Chapters 16, 18, and 19 Flashcards
1
Q
- What function do the nasal turbinates serve?
A) Separating the left and right nostrils
B) Warming and humidifying inhaled air
C) Decreasing the surface area of the nasopharynx
D) Secreting mucus that traps viruses and bacteria
A
Ans: B Page: 854 Type: General Knowledge
2
Q
- A patient who is experiencing an allergic reaction states that his tongue “feels thick” and speaks at a low volume. You should immediately evaluate for:
A) angioedema.
B) hypotension.
C) a gag reflex.
D) adventitious breath sounds.
A
Ans: A Page: 854 Type: General Knowledge
3
Q
- The oropharynx and nasopharynx meet in the back of the throat at the:
A) larynx.
B) hyoid bone.
C) hypopharynx.
D) glottic opening.
A
Ans: C Page: 854 Type: General Knowledge
4
Q
- Common effects of gag reflex stimulation include all of the following, EXCEPT:
A) vomiting.
B) tachycardia.
C) bradycardia.
D) increased intracranial pressure.
A
Ans: B Page: 854 Type: General Knowledge
5
Q
- The most obvious external landmark of the larynx is the:
A) cricoid cartilage.
B) hyoid bone.
C) arytenoid cartilage.
D) thyroid cartilage.
A
Ans: D Page: 854 Type: General Knowledge
6
Q
- On either side of the glottis, tissue forms a pocket called the: A) vallecula. B) piriform fossae. C) cuneiform cartilage. D) hypopharyngeal space.
A
Ans: B Page: 855 Type: General Knowledge
7
Q
- The _________ cartilage forms a complete ring and maintains the trachea in an open position. A) cricoid B) thyroid C) arytenoid D) laryngeal
A
Ans: A Page: 855 Type: General Knowledge
8
Q
- The cricothyroid membrane: A) is a cartilaginous structure located between the thyroid and cricoid cartilages. B) serves as the primary entry point to the airway when a patient is not breathing. C) is relatively avascular and is covered by skin and minimal subcutaneous tissue. D) is a thin membrane that can be palpated easily just above the thyroid cartilage.
A
Ans: C Page: 855 Type: General Knowledge
9
Q
- Which of the following statements regarding anatomic dead space is correct? A) Anatomic dead space is about 1 mL per pound of body weight. B) Air in the dead space participates in pulmonary gas exchange. C) The amount of dead space increases as tidal volume increases. D) If tidal volume is 500 mL, 200 mL remains in the dead space.
A
Ans: A Page: 860 Type: General Knowledge
10
Q
- The mainstem bronchus ends at the level of the: A) lobar bronchi. B) bronchioles. C) segmental bronchi. D) subsegmental bronchi.
A
Ans: B Page: 856 Type: General Knowledge
11
Q
- ________ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways. A) Kupfer B) Alveolar C) Ciliary D) Goblet
A
Ans: D Page: 857 Type: General Knowledge
12
Q
- What type of medication dries secretions in the airway and prevents the cilia from removing them effectively? A) Diuretic B) Antibiotic C) Antipyretic D) Antihistamine
A
Ans: D Page: 857 Type: General Knowledge
13
Q
- Wheezing is resolved with medications that: A) dry up secretions in the lower airway. B) reduce soft tissue swelling in the larynx. C) relax the smooth muscle of the bronchioles. D) cause bronchoconstriction and improved airflow.
A
Ans: C Page: 858 Type: General Knowledge
14
Q
- If the amount of pulmonary surfactant is decreased: A) alveolar surface tension increases. B) diffuse alveolar hyperinflation occurs. C) alveoli are able to expand more easily. D) pulmonary gas exchange is enhanced.
A
Ans: A Page: 858-859 Type: General Knowledge
15
Q
- In a person who is not bedridden, most pulmonary infections occur in the: A) middle lobes of the lungs. B) bases of the lungs. C) apices of the lungs. D) upper portion of the lungs.
A
Ans: B Page: 859 Type: General Knowledge
16
Q
- Polycythemia is a condition in which: A) excess red blood cells are produced in response to chronic hypoxia. B) an abundance of red blood cells causes severe thinning of the blood. C) fewer red blood cells are produced, resulting in decreased oxygenation. D) increased platelet production causes the blood to become abnormally thick.
A
Ans: A Page: 859 Type: General Knowledge
17
Q
- Cor pulmonale is defined as: A) increased preload caused by severe hypertension. B) left heart failure secondary to mitral valve damage. C) rupture of the alveoli due to increased surface tension. D) right heart failure secondary to chronic lung disease.
A
Ans: D Page: 859 Type: General Knowledge
18
Q
- A patent airway: A) is evidenced by visible chest rise. B) should be prophylactically suctioned. C) does not equate to adequate ventilation. D) is characterized by adequate tidal volume
A
Ans: C Page: 864 Type: General Knowledge
19
Q
- Hypoventilating patients: A) eliminate too much carbon dioxide. B) become hypercapneic and acidotic. C) experience an increase in blood pH. D) typically do not have an open airway.
A
Ans: B Page: 852-853 Type: General Knowledge
20
Q
- Hyperpnea and tachypnea: A) cause an increase in minute ventilation. B) are caused by decreased diaphragmatic function. C) are characterized by shallow chest wall movement. D) result from decreased negative-pressure ventilation.
A
Ans: A Page: 862 Type: General Knowledge
21
Q
- In contrast to negative-pressure ventilation, positive-pressure ventilation: A) is the forcing of air into the lungs. B) occurs when the diaphragm descends. C) is provided with a nonrebreathing mask. D) can only be provided to intubated patients.
A
Ans: A Page: 861-862 Type: General Knowledge
22
Q
- Difficulty with exhalation is MOST characteristic of: A) supraglottic swelling. B) upper airway obstruction. C) a mild asthma attack. D) obstructive lung disease.
A
Ans: D Page: 860 Type: General Knowledge
23
Q
- Apneustic breathing is characterized by: A) a sustained pattern of tachypnea and increased tidal volume. B) short, brisk inhalations with a long pause before exhalation. C) regular respirations with a normal rate and adequate tidal volume. D) a crescendo-decrescendo pattern of breathing with apneic periods.
A
Ans: B Page: 868 Type: General Knowledge
24
Q
- ___________ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea. A) Biot B) Agonal C) Eupneic D) Cheyne-Stokes
A
Ans: A Page: 868 Type: General Knowledge
25
25. An unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations. A) eupneic B) hyperpneic C) bradypneic D) Kussmaul
Ans: C Page: 868-869 Type: General Knowledge
26
26. Stretch receptors in the lungs are responsible for the ____________ reflex, which causes you to cough if you take too deep a breath. A) Cushing B) Hering-Breuer C) pneumotaxic D) yawning
Ans: B Page: 861 Type: General Knowledge
27
27. The by-product of cellular respiration is: A) oxygen. B) lactic acid. C) pyruvic acid. D) carbon dioxide.
Ans: D Page: 861 Type: General Knowledge
28
28. Respiratory alkalosis is the result of: A) carbon dioxide retention. B) slow and shallow respirations. C) increased hydrogen ion production. D) excess carbon dioxide elimination.
Ans: D Page: 853 Type: General Knowledge
29
29. If a patient's hemoglobin level is only 10 g/dL, ___ % would have to be desaturated before he or she would appear cyanotic. A) 10 B) 25 C) 30 D) 50
Ans: D Page: 869 Type: General Knowledge
30
30. A patient with orthopnea: A) seeks a sitting position when short of breath. B) is awakened from sleep with severe dyspnea. C) prefers to lie flat in order to facilitate breathing. D) generally has a slow, shallow respiratory pattern.
Ans: A Page: 881 Type: General Knowledge
31
31. The barrel-chest appearance classically seen in emphysemic patients is secondary to: A) widespread atelectasis. B) chest wall hypertrophy. C) air trapping in the lungs. D) carbon dioxide retention.
Ans: C Page: 863 Type: General Knowledge
32
32. If a patient's initial presentation makes you suspicious about a particular respiratory condition, you must: A) begin immediate treatment based on your suspicion. B) make your field impression based on the presentation. C) confirm your suspicions with a thorough assessment. D) immediately perform a focused physical examination.
Ans: C Page: 864 Type: General Knowledge
33
33. A patient with respiratory distress who is willing to lie flat: A) should be intubated at once. B) may be acutely deteriorating. C) has minimal fluid in the lungs. D) likely has basilar pneumonia.
Ans: B Page: 864 Type: General Knowledge
34
34. Retractions of the sternum or ribs during inhalation: A) are common in patients with emphysema. B) are signs of acute respiratory failure in adults. C) occur when soft tissue is pulled in around the bones. D) are especially common in infants and small children.
Ans: D Page: 864-865 Type: General Knowledge
35
35. Paradoxical respiratory movement is characterized by: A) the epigastrium and thorax moving in opposite directions. B) bulging of the intercostal muscles during deep inhalation. C) pulling upward of the suprasternal notch during inhalation. D) a marked decrease in movement in one of the hemithoraces.
Ans: A Page: 865 Type: General Knowledge
36
36. A patient with quiet tachypnea is MOST likely experiencing: A) shock. B) asthma. C) alkalosis. D) airway swelling.
Ans: A Page: 868 Type: General Knowledge
37
37. In contrast to decreased PO2 levels, increased PCO2 levels typically manifest as: A) anxiety. B) combativeness. C) sedation or sleepiness. D) restlessness or confusion.
Ans: C Page: 873 Type: General Knowledge
38
38. An otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when: A) hemoglobin levels fall below 12 g/dL. B) about 5 g/dL of hemoglobin is desaturated. C) his or her oxygen saturation falls below 50%. D) 10% of his or her hemoglobin is desaturated.
Ans: B Page: 869 Type: General Knowledge
39
39. The MOST clinically significant finding when questioning a patient with a chronic respiratory disease is: A) medication use prior to your arrival. B) a recent medication regimen change. C) a recent emergency department visit. D) prior intubation for the same problem.
Ans: D Page: 870 Type: General Knowledge
40
40. Which of the following conditions would LEAST likely present with an acute onset of respiratory distress? A) Pneumonia B) Anaphylaxis C) Pneumothorax D) Pulmonary embolism
Ans: A Page: 863 Type: General Knowledge
41
41. Hepatojugular reflux occurs when: A) left-sided heart failure causes blood to accumulate in the patient's liver. B) the jugular veins collapse in response to palpation of the right upper quadrant. C) mild pressure placed on the patient's liver further engorges the jugular veins. D) a patient's jugular veins are markedly engorged when lying in a supine position.
Ans: C Page: 873 Type: General Knowledge
42
42. Hepatomegaly and jugular venous distention are MOST suggestive of: A) left heart failure. B) right heart failure. C) pulmonary edema. D) severe pneumonia.
Ans: B Page: 873 Type: General Knowledge
43
43. Digital clubbing is MOST indicative of: A) acute hypoxemia. B) chronic hypoxia. C) right heart failure. D) peripheral vascular disease.
Ans: B Page: 874 Type: General Knowledge
44
44. The diaphragm of the stethoscope is designed to auscultate: A) heart tones. B) low-pitched sounds. C) bowel sounds. D) high-pitched sounds.
Ans: D Page: 874-875 Type: General Knowledge
45
45. Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the: A) right middle lobe. B) bases of the lungs. C) apices of the lungs. D) midaxillary line.
Ans: B Page: 865 Type: General Knowledge
46
46. __________ breath sounds are the MOST commonly heard breath sounds and have a much more obvious inspiratory component. A) Vesicular B) Bronchial C) Tracheal D) Bronchovesicular
Ans: A Page: 866 Type: General Knowledge
47
47. Inspiratory and expiratory\_\_\_\_\_\_\_\_\_\_ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds. A) tracheal B) bronchial C) vesicular D) bronchovesicular
Ans: B Page: 866 Type: General Knowledge
48
48. The presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates: A) right-sided congestive heart failure. B) isolated consolidation of secretions. C) thick secretions in the large airways. D) air being forced through narrowed airways.
Ans: C Page: 867 Type: General Knowledge
49
49. A patient who is coughing up purulent sputum is MOST likely experiencing: A) emphysema. B) dehydration. C) an infection. D) pulmonary edema.
Ans: C Page: 868 Type: General Knowledge
50
50. Frothy sputum that has a pink tinge to it is MOST suggestive of: A) tuberculosis. B) antihistamine use. C) chronic bronchitis. D) congestive heart failure.
Ans: D Page: 868 Type: General Knowledge
51
51. If a patient's hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient's oxygen saturation would MOST likely read: A) above 95%. B) between 90% and 95% C) between 85% and 90%. D) significantly lower than 85%.
Ans: A Page: 875 Type: General Knowledge
52
52. A pulse oximetry reading would be LEAST accurate in a patient: A) with chronic hypoxia. B) whose extremities are cool. C) with persistent tachycardia. D) with poor peripheral perfusion.
Ans: D Page: 875 Type: General Knowledge
53
53. When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in: A) small changes in oxygen saturation when large changes in PaO2 occur. B) large changes in oxygen saturation when small changes in PaO2 occur. C) small changes in oxygen saturation when small changes in PaO2 occur. D) large changes in oxygen saturation when large changes in PaO2 occur.
Ans: B Page: 876 Type: General Knowledge
54
54. With regard to pulse oximetry, the more hypoxic a patient becomes: A) the slower his or her PaO2 will fall. B) the faster he or she will desaturate. C) the slower he or she will desaturate. D) the less reliable the pulse oximeter is.
Ans: B Page: 876 Type: General Knowledge
55
55. If a colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled? A) Less than 0.5% B) Between 1% and 2% C) Between 2% and 5% D) More than 5%
Ans: A Page: 876 Type: General Knowledge
56
56. A sudden increase in end-tidal CO2 may be the earliest indicator of: A) ineffective chest compressions. B) inadvertent ET tube dislodgment. C) return of spontaneous circulation. D) developing respiratory alkalosis.
Ans: C Page: 877 Type: General Knowledge
57
57. Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus? A) Children's immune systems are not as developed as adults', so they are more prone to infection. B) Adults were vaccinated against the virus that causes croup, whereas most children were not. C) A child's airway is narrower than an adult's, and even minor swelling can result in obstruction. D) The virus that causes croup replicates far more aggressively in children than it does in adults.
Ans: C Page: 886 Type: General Knowledge
58
58. Which of the following statements regarding epiglottitis is correct? A) Unlike croup, epiglottitis most commonly occurs in the middle of the night, when the outside temperature is cool. B) Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium. C) Most cases of epiglottitis are progressive in their onset and result in severe swelling of the larynx, trachea, and bronchi. D) Characteristic signs of epiglottitis include a low-grade fever, a seal-like barking cough, and varying degrees of respiratory distress.
Ans: B Page: 887 Type: General Knowledge
59
59. Pneumonitis is especially common in older patients with: A) frequent infections. B) a history of a stroke. C) immunocompromise. D) chronic food aspiration.
Ans: D Page: 887 Type: General Knowledge
60
60. COPD is characterized by: A) narrowing of the smaller airways that is often reversible with prompt treatment. B) changes in pulmonary structure and function that are progressive and irreversible. C) small airway spasms during the inhalation phase, resulting in progressive hypoxia. D) widespread alveolar collapse due to increased pressure during the exhalation phase.
Ans: B Page: 888 Type: General Knowledge
61
61. Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT: A) a decreased expiratory phase. B) pursed-lip breathing. C) abdominal muscle use. D) chronic air trapping in the lungs.
Ans: A Page: 888 Type: General Knowledge
62
62. Reactive airway disease is characterized by: A) bronchospasm, edema, and mucus production. B) chronic bronchoconstriction of varying severity. C) acute, reversible swelling of the laryngeal muscles. D) excessive mucus production and a chronic cough.
Ans: A Page: 889 Type: General Knowledge
63
63. The primary treatment of bronchospasm is: A) assisted ventilation. B) humidified oxygen. C) bronchodilator therapy. D) corticosteroid therapy.
Ans: C Page: 889 Type: General Knowledge
64
64. Unlike bronchodilator therapy, corticosteroid therapy: A) causes immediate improvement in breathing. B) takes a few hours to reduce bronchial edema. C) is administered exclusively in a hospital setting. D) is the primary treatment for acute bronchospasm.
Ans: B Page: 890 Type: General Knowledge
65
65. A patient with status asthmaticus commonly presents with: A) compensatory respiratory alkalosis and stridor. B) accessory muscle use and inspiratory wheezing. C) audible expiratory wheezing and severe cyanosis. D) physical exhaustion and inaudible breath sounds.
Ans: D Page: 889 Type: General Knowledge
66
66. A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she: A) takes a bronchodilator and a corticosteroid. B) was previously intubated for his or her condition. C) was recently evaluated in an emergency department. D) has used his or her inhaler twice in the previous week.
Ans: B Page: 889 Type: General Knowledge
67
67. Emphysema is caused by: A) an abundance of pulmonary surfactant. B) chronic destruction of the alveolar walls. C) excessive mucus production in the bronchi. D) progressive weakening of the lung parenchyma.
Ans: B Page: 890 Type: General Knowledge
68
68. The classic presentation of chronic bronchitis is: A) excessive mucus production and a chronic or recurrent productive cough. B) a thin male with pursed-lip breathing and a history of heavy cigarette smoking. C) a dry, hacking cough and a barrel chest due to chronic pulmonary air trapping. D) expiratory wheezing and jugular venous distention due to pulmonary hypertension.
Ans: A Page: 890 Type: General Knowledge
69
69. Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD? A) Nonproductive cough B) White sputum and rales C) Fever and localized crackles D) Dyspnea and diffuse wheezing
Ans: C Page: 891 Type: General Knowledge
70
70. Patients with COPD typically experience an acute exacerbation of their condition because of: A) a secondary condition such as congestive heart failure or a pneumothorax. B) progressively worsening pneumonia that results in a diminished cough reflex. C) chronic noncompliance with their prescribed medications and home oxygen. D) environmental changes such as weather or the inhalation of trigger substances.
Ans: D Page: 891 Type: General Knowledge
71
71. The hypoxic drive is a phenomenon in which: A) a chronically hypoxic patient's primary respiratory drive is stimulated by increased levels of carbon dioxide in the arterial blood. B) a relatively large percentage of patients with COPD become acutely apneic after receiving high-flow oxygen. C) high levels of oxygen rapidly depress a COPD patient's respiratory rate and depth, leading to worsened hypoxia and severe acidosis. D) bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.
Ans: D Page: 892 Type: General Knowledge
72
72. Patients with decompensated asthma or COPD who require positive-pressure ventilation: A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease. B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide. D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.
Ans: B Page: 892 Type: General Knowledge
73
73. An increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs: A) during sudden weather changes. B) during an influenza outbreak. C) when the relative humidity is low. D) when people travel during a holiday.
Ans: A Page: 871 Type: General Knowledge
74
74. A patient who is coughing up thick pulmonary secretions should NOT take: A) a diuretic. B) antihistamines. C) an antitussive. D) bronchodilators.
Ans: C Page: 872 Type: General Knowledge
75
75. Intrapulmonary shunting occurs when: A) nonfunctional alveoli inhibit pulmonary gas exchange. B) the volume of anatomic dead space suddenly increases. C) hyperinflated alveoli retain high levels of carbon dioxide. D) resistance to airflow increases due to bronchoconstriction.
Ans: A Page: 859 Type: General Knowledge
76
76. Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A) pneumonia. B) bronchospasm. C) a pneumothorax. D) a pulmonary embolism.
Ans: A Page: 893 Type: General Knowledge
77
77. Patients with pneumonia often experience a coughing fit when they roll from one side to the other because: A) movement loosens pulmonary secretions and stimulates coughing. B) most cases of pneumonia occur in conjunction with bronchospasm. C) the secretions in their lungs suddenly disperse and impair breathing. D) pneumonia often occurs in the lung bases, typically on only one side.
Ans: D Page: 893 Type: General Knowledge
78
78. Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with: A) emphysema. B) lung cancer. C) pleural effusion. D) acute bronchitis.
Ans: B Page: 894 Type: General Knowledge
79
79. When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear: A) inspiratory rhonchi to the bilateral apices of the lungs. B) crackles in the bases of the lungs at the end of inspiration. C) faint rhonchi to all lung fields on inspiration and expiration. D) coarse crackles to the bases of the lungs during inspiration.
Ans: B Page: 895 Type: General Knowledge
80
80. A person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has: A) pleurisy. B) a pleural effusion. C) a pneumothorax. D) acute pneumonia.
Ans: C Page: 896 Type: General Knowledge
81
81. One of the hallmarks of a pulmonary embolism is: A) the disappearance of radial pulses during inhalation. B) pleuritic chest pain that occurs after a strong cough. C) cyanosis that does not resolve with oxygen therapy. D) jugular venous distention while in a supine position.
Ans: C Page: 896-897 Type: General Knowledge
82
82. Pickwickian syndrome is a condition in which respiratory compromise results from: A) extreme obesity. B) pulmonary edema. C) cervical spine injury. D) diaphragmatic rupture.
Ans: A Page: 853 Type: General Knowledge
83
83. You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on: A) LSD. B) ibuprofen. C) Prozac. D) heroin.
Ans: D Page: 853 Type: General Knowledge
84
84. A hyperventilating patient: A) may be acidotic and is trying to decrease his or her pH level. B) is most effectively treated by administering a sedative drug. C) should rebreathe his or her carbon dioxide to effect resolution. D) presents with tachypnea and marked use of accessory muscles.
Ans: A Page: 853 Type: General Knowledge
85
85. Patients with obvious respiratory failure require immediate: A) intubation. B) ventilation support. C) passive oxygenation. D) bronchodilator therapy.
Ans: B Page: 880-883 Type: General Knowledge
86
86. Intubation of a patient with severe asthma: A) is clearly indicated if the patient's condition does not resolve following field corticosteroid therapy. B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces. C) should only be performed after hyperventilating the patient with a bag-mask device for 2 to 3 minutes. D) is generally contraindicated because weaning the patient off of a ventilator can take several days.
Ans: B Page: 885 Type: General Knowledge
87
87. Use of a spacer device in conjunction with a metered-dose inhaler: A) is only indicated in children under 6 years of age, who are generally not able to use the inhaler effectively. B) may be required when assisting a patient who is breathing inadequately, but generally results in less medication delivery to the lungs. C) 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. D) requires the patient to time his or her inhalation to coincide with the discharge of the metered-dose inhaler.
Ans: C Page: 879 Type: General Knowledge
88
88. When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least ____ liters per minute. A) 4 B) 6 C) 8 D) 10
Ans: B Page: 878 Type: General Knowledge
89
89. Which of the following medications is a parasympathetic bronchodilator? A) Alupent B) Albuterol C) Bronkosol D) Ipratropium
Ans: D Page: 878 Type: General Knowledge
90
90. CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by: A) improving patency of the lower airway through the use of positive-end expiratory pressure. B) maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. C) increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia. D) delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.
Ans: A Page: 883-884 Type: General Knowledge
91
91. A critical step when using a CPAP unit to treat a patient with severe respiratory distress is: A) ensuring an adequate mask seal with minimal leakage. B) holding the mask to the noncompliant patient's face. C) starting with CPAP levels above 10 to 15 cm of water. D) setting the oxygen flow rate to at least 6 L/min.
Ans: A Page: 883-884 Type: General Knowledge
92
92. Use of an automated transport ventilator is NOT appropriate for patients who are: A) in cardiac arrest. B) apneic with a pulse. C) chemically paralyzed. D) breathing spontaneously.
Ans: D Page: 885 Type: General Knowledge
93
93. 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: A) increase her oxygen flow rate to 6 L/min. B) administer a beta-2 agonist via nebulizer. C) place her in a position that facilitates breathing. D) auscultate her lungs for adventitious breath sounds.
Ans: C Page: 880-881 Type: Critical Thinking
94
94. 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: A) bronchitis. B) pneumonia. C) end-stage COPD. D) COPD exacerbation.
Ans: B Page: 891 Type: Critical Thinking
95
95. A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's 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. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress? A) Oxygen noncompliance B) Recent antitussive use C) An underlying infection D) Acute right heart failure
Ans: B Page: 872 Type: Critical Thinking
96
96. 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 had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should: A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital. B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea. C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible. D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.
Ans: A Page: 884, 888-889 Type: Critical Thinking
97
97. A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST? A) Begin assisting his ventilations. B) Assess his oxygen saturation level. C) Administer a beta-2 agonist drug. D) Sit him up or place him on his side.
Ans: D Page: 853, 880-881 Type: Critical Thinking
98
98. A 21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves: A) performing a needle decompression to the right side of his chest. B) assisting his ventilations in order to increase his oxygen saturation. C) administering high-flow supplemental oxygen and transporting at once. D) applying a CPAP unit and starting an IV line en route to the hospital.
Ans: C Page: 896 Type: Critical Thinking
99
99. You are transporting a patient with a long history of emphysema. The patient called 9-1-1 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: A) remove the nonrebreathing mask and apply a nasal cannula. B) administer a sedative and a paralytic and then intubate his trachea. C) begin assisting his ventilations with a bag-mask and 100% oxygen. D) insert a nasal airway, apply a CPAP unit, and notify medical control.
Ans: C Page: 892 Type: Critical Thinking
100
100. 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: A) expect to hear crackles when you auscultate her lungs. B) suspect acute right heart failure and administer oxygen. C) start an IV of normal saline and give her a 250-mL bolus. D) conclude that she has been noncompliant with her diuretic.
Ans: B Page: 891 Type: Critical Thinking
101
101. 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 delivery via the nebulizer and his mental status is deteriorating. You should: A) assist his ventilations and establish vascular access. B) start an IV of normal saline and administer a steroid. C) apply high-flow oxygen via a nonrebreathing mask. D) assist him with a metered-dose inhaler bronchodilator.
Ans: A Page: 883 Type: Critical Thinking
102
102. 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 device, 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: A) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. C) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. D) decrease the amount of positive-end expiratory pressure that you are delivering and reassess.
Ans: B Page: 884 Type: Critical Thinking
103
103. 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: A) suction his oropharynx, perform intubation, and then administer naloxone via slow IV push. B) preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea. C) apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations. D) assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.
Ans: D Page: 853, 885 Type: Critical Thinking
104
104. You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for: A) a pleural effusion. B) spontaneous pneumothorax. C) acute pulmonary embolism D) hyperventilation syndrome.
Ans: C Page: 896-897 Type: Critical Thinking
105
105. You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B) provide aggressive airway management unless the daughter can produce a valid DNR order. C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.
Ans: D Page: 891-892 Type: Critical Thinking
106
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.
Ans: D Page: 1038 Type: General Knowledge
107
2. Components of the diencephalon include the: A) pons and medulla. B) brainstem and midbrain. C) thalamus and hypothalamus. D) cerebellum and cerebral cortex.
Ans: C Page: 1040 Type: General Knowledge
108
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.
Ans: D Page: 1040-1041 Type: General Knowledge
109
4. What portion of the brainstem regulates respiratory rate and depth? A) Pons B) Medulla C) Midbrain D) Basal nuclei
Ans: A Page: 1041 Type: General Knowledge
110
5. Emotions such as rage and anger are generated in the: A) thalamus. B) limbic system. C) hypothalamus. D) diencephalon.
Ans: B Page: 1041 Type: General Knowledge
111
6. 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.
Ans: B Page: 1041 Type: General Knowledge
112
7. A loss of balance and equilibrium suggests injury to the: A) midbrain. B) cerebrum. C) thalamus. D) cerebellum.
Ans: D Page: 1041-1042 Type: General Knowledge
113
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.
Ans: C Page: 1042 Type: General Knowledge
114
9. Chemicals that relay electrically conducted signals from one neuron to another are called: A) hormones. B) endorphins. C) catecholamines. D) neurotransmitters.
Ans: D Page: 1042 Type: General Knowledge
115
10. 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.
Ans: A Page: 1042 Type: General Knowledge
116
11. 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.
Ans: A Page: 1042-1043 Type: General Knowledge
117
12. A neoplasm is MOST accurately defined as a: A) normal cell. B) new growth. C) damaged cell. D) cancerous tumor.
Ans: B Page: 1071 Type: General Knowledge
118
13. 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.
Ans: B Page: 1071-1072 Type: General Knowledge
119
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.
Ans: C Page: 1061-1064 Type: General Knowledge
120
15. 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.
Ans: D Page: 1051-1052 Type: General Knowledge
121
16. The MOST common sign of an infectious disease is the presence of: A) a fever. B) seizures. C) a headache. D) tachycardia.
Ans: A Page: 1077 Type: General Knowledge
122
17. 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.
Ans: A Page: 1058 Type: General Knowledge
123
18. 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.
Ans: B Page: 1058-1060 Type: General Knowledge
124
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.
Ans: D Page: 1060 Type: General Knowledge
125
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.
Ans: C Page: 1060 Type: General Knowledge
126
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
Ans: B Page: 1060 Type: General Knowledge
127
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
Ans: D Page: 1060 Type: General Knowledge
128
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
Ans: A Page: 1060 Type: General Knowledge
129
24. 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.
Ans: C Page: 1061 Type: General Knowledge
130
25. 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.
Ans: B Page: 1061 Type: General Knowledge
131
26. 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.
Ans: B Page: 1043-1044 Type: General Knowledge
132
27. 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.
Ans: D Page: 1050 Type: General Knowledge
133
28. All of the following cranial nerves are responsible for airway control, EXCEPT the: A) abducens. B) trigeminal. C) hypoglossal. D) glossopharyngeal.
Ans: A Page: 1044 Type: General Knowledge
134
29. 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.
Ans: C Page: 1044, 1057 Type: General Knowledge
135
30. 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.
Ans: C Page: 1045 Type: General Knowledge
136
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
Ans: B Page: 1055 Type: General Knowledge
137
32. 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.
Ans: D Page: 1045 Type: General Knowledge
138
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.
Ans: D Page: 1051 Type: General Knowledge
139
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.
Ans: A Page: 1044 Type: General Knowledge
140
35. 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.
Ans: A Page: 1051 Type: General Knowledge
141
36. 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.
Ans: B Page: 1048 Type: General Knowledge
142
37. 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.
Ans: B Page: 1053 Type: General Knowledge
143
38. A patient who is unable to use a common object is said to be: A) agnosic. B) aphasic. C) atonic. D) apraxic.
Ans: D Page: 1053 Type: General Knowledge
144
39. 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.
Ans: C Page: 1053 Type: General Knowledge
145
40. The involuntary, rhythmic movement of the eyes is called: A) nystagmus. B) hyperopia. C) anisocoria. D) dysphagia.
Ans: A Page: 1073 Type: General Knowledge
146
41. 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.
Ans: B Page: 1054-1055 Type: General Knowledge
147
42. A staggering gait is MOST suggestive of damage to the: A) medulla. B) cerebrum. C) brainstem. D) cerebellum.
Ans: D Page: 1055 Type: General Knowledge
148
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
Ans: A Page: 1055 Type: General Knowledge
149
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
Ans: C Page: 1075 Type: General Knowledge
150
45. 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.
Ans: B Page: 1055 Type: General Knowledge
151
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
Ans: D Page: 1055, 1073 Type: General Knowledge
152
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
Ans: B Page: 1056 Type: General Knowledge
153
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.
Ans: A Page: 1067 Type: General Knowledge
154
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.
Ans: C Page: 1076 Type: General Knowledge
155
50. 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.
Ans: C Page: 1049-1050 Type: General Knowledge
156
51. 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.
Ans: B Page: 1044-1045 Type: Critical Thinking
157
52. 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.
Ans: D Page: 1044-1046, 1057 Type: Critical Thinking
158
53. 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.
Ans: A Page: 1061 Type: Critical Thinking
159
54. 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.
Ans: A Page: 1056-1057 Type: Critical Thinking
160
55. 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?”
Ans: D Page: 1064 Type: Critical Thinking
161
56. 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.
Ans: B Page: 1060-1063 Type: Critical Thinking
162
57. 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.
Ans: C Page: 1064-1065 Type: Critical Thinking
163
58. 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.
Ans: B Page: 1065-1066 Type: Critical Thinking
164
59. 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.
Ans: A Page: 1067-1069 Type: Critical Thinking
165
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
Ans: A Page: 1068 Type: Critical Thinking
166
61. 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.
Ans: D Page: 1069 Type: Critical Thinking
167
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.
Ans: B Page: 1069-1070 Type: Critical Thinking
168
63. 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.
Ans: C Page: 1070-1071 Type: Critical Thinking
169
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.
Ans: B Page: 1071-1072 Type: Critical Thinking
170
65. 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.
Ans: A Page: 1079 Type: Critical Thinking
171
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.
Ans: C Page: 1077 Type: Critical Thinking
172
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.
Ans: D Page: 1078 Type: General Knowledge
173
68. 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.
Ans: B Page: 1080 Type: General Knowledge
174
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
Ans: B Page: 1080-1081 Type: General Knowledge
175
70. 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.
Ans: C Page: 1079 Type: General Knowledge
176
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.
Ans: D Page: 1075 Type: General Knowledge
177
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
Ans: A Page: 1054 Type: General Knowledge
178
73. Which of the following cranial nerves regulates movement of the head and shoulders? A) Hypoglossal B) Abducens C) Accessory D) Trigeminal
Ans: C Page: 1054 Type: General Knowledge
179
74. 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.
Ans: B Page: 1052-1053 Type: General Knowledge
180
75. 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.
Ans: D Page: 1061 Type: General Knowledge
181
76. 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.
Ans: B Page: 1064 Type: General Knowledge
182
77. Which of the following causes of altered mental status is NOT an acute process? A) Uremia B) Acidosis C) Psychosis D) Epilepsy
Ans: A Page: 1066 Type: General Knowledge
183
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
Ans: C Page: 1067 Type: General Knowledge
184
79. 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.
Ans: B Page: 1069-1070 Type: General Knowledge
185
80. 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.
Ans: D Page: 1076-1077 Type: General Knowledge
186
1. The \_\_\_\_\_\_\_, also called the eyeball, is a spherical structure measuring about 1 inch in diameter. A) iris B) globe C) retina D) cornea
Ans: B Page: 1091 Type: General Knowledge
187
2. In contrast to the oculomotor nerve, the optic nerve: A) is the second cranial nerve and provides the sense of vision. B) carries parasympathetic nerve fibers that constrict the pupil. C) is the third cranial nerve and regulates movement of the eyes. D) innervates the muscles that cause motion of the upper eyelids.
Ans: A Page: 1091 Type: General Knowledge
188
3. Icteric sclera are: A) white. B) cloudy. C) yellow. D) bloodshot.
Ans: C Page: 1091 Type: General Knowledge
189
4. Cataracts are caused by clouding of the: A) iris. B) cornea. C) retina. D) sclera.
Ans: B Page: 1091 Type: General Knowledge
190
5. In dark-skinned patients, cyanosis can be detected in the: A) sclera. B) iris. C) cornea. D) conjunctiva.
Ans: D Page: 1091-1092 Type: General Knowledge
191
6. Which of the following structures receives light impulses and converts them to nerve signals that are conducted to the brain by the optic nerve and interpreted as vision? A) Retina B) Cornea C) Pupil D) Lens
Ans: A Page: 1092 Type: General Knowledge
192
7. Central vision is processed by the \_\_\_\_\_\_\_\_, which is the \_\_\_\_\_\_\_\_. A) retina, central portion of the macula B) pupil, circular opening within the iris C) macula, central portion of the retina D) iris, circular opening within the pupil
Ans: C Page: 1092 Type: General Knowledge
193
8. The __________ are cone-shaped fossae that enclose and protect the eyes. A) zygomas B) orbits C) condyles D) crista galli
Ans: B Page: 1091 Type: General Knowledge
194
9. Which of the following statements regarding vitreous humor is correct? A) Vitreous humor can be replenished, but it takes many years. B) Vitreous humor is contained within the posterior chamber of the eye. C) Vitreous humor is a jelly-like substance that maintains the shape of the globe. D) Vitreous humor is a clear fluid that is responsible for tear production.
Ans: C Page: 1092 Type: General Knowledge
195
10. Aqueous humor: A) is contained in the anterior chamber of the eye. B) cannot be replenished by the body if it is lost. C) is contained in the posterior chamber of the eye. D) is found between the iris and the lens of the eye.
Ans: A Page: 1092 Type: General Knowledge
196
11. The ________________ secretes and drains tears from the eye. A) nasolacrimal duct B) conjunctiva C) aqueous humor D) nasolacrimal apparatus
Ans: D Page: 1092 Type: General Knowledge
197
12. Cardiac monitoring is recommended when caring for a patient with an eye-related emergency because: A) eye drops or medication can cause a marked elevation in the heart rate. B) ocular pressure can stimulate the vagus nerve and cause bradycardia. C) vitreous humor loss can result in a variety of ventricular dysrhythmias. D) AV heart blocks commonly occur when vitreous humor is lost.
Ans: B Page: 1093 Type: General Knowledge
198
13. Common symptoms of diabetic retinopathy include all of the following, EXCEPT: A) floaters. B) blurred vision. C) yellow vision. D) blind spots.
Ans: C Page: 1093 Type: General Knowledge
199
14. Which of the following statements regarding the nasal septum is correct? A) It may be slightly deviated to one side or the other. B) The nasal septum is comprised mainly of cartilage. C) Inflammation of the nasal septum is common during infection. D) The nasal septum separates the oropharynx and nasopharynx.
Ans: A Page: 1106 Type: General Knowledge
200
15. Which cranial nerve innervates the muscles that cause motion of the eyeballs and upper eyelids? A) Optic B) Trigeminal C) Oculomotor D) Hypoglossal
Ans: C Page: 1091 Type: General Knowledge
201
16. The anterior chamber is the portion of the globe between the _____ and the \_\_\_\_\_, and is filled with _____ humor. A) iris, lens, vitreous B) cornea, iris, aqueous C) lens, iris, vitreous D) lens, cornea, aqueous
Ans: D Page: 1092 Type: General Knowledge
202
17. Which of the following statements regarding vitreous humor is correct? A) Vitreous humor is a jelly-like substance that is replenished if lost. B) Vitreous humor fills the posterior chamber and maintains the shape of the globe. C) Vitreous humor is a clear watery fluid that fills the anterior chamber. D) The most significant risk caused by a loss of vitreous humor is infection
Ans: B Page: 1092 Type: General Knowledge
203
18. A patient with a loss of peripheral vision MOST likely has damage to the: A) retina. B) pupil. C) cornea. D) lens.
Ans: A Page: 1092 Type: General Knowledge
204
19. The large cartilaginous external portion of the ear is called the: A) ossicle. B) cochlea. C) auricle. D) oval window.
Ans: C Page: 1102 Type: General Knowledge
205
20. The middle ear consists of the: A) cochlea and semicircular canals. B) organ of Corti and the external auditory canal. C) inner portion of the tympanic membrane and the ossicles. D) pinna and the exterior portion of the tympanic membrane.
Ans: C Page: 1102 Type: General Knowledge
206
21. _________ forms the principal mass of the tooth and is much denser and stronger than bone. A) Pulp B) Dentin C) Enamel D) Gingiva
Ans: B Page: 1109 Type: General Knowledge
207
22. The ___________ nerve provides motor function to the muscles of the tongue. A) hypoglossal B) trigeminal C) accessory D) glossopharyngeal
Ans: A Page: 1110 Type: General Knowledge
208
23. Hyphema is defined as: A) severe ecchymosis to the orbital region. B) blood in the anterior chamber of the eye. C) marked swelling of the globe of the eye. D) double vision following blunt eye trauma.
Ans: B Page: 1100 Type: General Knowledge
209
24. Signs and symptoms of retinal detachment include: A) flashing lights, specks, or floaters in the field of vision. B) double vision and partial or complete loss of peripheral vision. C) immediate pain and total loss of vision following blunt eye trauma. D) paralysis of upward gaze and greater than 50% loss of central vision.
Ans: A Page: 1101 Type: General Knowledge
210
25. What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelids
Ans: D Page: 1094 Type: General Knowledge
211
26. Which of the following statements regarding anisocoria is correct? A) Anisocoria is a condition in which the pupils are unequal. B) Anisocoria is a normal finding in the majority of the population. C) Physiologic anisocoria indicates significant intracranial pressure. D) Anisocoria is a condition characterized by bilateral pupillary dilation.
Ans: A Page: 1094 Type: General Knowledge
212
27. A patient with a dysconjugate gaze following an ocular injury: A) most likely has a concomitant basilar skull fracture. B) should have ice applied to the eyes to prevent blindness. C) has discoordination between the movements of both eyes. D) should be treated by irrigating both eyes for 20 minutes.
Ans: C Page: 1093 Type: General Knowledge
213
28. Movement of both of the eyes in unison is called: A) dysconjugate gaze. B) sympathetic eye movement. C) extraocular movement. D) physiologic anisocoria.
Ans: B Page: 1098, 1120 Type: General Knowledge
214
29. Alkali or strong acid burns to the eye should be irrigated for at least ____ minutes. A) 10 B) 15 C) 20 D) 30
Ans: C Page: 1095 Type: General Knowledge
215
30. The ONLY indication for removing contact lenses in the prehospital setting is: A) chemical eye burns. B) acute conjunctivitis. C) cardiopulmonary arrest. D) a foreign body in the eye.
Ans: A Page: 1097 Type: General Knowledge
216
31. A ruptured tympanic membrane: A) commonly results in permanent hearing loss. B) is characterized by CSF leakage from the ears. C) commonly leads to an infection of the middle ear. D) is extremely painful but typically heals spontaneously
Ans: D Page: 1106 Type: General Knowledge
217
32. Retinal injuries that are caused by exposure to extremely bright light: A) are generally not painful but may result in permanent damage. B) cause immediate intense pain and result in permanent blindness. C) are painless and almost always heal without permanent damage. D) cause severe pain but heal quickly and without permanent damage.
Ans: A Page: 1094 Type: General Knowledge
218
33. In which of the following situations is the Morgan lens NOT appropriate to use? A) Eye burn from a strong alkali B) An object impaled in the eye C) Eye burn from a strong acid D) Any foreign body in the eye
Ans: B Page: 1095 Type: General Knowledge
219
34. Which of the following statements regarding conjunctivitis is correct? A) Allergic conjunctivitis is extremely contagious. B) Conjunctivitis usually spreads to the opposite eye. C) Viral and bacterial conjunctivitis are not contagious. D) Lower respiratory infections often cause conjunctivitis.
Ans: B Page: 1097-1098 Type: General Knowledge
220
35. Metal filings are particularly inflammatory because they cause a “rust ring” of the ________ after 24 hours. A) iris B) sclera C) cornea D) retina
Ans: C Page: 1098 Type: General Knowledge
221
36. Patients with a corneal abrasion may present with all of the following, EXCEPT: A) hyphema. B) severe pain. C) photophobia. D) excess tearing.
Ans: A Page: 1098 Type: General Knowledge
222
37. A red, tender lump in the eyelid or at the lid margin is called a: A) rust ring. B) hyphema. C) chalazion. D) hordeolum.
Ans: D Page: 1098-1099 Type: General Knowledge
223
38. Glaucoma is a condition caused by: A) a loss of peripheral vision. B) retinal artery occlusion. C) increased intraocular pressure. D) decreased vitreous humor.
Ans: C Page: 1100 Type: General Knowledge
224
39. Patients with glaucoma often complain of: A) a blind spot toward the center of vision. B) a sudden painless complete loss of vision. C) specks or floaters in the field of vision. D) intense burning or itching around the eyes.
Ans: A Page: 1100 Type: General Knowledge
225
40. Headaches, nausea and vomiting, narrowing vision fields, and a “graying” in the field of vision are consistent with: A) glaucoma. B) papilledema. C) corneal abrasion. D) anterior uveitis.
Ans: B Page: 1101 Type: General Knowledge
226
41. Retinal detachment is especially common in: A) boxing. B) football. C) diabetics. D) water sports.
Ans: A Page: 1101 Type: General Knowledge
227
42. Within the cochlea, at the \_\_\_\_\_\_\_\_\_\_\_\_\_\_, vibration stimulates hair movements that form nerve impulses that travel to the brain via the auditory nerve. A) oval window B) cochlear duct C) semicircular canals D) organ of Corti
Ans: D Page: 1102 Type: General Knowledge
228
43. Which of the following is NOT an inner ear structure? A) Cochlea B) Oval window C) Eustachian tube D) Semicircular canal
Ans: C Page: 1102-1103 Type: General Knowledge
229
44. Vertigo or loss of balance following an ear infection or upper respiratory infection is MOST consistent with: A) labyrinthitis. B) Meniere disease. C) otitis externa. D) impacted cerumen.
Ans: A Page: 1104 Type: General Knowledge
230
45. What is the pathophysiology of Meniere disease? A) Irritation and swelling in the inner ear affect the nerves of the inner ear and produce dizziness, loss of balance, and tinnitus. B) Dysfunction of the eustachian tube leads to increased pressure within the middle ear, which causes damage to the malleus, incus, and stapes. C) The angle of the eustachian tube does not allow for proper drainage, which allows infective material to collect in the middle ear and cause infection. D) Endolymphatic rupture creates increased pressure in the cochlear duct, which then leads to damage to the organ of Corti and the semicircular canals.
Ans: D Page: 1105 Type: General Knowledge
231
46. Treatment for Meniere disease includes: A) tubes placed in the ears. B) diuretics and antiemetics. C) hearing aids and analgesics. D) hydration and antipyretics.
Ans: B Page: 1105 Type: General Knowledge
232
47. Signs or symptoms of otitis media include: A) hypersensitivity to sound. B) bilateral chronic tinnitus. C) bulging tympanic membrane. D) vertigo and violent vomiting.
Ans: C Page: 1105 Type: General Knowledge
233
48. Common causes of a ruptured tympanic membrane include all of the following, EXCEPT: A) diving injuries. B) otitis externa. C) foreign bodies. D) blast injuries.
Ans: B Page: 1106 Type: General Knowledge
234
49. Signs and symptoms of a ruptured tympanic membrane include: A) permanent deafness and a unilateral headache. B) CSF leakage from the ear and severe tinnitus. C) a low-grade fever and fullness in the ear. D) hearing loss and blood drainage from the ear.
Ans: D Page: 1106 Type: General Knowledge
235
50. A distorted sense of smell in which a person perceives unpleasant odors when the odors do not exist is called: A) dysosmia. B) hyperosmia. C) presbyosmia. D) anosmia.
Ans: A Page: 1106 Type: General Knowledge
236
51. The ______________ decrease(s) the weight of the skull and provide(s) resonance for the voice. A) turbinates B) nasal septum C) paranasal sinuses D) nasal mucosa
Ans: C Page: 1106 Type: General Knowledge
237
52. Causes of rhinitis may include all of the following, EXCEPT: A) chemical irritants. B) high humidity. C) antihypertensives. D) cold temperature.
Ans: B Page: 1107 Type: General Knowledge
238
53. Paralysis of cranial nerve ____ can cause unilateral facial and gag reflex paralysis. A) V B) VI C) VII D) X
Ans: C Page: 1108 Type: General Knowledge
239
54. Which of the following is a complication associated with dysfunction of cranial nerves VI, VII, IX, and XII? A) Hearing impairment B) Acute ischemic stroke C) Aspiration pneumonia D) Upper airway obstruction
Ans: C Page: 1108 Type: General Knowledge
240
55. The bony sockets for the teeth that reside in the mandible and maxilla are called: A) cusps. B) pulp. C) dentin. D) alveoli.
Ans: D Page: 1109 Type: General Knowledge
241
56. Mastication is defined as: A) chewing. B) swallowing. C) digesting. D) teeth clenching.
Ans: A Page: 1109 Type: General Knowledge
242
57. Which cranial nerve provides taste sensation to the posterior portions of the tongue and carries parasympathetic fibers to the salivary glands? A) Vagus B) Glossopharyngeal C) Hypoglossal D) Vestibulocochlear
Ans: B Page: 1110 Type: General Knowledge
243
58. Systemic signs of a dental abscess include: A) fever and chills. B) inflammation. C) swelling and pain. D) mandibular pain.
Ans: A Page: 1110 Type: General Knowledge
244
59. A yeast infection that causes white patches in the mouth or on the tongue is called: A) thrush. B) gingivitis. C) leukoplakia. D) halitosis.
Ans: A Page: 1111 Type: General Knowledge
245
60. Leukoplakia: A) is caused by the fungus Candida albicans. B) presents with red swollen gums that bleed easily during brushing. C) is a smoker's disease that causes excess cell growth in the mouth. D) presents with dark yellow or brown patches in the oral cavity.
Ans: C Page: 1111 Type: General Knowledge
246
61. You would MOST likely encounter oral candidiasis in a patient: A) who has had numerous cavities. B) who takes oral corticosteroids. C) with a history of gingivitis. D) who is immunocompromised.
Ans: D Page: 1112 Type: General Knowledge
247
62. Which of the following has the greatest potential for causing an airway problem? A) Oral candidiasis B) Leukoplakia C) Ludwig angina D) A dental abscess
Ans: C Page: 1113 Type: General Knowledge
248
63. Which of the following statements regarding epiglottitis is correct? A) It is caused by the Staphylococcus bacterium. B) It now occurs more often in adults. C) It is much less severe than croup. D) It affects children under 2 years of age.
Ans: B Page: 1113 Type: General Knowledge
249
64. Patients with epiglottitis present with: A) dysphagia. B) wheezing. C) dentalgia. D) hyperosmia.
Ans: A Page: 1113 Type: General Knowledge
250
65. Fever, hoarseness, and swollen lymph nodes in the neck are common clinical signs of: A) tracheitis. B) oral candidiasis. C) laryngitis. D) Ludwig angina.
Ans: C Page: 1113 Type: General Knowledge
251
66. A 4-year-old child presents with a deep “croup-like” cough, difficulty breathing, and a high fever. You should suspect: A) epiglottitis. B) pharyngitis. C) laryngitis. D) tracheitis.
Ans: D Page: 1113 Type: Critical Thinking
252
67. A young female presents with a headache, severe aching around her right ear, and difficulty chewing. Assessment and treatment for her should focus on: A) anticipating airway compromise. B) analgesia as needed and transport. C) placing her in a semi-Fowler position. D) avoiding the use of a nasopharyngeal airway.
Ans: B Page: 1114 Type: Critical Thinking
253
68. A construction worker was hammering when he experienced a sudden severe pain to his right eye. Assessment of his eye reveals that it is irritated and you can see a small sliver of metal imbedded in the globe. He is also wearing contact lenses. You should: A) remove his contact lenses and irrigate his eye with copious amounts of water. B) leave his contact lenses in place and cover both eyes with a sterile dressing. C) attempt to remove the foreign object only if he has any visual disturbances. D) remove his contact lenses and administer a narcotic analgesic for pain.
Ans: B Page: 1093-1097 Type: Critical Thinking
254
69. A man who was using an arc welder without eye protection presents with bilateral eye pain and diminished vision. He is conscious and alert, has a patent airway, and has stable vital signs. Treatment should include: A) covering his eyes with sterile, moist dressings; applying cool compresses lightly over his eyes; and placing him in a supine position. B) immediately irrigating his eyes with sterile saline or water; covering both eyes with dry, sterile dressings; and allowing him to sit up. C) placing him in a lateral recumbent position, keeping his eyelids closed with tape, and applying chemical warm compresses to his eyes. D) mixing baking powder with sterile water or saline and irrigating his eyes to prevent further damage caused by the ultraviolet light.
Ans: A Page: 1094-1095 Type: Critical Thinking
255
70. A chemistry student accidentally splashed a strong acid chemical into his eyes. He wears rigid gas-permeable contact lenses and is experiencing intense pain. You should: A) leave his contact lenses in place and irrigate his eyes throughout transport. B) carefully remove his contact lenses and cover both eyes with dry dressings. C) carefully remove his contact lenses and flush his eyes for at least 20 minutes. D) leave his contact lenses in place and neutralize the acid with a strong alkali.
Ans: C Page: 1095-1097 Type: Critical Thinking
256
71. 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: A) carefully assessing her eye for an object imbedded in the globe and removing it if one is present. B) instructing her to continue rapid eye blinking and administering analgesia as indicated. C) gently rubbing the surface of the eye with a cotton-tipped applicator to remove the foreign body. D) gently irrigating her eye and taping the affected eye closed to prevent it from drying out.
Ans: D Page: 1098 Type: Critical Thinking
257
72. You are assessing an unresponsive patient and note the presence of a hyphema to his left eye. This is evidence of: A) a foreign body in the eye. B) a chemical burn to the eye. C) lacrimal gland dysfunction. D) blunt force trauma to the eye.
Ans: D Page: 1100 Type: Critical Thinking
258
73. You are assessing a man who was boxing with his friend. He complains of seeing flashing lights and “floaters” in his field of vision. The MOST important intervention is: A) high-flow oxygen. B) immediate transport. C) irrigation of his eyes. D) covering both of his eyes.
Ans: B Page: 1101 Type: Critical Thinking
259
74. A 55-year-old female complains of severe vertigo, tinnitus, nausea, and a sense of fullness in her right ear. You should: A) administer an antiemetic and monitor her airway in case she vomits. B) carefully inspect her ear with an otoscope and administer furosemide. C) administer diphenhydramine to reduce any swelling in her inner ear. D) keep her supine, administer crystalloid fluid boluses, and inspect her ear.
Ans: A Page: 1105 Type: Critical Thinking
260
75. You are assessing an elderly man who has asthma and uses an inhaled corticosteroid on a regular basis. He has white patches on his tongue and the inside of his mouth. He is conscious and alert and his airway is patent. You should: A) suspect that he has leukoplakia. B) irrigate his mouth with sterile water. C) provide supportive care and transport. D) carefully scrape the lesions from his tongue.
Ans: C Page: 1111-1113 Type: Critical Thinking
