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Chapter 18 - Neurologic Emergencies Flashcards

1
Q
  1. The peripheral nervous system is responsible for:
    A) memory, understanding, and thought processes.
    B) feeling and autonomic sensory and motor functions.
    C) thought, perception, and voluntary motor functions.
    D) sending messages to and receiving messages from the brain.
A

Ans: D
Page: 1038
Type: General Knowledge

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2
Q 
2.  Components of the diencephalon include the:
A)  pons and medulla.
B)  brainstem and midbrain.
C)  thalamus and hypothalamus.
D)  cerebellum and cerebral cortex.
A

Ans: C
Page: 1040
Type: General Knowledge

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3
Q 
3.  A person's level of consciousness is regulated by the:
A)  diencephalon.
B)  cerebral cortex.
C)  occipital lobe of the brain.
D)  reticular activating system.
A

Ans: D
Page: 1040-1041
Type: General Knowledge

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4
Q 
4.  What portion of the brainstem regulates respiratory rate and depth?
A)  Pons
B)  Medulla
C)  Midbrain
D)  Basal nuclei
A

Ans: A
Page: 1041
Type: General Knowledge

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5
Q 
5.  Emotions such as rage and anger are generated in the:
A)  thalamus.
B)  limbic system.
C)  hypothalamus.
D)  diencephalon.
A

Ans: B
Page: 1041
Type: General Knowledge

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6
Q
  1. Among other functions, the medulla oblongata:
    A) directly regulates body temperature.
    B) controls blood pressure and heart rate.
    C) communicates with the pituitary gland.
    D) sends messages to move skeletal muscles.
A

Ans: B
Page: 1041
Type: General Knowledge

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7
Q 
7.  A loss of balance and equilibrium suggests injury to the:
A)  midbrain.
B)  cerebrum.
C)  thalamus.
D)  cerebellum.
A

Ans: D
Page: 1041-1042
Type: General Knowledge

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8
Q 
8.  A synapse is:
A)  a cluster of sensory nerve cells.
B)  the body's main neurotransmitter.
C)  a slight gap between nerve cells.
D)  the point where a nerve cell terminates.
A

Ans: C
Page: 1042
Type: General Knowledge

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9
Q 
9.  Chemicals that relay electrically conducted signals from one neuron to another are called:
A)  hormones.
B)  endorphins.
C)  catecholamines.
D)  neurotransmitters.
A

Ans: D
Page: 1042
Type: General Knowledge

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10
Q
  1. When a neuron generates an electrical impulse, it first sends the signal:
    A) along its axon to the axon terminal.
    B) to the cell’s nucleus via a dendrite.
    C) via neurotransmitters at the synapse.
    D) to the cell’s dendrites simultaneously.
A

Ans: A
Page: 1042
Type: General Knowledge

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11
Q
  1. Myelin functions by:
    A) allowing the neuron to send its signal consistently along the axon without losing its electricity.
    B) insulating the neuron, thus decreasing the speed of electrical conduction between two neurons.
    C) covering the neurons in the body that do not require rapid conduction of an electrical impulse.
    D) briefly delaying the conduction of an electrical impulse between the synaptic cleft and dendrite.
A

Ans: A
Page: 1042-1043
Type: General Knowledge

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12
Q 
12.  A neoplasm is MOST accurately defined as a:
A)  normal cell.
B)  new growth.
C)  damaged cell.
D)  cancerous tumor.
A

Ans: B
Page: 1071
Type: General Knowledge

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13
Q
  1. In contrast to a benign neoplasm, a malignant neoplasm:
    A) is relatively easy to remove surgically.
    B) can metastasize to other parts of the body.
    C) results in death in the vast majority of cases.
    D) remains within a capsule and grows minimally.
A

Ans: B
Page: 1071-1072
Type: General Knowledge

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14
Q 
14.  Prehospital treatment for a patient with a suspected stroke may include all of the following, EXCEPT:
A)  30° elevation of the head.
B)  diazepam or lorazepam.
C)  up to 325 mg of aspirin.
D)  crystalloid fluid boluses.
A

Ans: C
Page: 1061-1064
Type: General Knowledge

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15
Q
  1. Common reality is defined as:
    A) one person’s perception of his or her surroundings.
    B) a perceived thought that is not based on reality.
    C) minimal shared reality between two individuals.
    D) sensory stimulation that can be confirmed by others.
A

Ans: D
Page: 1051-1052
Type: General Knowledge

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16
Q 
16.  The MOST common sign of an infectious disease is the presence of:
A)  a fever.
B)  seizures.
C)  a headache.
D)  tachycardia.
A

Ans: A
Page: 1077
Type: General Knowledge

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17
Q
  1. When neurons are deprived of oxygen and glucose:
    A) they convert to anaerobic metabolism.
    B) they produce alkalotic waste products.
    C) spontaneous intracerebral bleeding occurs.
    D) the process of neuronal regeneration begins.
A

Ans: A
Page: 1058
Type: General Knowledge

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18
Q
  1. All of the following are examples of acute cerebrovascular emergencies, EXCEPT:
    A) embolic blockage of a cerebral artery.
    B) accumulation of atherosclerotic plaque.
    C) rupture of a cerebral arterial aneurysm.
    D) stroke secondary to thrombus rupture.
A

Ans: B
Page: 1058-1060
Type: General Knowledge

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19
Q 
19.  The MOST immediate and significant complication associated with a hemorrhagic stroke is:
A)  acute hypovolemic shock.
B)  hypertension and bradycardia.
C)  mean arterial pressure increase.
D)  increased intracranial pressure.
A

Ans: D
Page: 1060
Type: General Knowledge

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20
Q 
20.  As intracranial pressure rises:
A)  the heart rate acutely increases.
B)  the brain becomes hypocarbic.
C)  cerebral herniation may occur.
D)  mean arterial pressure decreases.
A

Ans: C
Page: 1060
Type: General Knowledge

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21
Q 
21.  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?
A)  60 mm Hg
B)  75 mm Hg
C)  90 mm Hg
D)  95 mm Hg
A

Ans: B
Page: 1060
Type: General Knowledge

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22
Q 
22.  Which of the following would MOST likely cause a sustained increase in intracranial pressure?
A)  Bearing down
B)  Frequent coughing
C)  Projectile vomiting
D)  Intracranial tumor
A

Ans: D
Page: 1060
Type: General Knowledge

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23
Q 
23.  Which of the following would have the MOST negative effect on the outcome of a patient with an intracranial hemorrhage?
A)  Hypotension
B)  Tachycardia
C)  Hypertension
D)  Slow rise in intracranial pressure
A

Ans: A
Page: 1060
Type: General Knowledge

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24
Q
  1. For any patient with an increase in intracranial pressure, the paramedic must:
    A) avoid administering IV fluid boluses.
    B) give glucose to prevent hypoglycemia.
    C) maintain an adequate blood pressure.
    D) take measures to lower blood pressure.
A

Ans: C
Page: 1061
Type: General Knowledge

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25
Q
  1. Hyperventilating a patient who has increased intracranial pressure (ICP) will:
    A) dilate the cerebral vasculature and cause further increases in ICP.
    B) constrict the cerebral vasculature and decrease cerebral perfusion.
    C) increase the carbon dioxide levels in the brain through vasodilation.
    D) decrease ICP and maintain adequate cerebral perfusion.
A

Ans: B
Page: 1061
Type: General Knowledge

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26
Q
  1. Management for a patient with a neurologic emergency begins by:
    A) ensuring that the patient’s airway remains patent.
    B) taking deliberate actions to ensure personal safety.
    C) determining the degree of neurologic impairment.
    D) protecting the patient from further injury or harm.
A

Ans: B
Page: 1043-1044
Type: General Knowledge

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27
Q
  1. Decerebrate posturing:
    A) is characterized by abnormal flexion of the arms and extension of the lower extremities.
    B) is considered less severe than decorticate posturing, because it indicates that the brainstem is intact.
    C) is an early clinical finding, because it occurs with minimal increases in intracranial pressure.
    D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brainstem.
A

Ans: D
Page: 1050
Type: General Knowledge

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28
Q 
28.  All of the following cranial nerves are responsible for airway control, EXCEPT the:
A)  abducens.
B)  trigeminal.
C)  hypoglossal.
D)  glossopharyngeal.
A

Ans: A
Page: 1044
Type: General Knowledge

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29
Q
  1. Patients with trismus often require:
    A) premedication with lidocaine before being intubated.
    B) hyperventilation to reduce severe intracranial pressure.
    C) sedation or chemical paralysis to facilitate airway control.
    D) immediate tracheal intubation before the airway swells shut.
A

Ans: C
Page: 1044, 1057
Type: General Knowledge

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30
Q
  1. In contrast to patients in shock, patients with increased intracranial pressure MOST often experience:
    A) systolic hypotension.
    B) an increased diastolic blood pressure.
    C) a widened pulse pressure.
    D) tachycardia and tachypnea.
A

Ans: C
Page: 1045
Type: General Knowledge

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31
Q 
31.  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?
A)  Rest
B)  Postural
C)  Intention
D)  Jacksonian
A

Ans: B
Page: 1055
Type: General Knowledge

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32
Q
  1. Apneustic breathing is characterized by:
    A) an irregular respiratory pattern with unpredictable periods of apnea.
    B) a gradual increase and decrease in breathing with periods of apnea.
    C) extreme tachypnea and hyperpnea with a fruity or acetone breath odor.
    D) a prolonged inspiratory phase with a shortened expiratory phase and bradypnea.
A

Ans: D
Page: 1045
Type: General Knowledge

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33
Q 
33.  An adult who opens her eyes in response to verbal stimuli, is disoriented, and pushes your hand away when you palpate a painful area has a Glasgow Coma Scale score of:
A)  9.
B)  10.
C)  11.
D)  12.
A

Ans: D
Page: 1051
Type: General Knowledge

34
Q 
34.  Common causes of trismus in an unresponsive patient include all of the following, EXCEPT:
A)  opiate toxicity.
B)  cerebral hypoxia.
C)  a head injury.
D)  an active seizure.
A

Ans: A
Page: 1044
Type: General Knowledge

35
Q
  1. A patient with a Glasgow Coma Scale score of 8 or less:
    A) may require definitive airway control.
    B) has moderate neurologic dysfunction.
    C) is often able to localize his or her pain.
    D) is likely experiencing brain herniation.
A

Ans: A
Page: 1051
Type: General Knowledge

36
Q
  1. A patient with a unilateral eyelid droop when smiling:
    A) has a condition called miosis.
    B) may be experiencing Bell palsy.
    C) likely has an intracerebral hemorrhage.
    D) is experiencing transient cerebral ischemia.
A

Ans: B
Page: 1048
Type: General Knowledge

37
Q
  1. A patient who is experiencing agnosia:
    A) has neuronal dysfunction between the temporal and frontal lobe.
    B) may call a knife a fork when he or she is asked to name the object.
    C) is probably experiencing an ischemic stroke in the cerebellar area.
    D) cannot use a pencil secondary to dysfunction of the occipital lobe.
A

Ans: B
Page: 1053
Type: General Knowledge

38
Q 
38.  A patient who is unable to use a common object is said to be:
A)  agnosic.
B)  aphasic.
C)  atonic.
D)  apraxic.
A

Ans: D
Page: 1053
Type: General Knowledge

39
Q
  1. Which of the following is an example of receptive aphasia?
    A) A patient with slurred speech is able to tell you his or her name.
    B) You hand a patient a pencil and he or she tries to cut paper with it.
    C) You ask a patient who the president is and he or she says, “January.”
    D) A patient responds with “no” when asked if he or she has hypertension.
A

Ans: C
Page: 1053
Type: General Knowledge

40
Q 
40.  The involuntary, rhythmic movement of the eyes is called:
A)  nystagmus.
B)  hyperopia.
C)  anisocoria.
D)  dysphagia.
A

Ans: A
Page: 1073
Type: General Knowledge

41
Q
  1. Because the facial nerve does not decussate, a stroke to the right cerebral hemisphere would MOST likely cause:
    A) left-sided weakness and a left-sided facial droop.
    B) left-sided weakness and a right-sided facial droop.
    C) right-sided weakness and a left-sided facial droop.
    D) right-sided weakness and a right-sided facial droop.
A

Ans: B
Page: 1054-1055
Type: General Knowledge

42
Q 
42.  A staggering gait is MOST suggestive of damage to the:
A)  medulla.
B)  cerebrum.
C)  brainstem.
D)  cerebellum.
A

Ans: D
Page: 1055
Type: General Knowledge

43
Q 
43.  \_\_\_\_\_\_\_\_\_\_ is a term used to describe changes in a person's ability to perform coordinated motions, such as walking.
A)  Ataxia
B)  Myoclonus
C)  Bradykinesia
D)  Decussation
A

Ans: A
Page: 1055
Type: General Knowledge

44
Q 
44.  Which of the following disease processes is characterized by an abnormal gait in which the patient places his or her feet very close together and shuffles while walking?
A)  Cerebral palsy
B)  Multiple sclerosis
C)  Parkinson disease
D)  Alzheimer disease
A

Ans: C
Page: 1075
Type: General Knowledge

45
Q
  1. When performing the arm drift test on a patient with a suspected stroke, a positive finding is characterized by:
    A) one arm drifting downward and turning away from the body when the patient’s eyes are closed.
    B) one arm drifting downward and turning toward the body when the patient’s eyes are closed.
    C) one arm drifting downward and turning away from the body when the patient’s eyes are open.
    D) both arms moving downward more than 3 inches in 30 seconds when the patient’s eyes are open.
A

Ans: B
Page: 1055
Type: General Knowledge

46
Q 
46.  Tremors that increase as the patient's hand gets closer to an object that he or she is trying to grab are called \_\_\_\_\_\_\_\_\_ tremors and are MOST common in patients with \_\_\_\_\_\_\_\_\_.
A)  rest, Parkinson disease
B)  postural, Alzheimer disease
C)  clonic, cerebral palsy
D)  intention, multiple sclerosis
A

Ans: D
Page: 1055, 1073
Type: General Knowledge

47
Q 
47.  A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called \_\_\_\_\_\_\_\_\_\_ activity.
A)  tonic
B)  clonic
C)  hypertonic
D)  myoclonic
A

Ans: B
Page: 1056
Type: General Knowledge

48
Q 
48.  An idiopathic seizure is one in which:
A)  the cause is not known.
B)  the entire brain is affected.
C)  a part of the brain is affected.
D)  a postictal phase is not present.
A

Ans: A
Page: 1067
Type: General Knowledge

49
Q 
49.  A patient experiences severe, shock-like or stabbing pain to one side of the face. This is consistent with:
A)  an acoustic neuroma.
B)  hemifacial spasm.
C)  trigeminal neuralgia.
D)  glossopharyngeal neuralgia.
A

Ans: C
Page: 1076
Type: General Knowledge

50
Q
  1. Applying pressure to the supraorbital foramen of a patient with a neurologic insult is intended to:
    A) stimulate the vagus nerve.
    B) determine if the spinal cord is intact.
    C) elicit a response to painful stimuli.
    D) assess for an orbital skull fracture.
A

Ans: C
Page: 1049-1050
Type: General Knowledge

51
Q
  1. 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, and irregular; and his skin is cool and clammy. You should:
    A) obtain a 12-lead ECG tracing and assess his pupils.
    B) assist his ventilations and assess his oxygen saturation.
    C) assess his blood glucose level and give high-flow oxygen.
    D) apply oxygen via nonrebreathing mask and apply the ECG.
A

Ans: B
Page: 1044-1045
Type: Critical Thinking

52
Q
  1. You are assessing an unresponsive 66-year-old man with a history of two prior strokes. According to the patient’s wife, he complained of a severe headache and then passed out. His respiratory effort is poor, blood pressure is elevated markedly, and pulse is slow and bounding. The glucometer reads “error.” You should:
    A) give high-flow oxygen, apply the cardiac monitor, start an IV line with normal saline, and administer 0.5 mg of atropine to treat his bradycardia.
    B) hyperventilate with a bag-mask at 30 breaths/min, begin transcutaneous pacing, establish vascular access, and administer 25 g of 50% dextrose.
    C) intubate after 30 seconds of preoxygenation, ventilate at a rate of 8 breaths/min, start an IV with normal saline, administer 50 g of 50% dextrose, and reassess.
    D) 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.
A

Ans: D
Page: 1044-1046, 1057
Type: Critical Thinking

53
Q
  1. A 39-year-old woman presents with signs and symptoms of an acute hemorrhagic stroke. She is responsive to deep painful stimuli only and has bilaterally dilated and sluggishly reactive pupils. Her respirations are slow and irregular, blood pressure is 80/50 mm Hg, and pulse is 40 and bounding. Initial treatment for this patient involves:
    A) positive-pressure ventilatory support.
    B) rapid infusion of a crystalloid solution.
    C) high-flow oxygen via nonrebreathing mask.
    D) immediate transcutaneous cardiac pacing.
A

Ans: A
Page: 1061
Type: Critical Thinking

54
Q
  1. You respond to the residence of a known heroin abuser. The patient, a 30-year-old man, is unconscious and unresponsive. He is hypoventilating, bradycardic, and hypotensive. Administration of 10 mg of naloxone has had no effect, and your transport time to the hospital is approximately 30 minutes. You should:
    A) check his blood glucose level as your partner prepares to intubate.
    B) transport at once and administer additional naloxone while en route.
    C) administer 25 g of 50% dextrose and reassess his level of consciousness.
    D) hyperventilate him with high-flow oxygen to minimize tissue hypoxia.
A

Ans: A
Page: 1056-1057
Type: Critical Thinking

55
Q
  1. A 59-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 her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient’s medical history from her husband, the MOST important question to ask him is:
    A) “Does your wife have a history of diabetes?”
    B) “Is your wife allergic to aspirin or contrast dye?”
    C) “When did your wife last see her physician?”
    D) “When did you first notice your wife’s symptoms?”
A

Ans: D
Page: 1064
Type: Critical Thinking

56
Q
  1. An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient’s wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should:
    A) consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago.
    B) rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.
    C) start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg.
    D) suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route.
A

Ans: B
Page: 1060-1063
Type: Critical Thinking

57
Q
  1. 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 70 mg/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 this scenario is correct?
    A) You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg.
    B) The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist.
    C) Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
    D) The patient’s signs and symptoms are likely the result of her blood sugar and will resolve with dextrose.
A

Ans: C
Page: 1064-1065
Type: Critical Thinking

58
Q
  1. 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 medications. Initial treatment for this patient involves:
    A) administering oxygen via nonrebreathing mask.
    B) ensuring airway patency and adequate breathing.
    C) evaluating his cardiac rhythm with the ECG monitor.
    D) performing a rapid check of his blood glucose level.
A

Ans: B
Page: 1065-1066
Type: Critical Thinking

59
Q
  1. 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 patient’s supervisor states that she has a history of seizures and takes Tegretol. The patient’s blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:
    A) administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren.
    B) establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital.
    C) giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity.
    D) administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.
A

Ans: A
Page: 1067-1069
Type: Critical Thinking

60
Q 
60.  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.
A)  absence
B)  tonic-clonic
C)  simple partial
D)  complex partial
A

Ans: A
Page: 1068
Type: Critical Thinking

61
Q
  1. 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:
    A) place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM.
    B) protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium.
    C) hyperventilate him with a bag-mask to eliminate excess carbon dioxide, establish vascular access, and give lorazepam.
    D) open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam.
A

Ans: D
Page: 1069
Type: Critical Thinking

62
Q 
62.  A 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 patient 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:
A)  a seizure.
B)  dehydration.
C)  a vasovagal response.
D)  acute hypoglycemia.
A

Ans: B
Page: 1069-1070
Type: Critical Thinking

63
Q
  1. 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:
    A) carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting.
    B) placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care.
    C) oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
    D) administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure.
A

Ans: C
Page: 1070-1071
Type: Critical Thinking

64
Q 
64.  A 51-year-old man complains of chronic headaches that have worsened progressively 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 states that he has been taking acetaminophen for the headaches. You should be MOST suspicious for:
A)  acute sinusitis.
B)  an intracranial neoplasm.
C)  acute hemorrhagic stroke.
D)  a ruptured cerebral artery.
A

Ans: B
Page: 1071-1072
Type: Critical Thinking

65
Q
  1. A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should:
    A) provide supportive care and safely transport her to the hospital.
    B) assist her with her prescribed insulin to lower her blood glucose.
    C) advise her to take ibuprofen and to follow up with her physician.
    D) conclude that she has peripheral neuropathy and give her fentanyl.
A

Ans: A
Page: 1079
Type: Critical Thinking

66
Q 
66.  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:
A)  diazepam, 5 mg.
B)  promethazine, 25 mg.
C)  diphenhydramine, 25 mg.
D)  ondansetron, 4 mg.
A

Ans: C
Page: 1077
Type: Critical Thinking

67
Q 
67.  A patient with suspected meningitis involuntarily flexes her knees when her head is flexed toward her chest. This is called:
A)  Kernig sign.
B)  Grey Turner sign.
C)  Cullen sign.
D)  Brudzinski sign.
A

Ans: D
Page: 1078
Type: General Knowledge

68
Q
  1. Increased intracranial pressure hydrocephalus occurs when:
    A) the movement of CSF in the brain exceeds the production of CSF.
    B) the movement of CSF decreases, but the production of CSF does not.
    C) CSF production increases, which causes increased pressure in the skull.
    D) total CSF volume decreases, which leads to excessive cerebral edema.
A

Ans: B
Page: 1080
Type: General Knowledge

69
Q 
69.  Which of the following conditions is a neural tube defect in which part of the nervous system remains outside the body?
A)  Multiple sclerosis
B)  Spina bifida
C)  Poliomyelitis
D)  Cerebral palsy
A

Ans: B
Page: 1080-1081
Type: General Knowledge

70
Q
  1. Common signs and symptoms of a cerebral abscess include:
    A) hemiplegia, low-grade fever, hyperactivity, and a diffuse stabbing headache.
    B) paralysis below the waist, high fever, a diffuse headache, and slurred speech.
    C) high-grade fever, persistent localized headache, confusion, and focal impairment.
    D) an absence of fever, severe localized headache, and vomiting without nausea.
A

Ans: C
Page: 1079
Type: General Knowledge

71
Q 
71.  When a patient with Parkinson disease is asked to turn, he or she takes small steps until the turn is complete. This is called:
A)  ataxia.
B)  decussation.
C)  dystonia.
D)  bradykinesia.
A

Ans: D
Page: 1075
Type: General Knowledge

72
Q 
72.  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?
A)  Trochlear, oculomotor, abducens
B)  Facial, accessory, glossopharyngeal
C)  Accessory, olfactory, hypoglossal
D)  Optic, trigeminal, glossopharyngeal
A

Ans: A
Page: 1054
Type: General Knowledge

73
Q 
73.  Which of the following cranial nerves regulates movement of the head and shoulders?
A)  Hypoglossal
B)  Abducens
C)  Accessory
D)  Trigeminal
A

Ans: C
Page: 1054
Type: General Knowledge

74
Q
  1. Pupils that differ in size by less than 1 mm:
    A) indicate increased intracranial pressure.
    B) may be a normal variant in some patients.
    C) are a sign of methamphetamine abuse.
    D) are a sign of optic nerve compression.
A

Ans: B
Page: 1052-1053
Type: General Knowledge

75
Q
  1. A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure:
    A) dilates the blood vessels and can cause brain herniation.
    B) lowers intracranial pressure and oxygenates the brain.
    C) increases intracranial pressure, but oxygenates the brain.
    D) causes vasoconstriction and can impair brain perfusion.
A

Ans: D
Page: 1061
Type: General Knowledge

76
Q
  1. According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if:
    A) the patient is younger than 45 years of age.
    B) the blood glucose is between 60 and 400 mg/dL.
    C) at baseline, the patient is normally bedridden.
    D) a bilateral facial droop is present during the exam.
A

Ans: B
Page: 1064
Type: General Knowledge

77
Q 
77.  Which of the following causes of altered mental status is NOT an acute process?
A)  Uremia
B)  Acidosis
C)  Psychosis
D)  Epilepsy
A

Ans: A
Page: 1066
Type: General Knowledge

78
Q 
78.  During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the \_\_\_\_\_\_\_\_\_ phase of the seizure.
A)  tonic
B)  clonic
C)  hypertonic
D)  postictal
A

Ans: C
Page: 1067
Type: General Knowledge

79
Q
  1. In contrast to syncope, a seizure:
    A) is less commonly observed in older patients.
    B) can occur when the patient is in any position.
    C) most often occurs when the patient is standing.
    D) is characterized by a quick return of orientation.
A

Ans: B
Page: 1069-1070
Type: General Knowledge

80
Q
  1. Spasmodic torticollis is characterized by:
    A) sustained and painful contraction of the eyelids.
    B) involuntary unilateral myoclonic contractions of the face.
    C) severe stabbing pain, usually to one side of the face.
    D) neck muscle contraction, which twists the head to one side.
A

Ans: D
Page: 1076-1077
Type: General Knowledge

final (18 decks)

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