Chapter 14 Flashcards
1
Q
Electromechanical infusion pumps are most beneficial when administering a medication maintenance infusion because:
A
these devices allow for precise medication dosing.
2
Q
Which of the following medications is appropriate to administer via the rectal route?
A
Diazepam (Valium)
3
Q
Which of the following medications or preparations is commonly given via the transdermal route?
A
Analgesia
4
Q
In which of the following cases would the paramedic likely instill medication down a gastric tube?
A
Toxic ingestion in patients with a depressed swallowing mechanism
5
Q
Once the catheter is in position and the contents of the IV bag are flowing properly, you must:
A
secure the IV line.
6
Q
Typically, intranasal medications require:
A
2 to 2.5 times the standard IV dose
7
Q
If a manually inserted IO needle is placed properly in an adult, it should:
A
rest at a 90-degree angle to the bone
8
Q
To convert 2.5 L to milliliters, you should:
A
multiply 2.5 by 1,000
9
Q
After attaching the prepared IV line to the hub of the IV catheter and removing the constricting band, you should:
A
open the IV line and observe for swelling or infiltration.
10
Q
Which of the following is an example of a colloid solution?
A
Plasmanate
11
Q
Which medication can require an initial bolus and then may need a continuous IV infusion to maintain a therapeutic level of the drug?
A
Lidocaine
12
Q
A nonhypovolemic patient is severely hypotensive and requires a dopamine infusion at 5 mcg/kg/min. The patient’s estimated weight is 190 lb. You add 800 mg of dopamine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate?
A
16
13
Q
Colloid solutions:
A
contain proteins that are too large to pass out of the capillary membranes, so the solutions remain in the vascular compartment.
14
Q
When administering a drug via IV bolus, you are giving the drug:
A
in one mass.
15
Q
After inserting the needle during an intramuscular injection, but before delivering the medication, you should:
A
pull back on the plunger to aspirate for blood.
16
Q
The purpose of a Volutrol (Buretrol) administration set is to:
A
avoid inadvertent fluid overload.
17
Q
You are preparing to administer a dopamine infusion to a severely hypotensive patient. What is the concentration on hand if you add 800 mg of dopamine to a 500-mL bag of normal saline?
A
1,600 mcg/mL
18
Q
When administering a medication via the intramuscular route, you should:
A
stretch the skin over the injection site and insert the needle at a 90-degree angle.
19
Q
Prior to cannulating an external jugular vein, it is most important to:
A
palpate for the carotid pulse
20
Q
You are treating an unconscious 39-year-old man who overdosed on heroin. You are unable to establish an IV line because his veins are severely sclerosed, and your protocols do not allow for IO cannulation. You should:
A
administer naloxone via the mucosal atomizer device.
21
Q
Through which of the following over-the-needle catheters can you infuse the greatest amount of fluid over the shortest period of time?
A
14 gauge, 1 ¼ inch
22
Q
A hypertonic solution has an osmolarity higher than that of serum, meaning that the solution
A
has more ionic concentration than serum and pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment.
23
Q
Thrombophlebitis is most commonly caused by:
A
lapses in aseptic technique.
24
Q
When changing an IV bag, it is important to:
A
ensure that some fluid remains in the drip chamber.
25
A hypoglycemic patient requires IV dextrose. Medical control orders you to administer 25 mL. You have a prefilled syringe of 50% dextrose that contains 25 g/50 mL. How much dextrose will you give?
12.5 g
26
The most common inhaled medication is:
oxygen.
27
When preparing an IV administration set, you should:
remove the protective cover from the piercing spike.
28
Which of the following conditions or situations is associated with the highest risk of vein rupture during IV cannulation?
Diabetes
29
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.
30
Which of the following statements regarding sharps containers is correct?
Sharps containers should be puncture proof and should bear a biohazard logo.
31
When administering sublingual nitroglycerin to a patient, you should do which of the following?
Perform a focused history and physical examination.
32
When administering a medication, the paramedic:
is just as responsible for the administration of the drug and its possible consequences as the physician giving the order.
33
Which route is the most commonly used medication route in the prehospital setting?
IV
34
Which of the following is an example of a peripheral vein?
Lower extremity veins
35
When drawing medication from an ampule, you should
Gently tap the ampule if medication is stuck in the neck
36
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.
37
After inserting an 18-gauge over-the-needle catheter into the hand vein of a 30-year-old woman and securing the IV line in place, you note edema at the catheter site despite continued flow of the IV. The woman complains of pain and tightness around the IV site. You should:
Recognize that infiltration has occurred and immediately discontinue the IV
38
Which of the following statements regarding osteomyelitis is correct?
Osteomyelitis is the result of an infection
39
How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/mL
500
40
Blood tubing is a
macrodrip administration set that is designed to facilitate rapid fluid replacement by manual infusion of multiple IV bags or a combination of IV fluids and blood.
41
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.
42
When initiating an IV line in the upper extremity of a stable patient, you should:
Start distally and work proximally
43
Arteriovenous (AV) fistulas are used for individuals with which disorder?
Myasthenia gravis
44
In the prehospital setting, the most commonly used IV solutions are
isotonic crystalloids.
45
Common risks associated with cannulation of the external jugular vein include which of the following?
Air embolism
46
Which of the following steps is usually necessary when administering a drug via the IO route, but not necessary when administering a drug via the IV bolus route?
Placing a pressure infuser device around the IV bag
47
Which of the following questions should the paramedic ask themselves when determining the most appropriate IV solution to use on a patient?
Will the patient need fluid replacement?
48
When determining whether an occluded IV line should be reestablished, you should:
infuse 10 mL of normal saline through the injection port to attempt to disrupt the occlusion.
49
A vasovagal reaction is the result of:
dilation of the vasculature.
50
A 71-year-old woman presents with tachypnea, flushed skin, and postural hypotension. Which of the following chief complaints is most consistent with these clinical findings?
Diarrhea
51
Pain, tenderness, and blood rapidly pooling around the IV site are indicative of:
hematoma
52
Which of the following statements regarding IO cannulation and infusion is correct?
The IO space remains patent, even when peripheral veins have collapsed.
53
On the Fahrenheit scale, water freezes at:
32 degrees
54
To avoid inadvertently cannulating an artery, you should:
always check for a pulse in any vessel you intend to cannulate.
55
A 60-year-old woman with acute chest discomfort requires 0.4 mg of sublingual nitroglycerin. Prior to administering the medication, you should:
ask her if she wears a transdermal nitroglycerin patch.
56
The IO space collectively comprises which bone of the epiphyses?
Cancellous
57
IO cannulation is contraindicated in which of the following situations?
Bilateral knee replacements
58
In contrast to an antiseptic, a disinfectant is:
toxic to living tissues and should never be used on a patient.
59
When selecting a vein for cannulation, you should avoid areas of the vein that:
Pass over joints
60
Overhydration occurs when:
fluid is forced from the engorged interstitial compartment into the intracellular compartment.
61
An unconscious 4-year-old child with a blood glucose reading of 30 mg/dL requires 2 mL/kg of D50. The child's estimated weight is 35 lb. You have a prefilled syringe of D50 at a concentration of 25 g/50 mL. How many milligrams of dextrose will you administer to the child?
15.900
62
The signs and symptoms that occur when an IV catheter is sheared and becomes a free-floating segment in the circulatory system closely resemble
an air embolus.
63
The most important point to remember about IV therapy is to:
keep the IV equipment sterile
64
A 130-lb patient weighs how many kilograms?
59
65
Which of the following is a sign or symptom of dehydration?
Orthostatic hypotension
66
Which of the following statements regarding synthetic blood substitutes is correct?
They have the ability to carry oxygen to the body's cells.
67
Which of the following statements regarding isotonic solutions is correct?
Isotonic solutions have almost the same osmolarity as bodily fluids.
68
You are transporting a 1-year-old child with moderate dehydration. Your estimated time of arrival at the hospital is 45 minutes. When administering an isotonic crystalloid solution to this child, you should:
use a Volutrol administration set and fill the calibrated drip chamber with a precalculated volume of fluid.
69
The first step in discontinuing an IV line is to:
shut off the flow of fluid with the roller clamp
70
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.
71
Once D5W is infused into the body:
the body metabolizes the dextrose quickly and the solution becomes hypotonic.
72
If an adult patient requires fluid replacement for hypovolemic shock, what would be the minimum catheter size to be used?
18 gauge
73
Once an IV solution is removed from its protective sterile plastic bag, it must be used
Within 24 hours
74
What medication route is typically used during allergy testing or when performing a skin test for tuberculosis?
Intradermal
75
Medical asepsis is defined as:
the practice of preventing contamination of the patient.
76
If you receive a medication order from online medical control that seems inappropriate to you, you should:
ask the physician to repeat and clarify the order.
77
To make push-dose epinephrine, you should
place 1 mL of epinephrine into 9 mL of normal saline.
78
Hypotonic solutions:
hydrate the cells while depleting the vascular compartment.
79
Signs and symptoms of circulatory overload include
hypertension
80
You are treating a 29-year-old man who was struck in the abdomen with a steel pipe. He is confused, has absent radial pulses, and has a blood pressure of 78/50 mm Hg. You should administer:
normal saline fluid boluses until his mental status and radial pulses improve.
81
A microdrip administration set:
delivers 1 mL for every 60 drops.
82
Medication absorption through a nitroglycerin patch would be increased if the patient has:
skin that is thin or nonintact
83
It is most important to exercise caution when administering isotonic solutions to patients with
hypertension and congestive heart failure
84
1 cc is equal to how many milliliters?
1
85
In the prehospital setting, saline locks are used primarily for patients who:
do not need additional fluids but may need rapid medication delivery.
86
A severely burned patient requires 4,500 mL of isotonic crystalloid solution over 8 hours, so medical control orders you to begin the infusion in the field. If your administration set allows 10 gtts/mL, at how many gtts/min will you set the IV flow rate in order to deliver the ordered amount of fluid?
94
87
Immediately after administering intramuscular epinephrine to a patient with an allergic reaction, you should:
dispose of the needle and syringe in a sharps container.
88
An elderly man with congestive heart failure and shortness of breath requires an IV line in case medication administration is necessary. Which of the following IV catheters is most appropriate to use when starting the IV?
20 gauge, 1 ¼ inch
89
Large protruding arm veins in an otherwise healthy adult can be difficult to cannulate because they often:
roll from side to side during the cannulation attempt.
90
A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer?
0.1 mg
91
100 mL is equal to:
0.1 L
92
During the attempted resuscitation of a man in V-Fib cardiac arrest, your protocols call for the administration of 1.5 mg/kg of lidocaine. You have prefilled syringes of lidocaine in a concentration of 100 mg/5 mL. The patient weighs 180 lb. How many milliliters will you administer?
6.2
93
0.2 mg equals:
200 mcg
94
To administer a drug, you must know the weight of the drug that is present in:
1 mL
95
An 80-kg patient weighs how many pounds?
176
96
Which of the following IO devices should not be used in children?
FAST1
97
Administering large amounts of an isotonic crystalloid solution to a patient with internal bleeding would most likely:
increase the severity of internal bleeding by interfering with hemostasis.
98
Drug reconstitution involves:
injecting diluent or sterile water from one vial into the vial that contains the powdered form of the medication.
99
Pyrogenic reactions can be largely avoided by:
inspecting the IV solution carefully before use.
100
The use of O-negative blood in the prehospital setting can be challenging because:
It requires refrigeration
101
As you are preparing to start an IV on a young man, he sees the needle, becomes acutely diaphoretic, and passes out. After placing him in the appropriate position, what should you do?
Administer high-flow oxygen.
102
“Trace marks” along the course of patient’s vein are usually a sign of:
Sclerosis caused by frequent cannulation.
103
Which of the following statements regarding isotonic crystalloid solutions is correct?
Approximately two-thirds of infused isotonic crystalloid solution will leave the vascular space within 1 hour.
104
Although medications that are used for maintenance infusions are commonly premixed and prepackaged, you must still:
Be aware of the concentration of the drug in the premixed solution.
105
While attempting to start an IV on a patient with large protruding veins, you note that the vein rolls from side to side during your cannulation attempt. What should you do to remedy this situation?
Apple downward manual traction below the venipuncture site to stabilize the vein in position.
106
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.
107
The most prominent clinical indicator of a pyrogenic reaction is:
Fever.
108
Shortly after establishing an IV line of normal saline, your patient complains of a burning sensation alone the course of the vein. You should:
Observe the patient for signs and symptoms of an allergic reaction.
109
While establishing IO access in a critically ill patient, you locate the appropriate anatomic landmark, cleanse the site, and insert the IO catheter at a 45-degree angle. After attaching the IV line and turning the flow on, you note edema developing on the opposite side of the extremity. What has most likely happened?
Extravasation due to an inappropriate angle of IO catheter insertion.
110
Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give?
5 mL.
111
IV fluids introduced into the circulatory system:
Can affect the tonicity of the extracellular fluid and can be harmful.
112
Which of the following statements regarding subcutaneous medication administration is correct?
Volumes of a drug given subcutaneously are typically 1mL or less.
113
Which of the following represents the appropriate metric units of weight from largest to smallest?
Kg, g, mg, mcg
114
Vein irritation during IV therapy is usually caused by:
An infusion rate that is too rapid.
115
When a patient needs rapid fluid replacement, you should:
Select an administration set that contains a large opening between the piercing spike and drip chamber.
116
A prefilled syringe of lidocaine contains
100 mg/5 mL of volume. How many milligrams per milliliter (mg/mL) are present in the syringe?
20.
117
A 1% lidocaine (Xylocaine) concentration contains:
1,000 mg/100 mL.
118
A patient with a core body temperature of 35 degrees on the Celsius scale has a core body temperature of which of the following on the Fahrenheit scale?
95 degrees.
119
Neither subcutaneous nor intramuscular injections should be given to patients:
With inadequate peripheral perfusion.
120
The most common cause of circulatory overload in the prehospital setting is:
Failure to readjust the drip rate after flushing the IV line immediately after insertion.
121
If the posterior aspect of the leg rapidly becomes edematous during IO infusion, you should:
Suspect extravasation of fluid.
122
Following return of spontaneous circulation, you are ordered to being a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500-mL bag of normal saline are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate?
45
123
Which of the following is/are the first sign(s) of IV occlusion?
A decreasing drip rate or the presence of blood in the IV tubing.
124
The main benefit of using a prefilled medication syringe is that:
It does not require you to draw up each individual medication dose.
125
Approximately 20 minutes after starting an IV on a 40-year-old man, he begins complaining of a backache and chills. You should be suspicious of:
A pyrogenic reaction.
