronic condition

Question 12

In EMS, the process of concept formation involves:
A) determining the validity of obtained data.
B) gathering information about your patient.
C) knowing which treatment algorithm to use.
D) interpreting a patient’s signs and symptoms.

Answer 12

B) gathering information about your patient.

Question 13

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

Answer 13

A) data interpretation

Question 14

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

Answer 14

A) show a lack of compassion and interest in providing the best possible care.

Question 15

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

Answer 15

D) almost guarantees that the care you provide will be suboptimal.

Question 16

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

Answer 16

C) what you feel is the cause of your patient’s problem.

Question 17

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

Answer 17

C) Reassessing a patient’s blood pressure after administering nitroglycerin

Question 18

The MOST effective way for the paramedic to avoid tunnel vision is to:
A) perform a secondary assessment on every patient he or she encounters.
B) keep an open mind to all of the possible causes of the patient’s problem.
C) reassess all patients at least every 15 minutes until patient care is transferred.
D) possess a detailed knowledge of anatomy, physiology, and pathophysiology.

Answer 18

B) keep an open mind to all of the possible causes of the patient’s problem.

Question 19

_______________ occurs after a call is over and commonly is associated with the run review or critique.
A) Reflection in action
B) Reflection on action
C) Data interpretation
D) Application of principle

Answer 19

B) Reflection on action

Question 20

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

Answer 20

A) medical ambiguity.

Question 21

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

Answer 21

C) A driver who passed out and then struck a tree

Question 22

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

Answer 22

D) diminishing your ability to concentrate.

Question 23

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

Answer 23

D) Memorizing all patient care algorithms

Question 24

When reading the scene, the paramedic must remember that:
A) noting the mechanism of injury is the first element to evaluate.
B) scene information becomes unavailable once transport is initiated.
C) safety issues must be addressed while you are caring for the patient.
D) bystanders are a reliable source of information regarding an incident.

Answer 24

B) scene information becomes unavailable once transport is initiated.

Question 25

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

Answer 25

A) The person at fault

Question 26

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

Answer 26

C) Object from which the patient fell

Question 27

When you introduce yourself to your patient and ask why 9-1-1 was called, the patient looks at you, shakes your hand, and answers your questions appropriately. From these findings, you can gather that the patient:
A) has not experienced a traumatic injury.
B) has a Glasgow Coma Scale score of 15.
C) will likely not require medication therapy.
D) does not have a life-threatening condition.

Answer 27

B) has a Glasgow Coma Scale score of 15.

Question 28

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

Answer 28

D) ascertain whether this is a new problem or worsening of a preexisting condition.

Question 29

When caring for a critically ill patient, three or more sets of vital signs will allow you to:
A) determine how fast the patient’s condition is deteriorating and whether cardiac arrest is imminent.
B) assess trends and to reassess whether the patient’s condition is stabilizing, getting better, or getting worse.
C) quantify that the patient’s condition is stabilizing, even if he or she has an altered level of consciousness.
D) determine what body system is in dysfunction, which will further facilitate the provision of specific care.

Answer 29

B) assess trends and to reassess whether the patient’s condition is stabilizing, getting better, or getting worse.

Question 30

After addressing any life threats in the order in which you find them, you should next:
A) consider the worst-case scenario that could be causing the patient’s symptoms and either rule it out or rule it in.
B) determine the most common and statistically probable cause for the patient’s current signs and symptoms.
C) formulate a working field diagnosis on the basis of what you discovered in the initial assessment of the patient.
D) provide symptomatic care and promptly transport the patient to an appropriate medical treatment facility.

Answer 30

A) consider the worst-case scenario that could be causing the patient’s symptoms and either rule it out or rule it in.

Question 31

Given the number of possible diagnoses in any situation and the limited physical and technical resources of the field, you will MOST likely:
A) regularly be treating patients who can only be diagnosed at the hospital.
B) have difficulty providing supportive care secondary to medical ambiguity.
C) regularly be able to formulate a definitive diagnosis of the patient’s current condition.
D) not be able to stabilize the patient’s condition adequately in the field setting.

Answer 31

A) regularly be treating patients who can only be diagnosed at the hospital.

Question 32

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

Answer 32

C) ensure he or she does not overlook anything that can be treated in the field.

Question 33

No matter how sure he or she is of the working diagnosis, the thinking paramedic must:
A) confer with online medical control to confirm his or her diagnosis.
B) always keep part of the thought process open to other possibilities.
C) implement a treatment plan based solely on the working diagnosis.
D) remain confident that his or her working diagnosis is an accurate one.

Answer 33

B) always keep part of the thought process open to other possibilities.

Question 34

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

Answer 34

D) the gradual result of the provider constantly striving to improve his or her practice.