Chapters 16, 18, and 19 random

Question 1

17. 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.

Answer 1

Ans: D Page: 859 Type: General Knowledge

Question 2

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.

Answer 2

Ans: A Page: 1094 Type: General Knowledge

Question 3

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.

Answer 3

Ans: D Page: 1105 Type: General Knowledge

Question 4

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.

Answer 4

Ans: D Page: 870 Type: General Knowledge

Question 5

8. 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.

Answer 5

Ans: C Page: 855 Type: General Knowledge

Question 6

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

Answer 6

Ans: B Page: 1056 Type: General Knowledge

Question 7

17. 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.

Answer 7

Ans: D Page: 859 Type: General Knowledge

Question 8

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

Answer 8

Ans: A Page: 1068 Type: Critical Thinking

Question 9

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.

Answer 9

Ans: C Page: 896 Type: General Knowledge

Question 10

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.

Answer 10

Ans: C Page: 1111 Type: General Knowledge

Question 11

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.

Answer 11

Ans: D Page: 1075 Type: General Knowledge

Question 12

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.

Answer 12

Ans: A Page: 865 Type: General Knowledge

Question 13

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.

Answer 13

Ans: D Page: 1113 Type: Critical Thinking

Question 14

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.

Answer 14

Ans: D Page: 1106 Type: General Knowledge

Question 15

76. Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A) pneumonia. B) bronchospasm. C) a pneumothorax. D) a pulmonary embolism.

Answer 15

Ans: A Page: 893 Type: General Knowledge

Question 16

43. Digital clubbing is MOST indicative of: A) acute hypoxemia. B) chronic hypoxia. C) right heart failure. D) peripheral vascular disease.

Answer 16

Ans: B Page: 874 Type: General Knowledge

Question 17

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.

Answer 17

Ans: D Page: 853 Type: General Knowledge

Question 18

52. Causes of rhinitis may include all of the following, EXCEPT: A) chemical irritants. B) high humidity. C) antihypertensives. D) cold temperature.

Answer 18

Ans: B Page: 1107 Type: General Knowledge

Question 19

14. 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.

Answer 19

Ans: A Page: 858-859 Type: General Knowledge

Question 20

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.

Answer 20

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

Question 21

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.

Answer 21

Ans: A Page: 1106 Type: General Knowledge

Question 22

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.

Answer 22

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

Question 23

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.

Answer 23

Ans: B Page: 1114 Type: Critical Thinking

Question 24

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

Answer 24

Ans: C Page: 1098 Type: General Knowledge

Question 25

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.

Answer 25

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

Question 26

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.

Answer 26

Ans: B Page: 885 Type: General Knowledge

Question 27

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

Answer 27

Ans: B Page: 1110 Type: General Knowledge

Question 28

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.

Answer 28

Ans: A Page: 1092 Type: General Knowledge

Question 29

24. ___________ 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

Answer 29

Ans: A Page: 868 Type: General Knowledge

Question 30

28. Movement of both of the eyes in unison is called: A) dysconjugate gaze. B) sympathetic eye movement. C) extraocular movement. D) physiologic anisocoria.

Answer 30

Ans: B Page: 1098, 1120 Type: General Knowledge

Question 31

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

Answer 31

Ans: B Page: 866 Type: General Knowledge

Question 32

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.

Answer 32

Ans: C Page: 1102 Type: General Knowledge

Question 33

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

Answer 33

Ans: D Page: 1042 Type: General Knowledge

Question 34

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.

Answer 34

Ans: C Page: 879 Type: General Knowledge

Question 35

15. 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.

Answer 35

Ans: B Page: 859 Type: General Knowledge

Question 36

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

Answer 36

Ans: C Page: 1067 Type: General Knowledge

Question 37

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.

Answer 37

Ans: D Page: 1078 Type: General Knowledge

Question 38

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.

Answer 38

Ans: A Page: 1105 Type: Critical Thinking

Question 39

3. Icteric sclera are: A) white. B) cloudy. C) yellow. D) bloodshot.

Answer 39

Ans: C Page: 1091 Type: General Knowledge

Question 40

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

Answer 40

Ans: C Page: 1075 Type: General Knowledge

Question 41

13. Common symptoms of diabetic retinopathy include all of the following, EXCEPT: A) floaters. B) blurred vision. C) yellow vision. D) blind spots.

Answer 41

Ans: C Page: 1093 Type: General Knowledge

Question 42

41. Retinal detachment is especially common in: A) boxing. B) football. C) diabetics. D) water sports.

Answer 42

Ans: A Page: 1101 Type: General Knowledge

Question 43

29. Alkali or strong acid burns to the eye should be irrigated for at least ____ minutes. A) 10 B) 15 C) 20 D) 30

Answer 43

Ans: C Page: 1095 Type: General Knowledge

Question 44

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.

Answer 44

Ans: B Page: 891 Type: Critical Thinking

Question 45

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.

Answer 45

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

Question 46

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.

Answer 46

Ans: D Page: 853, 880-881 Type: Critical Thinking

Question 47

36. Patients with a corneal abrasion may present with all of the following, EXCEPT: A) hyphema. B) severe pain. C) photophobia. D) excess tearing.

Answer 47

Ans: A Page: 1098 Type: General Knowledge

Question 48

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.

Answer 48

Ans: D Page: 1060 Type: General Knowledge

Question 49

22. The ___________ nerve provides motor function to the muscles of the tongue. A) hypoglossal B) trigeminal C) accessory D) glossopharyngeal

Answer 49

Ans: A Page: 1110 Type: General Knowledge

Question 50

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

Answer 50

Ans: B Page: 872 Type: Critical Thinking

Question 51

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.

Answer 51

Ans: C Page: 1061 Type: General Knowledge

Question 52

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.

Answer 52

Ans: C Page: 1061 Type: General Knowledge

Question 53

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.

Answer 53

Ans: C Page: 1053 Type: General Knowledge

Question 54

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.

Answer 54

Ans: B Page: 887 Type: General Knowledge

Question 55

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?”

Answer 55

Ans: D Page: 1064 Type: Critical Thinking

Question 56

19. The large cartilaginous external portion of the ear is called the: A) ossicle. B) cochlea. C) auricle. D) oval window.

Answer 56

Ans: C Page: 1102 Type: General Knowledge

Question 57

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

Answer 57

Ans: B Page: 1071 Type: General Knowledge

Question 58

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.

Answer 58

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

Question 59

21. _________ forms the principal mass of the tooth and is much denser and stronger than bone. A) Pulp B) Dentin C) Enamel D) Gingiva

Answer 59

Ans: B Page: 1109 Type: General Knowledge

Question 60

63. The primary treatment of bronchospasm is: A) assisted ventilation. B) humidified oxygen. C) bronchodilator therapy. D) corticosteroid therapy.

Answer 60

Ans: C Page: 889 Type: General Knowledge

Question 61

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

Answer 61

Ans: A Page: 1055 Type: General Knowledge

Question 62

18. 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

Answer 62

Ans: C Page: 864 Type: General Knowledge

Question 63

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.

Answer 63

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

Question 64

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.

Answer 64

Ans: B Page: 892 Type: General Knowledge

Question 65

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

Answer 65

Ans: B Page: 1041 Type: General Knowledge

Question 66

18. A patient with a loss of peripheral vision MOST likely has damage to the: A) retina. B) pupil. C) cornea. D) lens.

Answer 66

Ans: A Page: 1092 Type: General Knowledge

Question 67

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.

Answer 67

Ans: A Page: 1111 Type: General Knowledge

Question 68

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.

Answer 68

Ans: B Page: 1106 Type: General Knowledge

Question 69

4. Common effects of gag reflex stimulation include all of the following, EXCEPT:

A) vomiting.

B) tachycardia.

C) bradycardia.

D) increased intracranial pressure.

Answer 69

Ans: B Page: 854 Type: General Knowledge

Question 70

53. Paralysis of cranial nerve ____ can cause unilateral facial and gag reflex paralysis. A) V B) VI C) VII D) X

Answer 70

Ans: C Page: 1108 Type: General Knowledge

Question 71

74. A patient who is coughing up thick pulmonary secretions should NOT take: A) a diuretic. B) antihistamines. C) an antitussive. D) bronchodilators.

Answer 71

Ans: C Page: 872 Type: General Knowledge

Question 72

5. In dark-skinned patients, cyanosis can be detected in the: A) sclera. B) iris. C) cornea. D) conjunctiva.

Answer 72

Ans: D Page: 1091-1092 Type: General Knowledge

Question 73

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.

Answer 73

Ans: B Page: 1080 Type: General Knowledge

Question 74

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.

Answer 74

Ans: B Page: 890 Type: General Knowledge

Question 75

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.

Answer 75

Ans: A Page: 853 Type: General Knowledge

Question 76

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.

Answer 76

Ans: C Page: 873 Type: General Knowledge

Question 77

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.

Answer 77

Ans: A Page: 883 Type: Critical Thinking

Question 78

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.

Answer 78

Ans: C Page: 892 Type: Critical Thinking

Question 79

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.

Answer 79

Ans: A Page: 1079 Type: Critical Thinking

Question 80

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.

Answer 80

Ans: A Page: 890 Type: General Knowledge

Question 81

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.

Answer 81

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

Question 82

49. A patient who is coughing up purulent sputum is MOST likely experiencing: A) emphysema. B) dehydration. C) an infection. D) pulmonary edema.

Answer 82

Ans: C Page: 868 Type: General Knowledge

Question 83

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.

Answer 83

Ans: D Page: 853, 885 Type: Critical Thinking

Question 84

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.

Answer 84

Ans: D Page: 1105 Type: General Knowledge

Question 85

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

Answer 85

Ans: B Page: 1071 Type: General Knowledge

Question 86

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.

Answer 86

Ans: B Page: 895 Type: General Knowledge

Question 87

13. 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.

Answer 87

Ans: C Page: 858 Type: General Knowledge

Question 88

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.

Answer 88

Ans: A Page: 1097 Type: General Knowledge

Question 89

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.

Answer 89

Ans: A Page: 888 Type: General Knowledge

Question 90

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.

Answer 90

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

Question 91

53. Paralysis of cranial nerve ____ can cause unilateral facial and gag reflex paralysis. A) V B) VI C) VII D) X

Answer 91

Ans: C Page: 1108 Type: General Knowledge

Question 92

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%

Answer 92

Ans: A Page: 876 Type: General Knowledge

Question 93

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.

Answer 93

Ans: D Page: 1045 Type: General Knowledge

Question 94

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.

Answer 94

Ans: C Page: 1079 Type: General Knowledge

Question 95

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.

Answer 95

Ans: C Page: 867 Type: General Knowledge

Question 96

36. Patients with a corneal abrasion may present with all of the following, EXCEPT: A) hyphema. B) severe pain. C) photophobia. D) excess tearing.

Answer 96

Ans: A Page: 1098 Type: General Knowledge

Question 97

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

Answer 97

Ans: D Page: 1102 Type: General Knowledge

Question 98

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.

Answer 98

Ans: B Page: 1101 Type: General Knowledge

Question 99

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

Answer 99

Ans: B Page: 872 Type: Critical Thinking

Question 100

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.

Answer 100

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

Question 101

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.

Answer 101

Ans: C Page: 1113 Type: General Knowledge

Question 102

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.

Answer 102

Ans: B Page: 1097-1098 Type: General Knowledge

Question 103

89. Which of the following medications is a parasympathetic bronchodilator? A) Alupent B) Albuterol C) Bronkosol D) Ipratropium

Answer 103

Ans: D Page: 878 Type: General Knowledge

Question 104

36. A patient with quiet tachypnea is MOST likely experiencing: A) shock. B) asthma. C) alkalosis. D) airway swelling.

Answer 104

Ans: A Page: 868 Type: General Knowledge

Question 105

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.

Answer 105

Ans: B Page: 894 Type: General Knowledge

Question 106

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.

Answer 106

Ans: C Page: 873 Type: General Knowledge

Question 107

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.

Answer 107

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

Question 108

55. The bony sockets for the teeth that reside in the mandible and maxilla are called: A) cusps. B) pulp. C) dentin. D) alveoli.

Answer 108

Ans: D Page: 1109 Type: General Knowledge

Question 109

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.

Answer 109

Ans: C Page: 1095-1097 Type: Critical Thinking

Question 110

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.

Answer 110

Ans: C Page: 1105 Type: General Knowledge

Question 111

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.

Answer 111

Ans: D Page: 1069 Type: Critical Thinking

Question 112

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.

Answer 112

Ans: C Page: 1060 Type: General Knowledge

Question 113

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.

Answer 113

Ans: C Page: 1100 Type: General Knowledge

Question 114

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.

Answer 114

Ans: B Page: 865 Type: General Knowledge

Question 115

23. 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.

Answer 115

Ans: B Page: 868 Type: General Knowledge

Question 116

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.

Answer 116

Ans: A Page: 883-884 Type: General Knowledge

Question 117

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

Answer 117

Ans: B Page: 1092 Type: General Knowledge

Question 118

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.

Answer 118

Ans: B Page: 864 Type: General Knowledge

Question 119

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.

Answer 119

Ans: C Page: 867 Type: General Knowledge

Question 120

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.

Answer 120

Ans: C Page: 880-881 Type: Critical Thinking

Question 121

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.

Answer 121

Ans: A Page: 1091 Type: General Knowledge

Question 122

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.

Answer 122

Ans: A Page: 1094 Type: General Knowledge

Question 123

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.

Answer 123

Ans: B Page: 1048 Type: General Knowledge

Question 124

20. 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.

Answer 124

Ans: A Page: 862 Type: General Knowledge

Question 125

36. A patient with quiet tachypnea is MOST likely experiencing: A) shock. B) asthma. C) alkalosis. D) airway swelling.

Answer 125

Ans: A Page: 868 Type: General Knowledge

Question 126

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.

Answer 126

Ans: C Page: 1100 Type: General Knowledge

Question 127

8. 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.

Answer 127

Ans: C Page: 855 Type: General Knowledge

Question 128

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

Answer 128

Ans: A Page: 1054 Type: General Knowledge

Question 129

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.

Answer 129

Ans: C Page: 1060 Type: General Knowledge

Question 130

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

Answer 130

Ans: A Page: 1041 Type: General Knowledge

Question 131

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

Answer 131

Ans: B Page: 1092 Type: General Knowledge

Question 132

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.

Answer 132

Ans: B Page: 876 Type: General Knowledge

Question 133

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.

Answer 133

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

Question 134

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.

Answer 134

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

Question 135

6. On either side of the glottis, tissue forms a pocket called the: A) vallecula. B) piriform fossae. C) cuneiform cartilage. D) hypopharyngeal space.

Answer 135

Ans: B Page: 855 Type: General Knowledge

Question 136

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.

Answer 136

Ans: A Page: 871 Type: General Knowledge

Question 137

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.

Answer 137

Ans: D Page: 889 Type: General Knowledge

Question 138

3. The oropharynx and nasopharynx meet in the back of the throat at the:

A) larynx.

B) hyoid bone.

C) hypopharynx.

D) glottic opening.

Answer 138

Ans: C Page: 854 Type: General Knowledge

Question 139

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.

Answer 139

Ans: B Page: 1101 Type: Critical Thinking

Question 140

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.

Answer 140

Ans: A Page: 1106 Type: General Knowledge

Question 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.

Answer 141

Ans: B Page: 1048 Type: General Knowledge

Question 142

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.

Answer 142

Ans: D Page: 1038 Type: General Knowledge

Question 143

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.

Answer 143

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

Question 144

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

Answer 144

Ans: A Page: 1044 Type: General Knowledge

Question 145

1. 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

Answer 145

Ans: B Page: 854 Type: General Knowledge

Question 146

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.

Answer 146

Ans: A Page: 1104 Type: General Knowledge

Question 147

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.

Answer 147

Ans: D Page: 868 Type: General Knowledge

Question 148

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

Answer 148

Ans: A Page: 1060 Type: General Knowledge

Question 149

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.

Answer 149

Ans: D Page: 853, 885 Type: Critical Thinking

Question 150

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.

Answer 150

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

Question 151

22. Difficulty with exhalation is MOST characteristic of: A) supraglottic swelling. B) upper airway obstruction. C) a mild asthma attack. D) obstructive lung disease.

Answer 151

Ans: D Page: 860 Type: General Knowledge

Question 152

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.

Answer 152

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

Question 153

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.

Answer 153

Ans: D Page: 1106 Type: General Knowledge

Question 154

74. A patient who is coughing up thick pulmonary secretions should NOT take: A) a diuretic. B) antihistamines. C) an antitussive. D) bronchodilators.

Answer 154

Ans: C Page: 872 Type: General Knowledge

Question 155

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.

Answer 155

Ans: A Page: 1105 Type: Critical Thinking

Question 156

43. Which of the following is NOT an inner ear structure? A) Cochlea B) Oval window C) Eustachian tube D) Semicircular canal

Answer 156

Ans: C Page: 1102-1103 Type: General Knowledge

Question 157

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.

Answer 157

Ans: B Page: 1101 Type: General Knowledge

Question 158

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.

Answer 158

Ans: D Page: 853 Type: General Knowledge

Question 159

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.

Answer 159

Ans: A Page: 1061 Type: Critical Thinking

Question 160

25. What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelids

Answer 160

Ans: D Page: 1094 Type: General Knowledge

Question 161

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.

Answer 161

Ans: A Page: 890 Type: General Knowledge

Question 162

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

Answer 162

Ans: A Page: 1066 Type: General Knowledge

Question 163

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.

Answer 163

Ans: C Page: 1076 Type: General Knowledge

Question 164

29. Alkali or strong acid burns to the eye should be irrigated for at least ____ minutes. A) 10 B) 15 C) 20 D) 30

Answer 164

Ans: C Page: 1095 Type: General Knowledge

Question 165

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.

Answer 165

Ans: D Page: 1038 Type: General Knowledge

Question 166

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.

Answer 166

Ans: B Page: 1093 Type: General Knowledge

Question 167

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.

Answer 167

Ans: C Page: 1111-1113 Type: Critical Thinking

Question 168

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

Answer 168

Ans: A Page: 1060 Type: General Knowledge

Question 169

9. 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.

Answer 169

Ans: A Page: 860 Type: General Knowledge

Question 170

58. Systemic signs of a dental abscess include: A) fever and chills. B) inflammation. C) swelling and pain. D) mandibular pain.

Answer 170

Ans: A Page: 1110 Type: General Knowledge

Question 171

4. Cataracts are caused by clouding of the: A) iris. B) cornea. C) retina. D) sclera.

Answer 171

Ans: B Page: 1091 Type: General Knowledge

Question 172

44. The diaphragm of the stethoscope is designed to auscultate: A) heart tones. B) low-pitched sounds. C) bowel sounds. D) high-pitched sounds.

Answer 172

Ans: D Page: 874-875 Type: General Knowledge

Question 173

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.

Answer 173

Ans: B Page: 1105 Type: General Knowledge

Question 174

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.

Answer 174

Ans: B Page: 895 Type: General Knowledge

Question 175

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.

Answer 175

Ans: C Page: 864 Type: General Knowledge

Question 176

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.

Answer 176

Ans: C Page: 896 Type: Critical Thinking

Question 177

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.

Answer 177

Ans: A Page: 1097 Type: General Knowledge

Question 178

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.

Answer 178

Ans: D Page: 853 Type: General Knowledge

Question 179

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.

Answer 179

Ans: B Page: 891 Type: Critical Thinking

Question 180

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

Answer 180

Ans: A Page: 1092 Type: General Knowledge

Question 181

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

Answer 181

Ans: D Page: 1060 Type: General Knowledge

Question 182

1. The _______, also called the eyeball, is a spherical structure measuring about 1 inch in diameter. A) iris B) globe C) retina D) cornea

Answer 182

Ans: B Page: 1091 Type: General Knowledge

Question 183

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.

Answer 183

Ans: A Page: 859 Type: General Knowledge

Question 184

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.

Answer 184

Ans: B Page: 1064 Type: General Knowledge

Question 185

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.

Answer 185

Ans: C Page: 896 Type: General Knowledge

Question 186

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.

Answer 186

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

Question 187

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

Answer 187

Ans: B Page: 1055 Type: General Knowledge

Question 188

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

Answer 188

Ans: D Page: 1042 Type: General Knowledge

Question 189

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.

Answer 189

Ans: A Page: 871 Type: General Knowledge

Question 190

85. Patients with obvious respiratory failure require immediate: A) intubation. B) ventilation support. C) passive oxygenation. D) bronchodilator therapy.

Answer 190

Ans: B Page: 880-883 Type: General Knowledge

Question 191

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.

Answer 191

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

Question 192

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.

Answer 192

Ans: D Page: 870 Type: General Knowledge

Question 193

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.

Answer 193

Ans: D Page: 1069 Type: Critical Thinking

Question 194

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?”

Answer 194

Ans: D Page: 1064 Type: Critical Thinking

Question 195

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.

Answer 195

Ans: D Page: 853, 880-881 Type: Critical Thinking

Question 196

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.

Answer 196

Ans: C Page: 1105 Type: General Knowledge

Question 197

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.

Answer 197

Ans: A Page: 1106 Type: General Knowledge

Question 198

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.

Answer 198

Ans: D Page: 1098 Type: Critical Thinking

Question 199

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.

Answer 199

Ans: C Page: 863 Type: General Knowledge

Question 200

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.

Answer 200

Ans: D Page: 885 Type: General Knowledge

Question 201

7. The _________ cartilage forms a complete ring and maintains the trachea in an open position. A) cricoid B) thyroid C) arytenoid D) laryngeal

Answer 201

Ans: A Page: 855 Type: General Knowledge

Question 202

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.

Answer 202

Ans: C Page: 1045 Type: General Knowledge

Question 203

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.

Answer 203

Ans: A Page: 1094 Type: General Knowledge

Question 204

4. Common effects of gag reflex stimulation include all of the following, EXCEPT:

A) vomiting.

B) tachycardia.

C) bradycardia.

D) increased intracranial pressure.

Answer 204

Ans: B Page: 854 Type: General Knowledge

Question 205

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.

Answer 205

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

Question 206

15. 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.

Answer 206

Ans: B Page: 859 Type: General Knowledge

Question 207

14. 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.

Answer 207

Ans: A Page: 858-859 Type: General Knowledge

Question 208

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.

Answer 208

Ans: C Page: 864 Type: General Knowledge

Question 209

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.

Answer 209

Ans: C Page: 873 Type: General Knowledge

Question 210

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.

Answer 210

Ans: B Page: 894 Type: General Knowledge

Question 211

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

Answer 211

Ans: B Page: 1110 Type: General Knowledge

Question 212

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.

Answer 212

Ans: B Page: 876 Type: General Knowledge

Question 213

18. A patient with a loss of peripheral vision MOST likely has damage to the: A) retina. B) pupil. C) cornea. D) lens.

Answer 213

Ans: A Page: 1092 Type: General Knowledge

Question 214

19. The large cartilaginous external portion of the ear is called the: A) ossicle. B) cochlea. C) auricle. D) oval window.

Answer 214

Ans: C Page: 1102 Type: General Knowledge

Question 215

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.

Answer 215

Ans: A Page: 883-884 Type: General Knowledge

Question 216

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

Answer 216

Ans: C Page: 1106 Type: General Knowledge

Question 217

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.

Answer 217

Ans: A Page: 1100 Type: General Knowledge

Question 218

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.

Answer 218

Ans: A Page: 853 Type: General Knowledge

Question 219

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

Answer 219

Ans: C Page: 1040 Type: General Knowledge

Question 220

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.

Answer 220

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

Question 221

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.

Answer 221

Ans: B Page: 1093 Type: General Knowledge

Question 222

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.

Answer 222

Ans: C Page: 1111-1113 Type: Critical Thinking

Question 223

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.

Answer 223

Ans: B Page: 1113 Type: General Knowledge

Question 224

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.

Answer 224

Ans: B Page: 1093-1097 Type: Critical Thinking

Question 225

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

Answer 225

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

Question 226

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.

Answer 226

Ans: B Page: 1080 Type: General Knowledge

Question 227

12. 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

Answer 227

Ans: D Page: 857 Type: General Knowledge

Question 228

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

Answer 228

Ans: D Page: 1092 Type: General Knowledge

Question 229

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

Answer 229

Ans: D Page: 1102 Type: General Knowledge

Question 230

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.

Answer 230

Ans: A Page: 1061 Type: Critical Thinking

Question 231

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.

Answer 231

Ans: A Page: 1091 Type: General Knowledge

Question 232

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.

Answer 232

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

Question 233

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.

Answer 233

Ans: D Page: 885 Type: General Knowledge

Question 234

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.

Answer 234

Ans: A Page: 1079 Type: Critical Thinking

Question 235

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

Answer 235

Ans: B Page: 861 Type: General Knowledge

Question 236

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.

Answer 236

Ans: B Page: 1101 Type: Critical Thinking

Question 237

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

Answer 237

Ans: A Page: 1066 Type: General Knowledge

Question 238

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

Answer 238

Ans: C Page: 1106 Type: General Knowledge

Question 239

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.

Answer 239

Ans: D Page: 1060 Type: General Knowledge

Question 240

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.

Answer 240

Ans: C Page: 896-897 Type: General Knowledge

Question 241

15. Which cranial nerve innervates the muscles that cause motion of the eyeballs and upper eyelids? A) Optic B) Trigeminal C) Oculomotor D) Hypoglossal

Answer 241

Ans: C Page: 1091 Type: General Knowledge

Question 242

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.

Answer 242

Ans: D Page: 1113 Type: Critical Thinking

Question 243

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.

Answer 243

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

Question 244

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.

Answer 244

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

Question 245

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.

Answer 245

Ans: D Page: 1045 Type: General Knowledge

Question 246

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

Answer 246

Ans: C Page: 1067 Type: General Knowledge

Question 247

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

Answer 247

Ans: C Page: 891 Type: General Knowledge

Question 248

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

Answer 248

Ans: C Page: 1108 Type: General Knowledge

Question 249

7. The _________ cartilage forms a complete ring and maintains the trachea in an open position. A) cricoid B) thyroid C) arytenoid D) laryngeal

Answer 249

Ans: A Page: 855 Type: General Knowledge

Question 250

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.

Answer 250

Ans: A Page: 1067 Type: General Knowledge

Question 251

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.

Answer 251

Ans: C Page: 880-881 Type: Critical Thinking

Question 252

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.

Answer 252

Ans: B Page: 1093-1097 Type: Critical Thinking

Question 253

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.

Answer 253

Ans: B Page: 1055 Type: General Knowledge

Question 254

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.

Answer 254

Ans: D Page: 875 Type: General Knowledge

Question 255

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.

Answer 255

Ans: B Page: 864 Type: General Knowledge

Question 256

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

Answer 256

Ans: B Page: 878 Type: General Knowledge

Question 257

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

Answer 257

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

Question 258

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

Answer 258

Ans: C Page: 1113 Type: General Knowledge

Question 259

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.

Answer 259

Ans: B Page: 891 Type: Critical Thinking

Question 260

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.

Answer 260

Ans: D Page: 1061 Type: General Knowledge

Question 261

89. Which of the following medications is a parasympathetic bronchodilator? A) Alupent B) Albuterol C) Bronkosol D) Ipratropium

Answer 261

Ans: D Page: 878 Type: General Knowledge

Question 262

6. On either side of the glottis, tissue forms a pocket called the: A) vallecula. B) piriform fossae. C) cuneiform cartilage. D) hypopharyngeal space.

Answer 262

Ans: B Page: 855 Type: General Knowledge

Question 263

85. Patients with obvious respiratory failure require immediate: A) intubation. B) ventilation support. C) passive oxygenation. D) bronchodilator therapy.

Answer 263

Ans: B Page: 880-883 Type: General Knowledge

Question 264

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

Answer 264

Ans: A Page: 1073 Type: General Knowledge

Question 265

25. What part of the eye is MOST commonly injured following a thermal burn? A) Globe B) Retina C) Cornea D) Eyelids

Answer 265

Ans: D Page: 1094 Type: General Knowledge

Question 266

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

Answer 266

Ans: A Page: 863 Type: General Knowledge

Question 267

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.

Answer 267

Ans: D Page: 1051 Type: General Knowledge

Question 268

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.

Answer 268

Ans: A Page: 1051 Type: General Knowledge

Question 269

12. 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

Answer 269

Ans: D Page: 857 Type: General Knowledge

Question 270

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.

Answer 270

Ans: B Page: 869 Type: General Knowledge

Question 271

5. The most obvious external landmark of the larynx is the:

A) cricoid cartilage.

B) hyoid bone.

C) arytenoid cartilage.

D) thyroid cartilage.

Answer 271

Ans: D Page: 854 Type: General Knowledge

Question 272

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.

Answer 272

Ans: A Page: 883 Type: Critical Thinking

Question 273

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.

Answer 273

Ans: A Page: 1101 Type: General Knowledge

Question 274

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.

Answer 274

Ans: D Page: 893 Type: General Knowledge

Question 275

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.

Answer 275

Ans: D Page: 893 Type: General Knowledge

Question 276

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.

Answer 276

Ans: B Page: 890 Type: General Knowledge

Question 277

44. The diaphragm of the stethoscope is designed to auscultate: A) heart tones. B) low-pitched sounds. C) bowel sounds. D) high-pitched sounds.

Answer 277

Ans: D Page: 874-875 Type: General Knowledge

Question 278

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.

Answer 278

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

Question 279

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.

Answer 279

Ans: C Page: 1042 Type: General Knowledge

Question 280

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.

Answer 280

Ans: A Page: 1044 Type: General Knowledge

Question 281

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.

Answer 281

Ans: B Page: 876 Type: General Knowledge

Question 282

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.

Answer 282

Ans: C Page: 1077 Type: Critical Thinking

Question 283

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.

Answer 283

Ans: B Page: 1041 Type: General Knowledge

Question 284

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.

Answer 284

Ans: B Page: 1097-1098 Type: General Knowledge

Question 285

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

Answer 285

Ans: B Page: 1055 Type: General Knowledge

Question 286

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

Answer 286

Ans: C Page: 1098 Type: General Knowledge

Question 287

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.

Answer 287

Ans: B Page: 869 Type: General Knowledge

Question 288

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.

Answer 288

Ans: C Page: 873 Type: General Knowledge

Question 289

19. 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.

Answer 289

Ans: B Page: 852-853 Type: General Knowledge

Question 290

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.

Answer 290

Ans: C Page: 1042 Type: General Knowledge

Question 291

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.

Answer 291

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

Question 292

21. 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.

Answer 292

Ans: A Page: 861-862 Type: General Knowledge

Question 293

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.

Answer 293

Ans: A Page: 889 Type: General Knowledge

Question 294

42. Hepatomegaly and jugular venous distention are MOST suggestive of: A) left heart failure. B) right heart failure. C) pulmonary edema. D) severe pneumonia.

Answer 294

Ans: B Page: 873 Type: General Knowledge

Question 295

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.

Answer 295

Ans: B Page: 889 Type: General Knowledge

Question 296

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.

Answer 296

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

Question 297

15. Which cranial nerve innervates the muscles that cause motion of the eyeballs and upper eyelids? A) Optic B) Trigeminal C) Oculomotor D) Hypoglossal

Answer 297

Ans: C Page: 1091 Type: General Knowledge

Question 298

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.

Answer 298

Ans: D Page: 864-865 Type: General Knowledge

Question 299

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

Answer 299

Ans: C Page: 1075 Type: General Knowledge

Question 300

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.

Answer 300

Ans: B Page: 884 Type: Critical Thinking

Question 301

24. ___________ 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

Answer 301

Ans: A Page: 868 Type: General Knowledge

Question 302

64. Patients with epiglottitis present with: A) dysphagia. B) wheezing. C) dentalgia. D) hyperosmia.

Answer 302

Ans: A Page: 1113 Type: General Knowledge

Question 303

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

Answer 303

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

Question 304

10. The mainstem bronchus ends at the level of the: A) lobar bronchi. B) bronchioles. C) segmental bronchi. D) subsegmental bronchi.

Answer 304

Ans: B Page: 856 Type: General Knowledge

Question 305

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.

Answer 305

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

Question 306

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.

Answer 306

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

Question 307

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.

Answer 307

Ans: B Page: 1106 Type: General Knowledge

Question 308

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.

Answer 308

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

Question 309

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

Answer 309

Ans: B Page: 878 Type: General Knowledge

Question 310

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.

Answer 310

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

Question 311

2. 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.

Answer 311

Ans: A Page: 854 Type: General Knowledge

Question 312

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.

Answer 312

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

Question 313

28. Movement of both of the eyes in unison is called: A) dysconjugate gaze. B) sympathetic eye movement. C) extraocular movement. D) physiologic anisocoria.

Answer 313

Ans: B Page: 1098, 1120 Type: General Knowledge

Question 314

11. ________ 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

Answer 314

Ans: D Page: 857 Type: General Knowledge

Question 315

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.

Answer 315

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

Question 316

56. Mastication is defined as: A) chewing. B) swallowing. C) digesting. D) teeth clenching.

Answer 316

Ans: A Page: 1109 Type: General Knowledge

Question 317

16. 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.

Answer 317

Ans: A Page: 859 Type: General Knowledge

Question 318

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

Answer 318

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

Question 319

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.

Answer 319

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

Question 320

49. A patient who is coughing up purulent sputum is MOST likely experiencing: A) emphysema. B) dehydration. C) an infection. D) pulmonary edema.

Answer 320

Ans: C Page: 868 Type: General Knowledge

Question 321

18. 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

Answer 321

Ans: C Page: 864 Type: General Knowledge

Question 322

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

Answer 322

Ans: C Page: 1092 Type: General Knowledge

Question 323

43. Which of the following is NOT an inner ear structure? A) Cochlea B) Oval window C) Eustachian tube D) Semicircular canal

Answer 323

Ans: C Page: 1102-1103 Type: General Knowledge

Question 324

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.

Answer 324

Ans: B Page: 1064 Type: General Knowledge

Question 325

22. Difficulty with exhalation is MOST characteristic of: A) supraglottic swelling. B) upper airway obstruction. C) a mild asthma attack. D) obstructive lung disease.

Answer 325

Ans: D Page: 860 Type: General Knowledge

Question 326

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

Answer 326

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

Question 327

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.

Answer 327

Ans: B Page: 890 Type: General Knowledge

Question 328

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

Answer 328

Ans: B Page: 1060 Type: General Knowledge

Question 329

23. 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.

Answer 329

Ans: B Page: 868 Type: General Knowledge

Question 330

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.

Answer 330

Ans: D Page: 1050 Type: General Knowledge

Question 331

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

Answer 331

Ans: D Page: 1055 Type: General Knowledge

Question 332

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.

Answer 332

Ans: A Page: 859 Type: General Knowledge

Question 333

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.

Answer 333

Ans: D Page: 1112 Type: General Knowledge

Question 334

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.

Answer 334

Ans: C Page: 1079 Type: General Knowledge

Question 335

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.

Answer 335

Ans: C Page: 1076 Type: General Knowledge

Question 336

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

Answer 336

Ans: A Page: 1041 Type: General Knowledge

Question 337

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

Answer 337

Ans: B Page: 866 Type: General Knowledge

Question 338

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.

Answer 338

Ans: D Page: 853 Type: General Knowledge

Question 339

58. Systemic signs of a dental abscess include: A) fever and chills. B) inflammation. C) swelling and pain. D) mandibular pain.

Answer 339

Ans: A Page: 1110 Type: General Knowledge

Question 340

27. The by-product of cellular respiration is: A) oxygen. B) lactic acid. C) pyruvic acid. D) carbon dioxide.

Answer 340

Ans: D Page: 861 Type: General Knowledge

Question 341

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.

Answer 341

Ans: B Page: 876 Type: General Knowledge

Question 342

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.

Answer 342

Ans: A Page: 1051 Type: General Knowledge

Question 343

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.

Answer 343

Ans: A Page: 1101 Type: General Knowledge

Question 344

56. Mastication is defined as: A) chewing. B) swallowing. C) digesting. D) teeth clenching.

Answer 344

Ans: A Page: 1109 Type: General Knowledge

Question 345

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.

Answer 345

Ans: A Page: 853 Type: General Knowledge

Question 346

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.

Answer 346

Ans: C Page: 1053 Type: General Knowledge

Question 347

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.

Answer 347

Ans: C Page: 886 Type: General Knowledge

Question 348

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.

Answer 348

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

Question 349

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.

Answer 349

Ans: D Page: 891 Type: General Knowledge

Question 350

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.

Answer 350

Ans: C Page: 1111 Type: General Knowledge

Question 351

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

Answer 351

Ans: D Page: 1055 Type: General Knowledge

Question 352

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.

Answer 352

Ans: A Page: 1106 Type: General Knowledge

Question 353

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

Answer 353

Ans: A Page: 1077 Type: General Knowledge

Question 354

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.

Answer 354

Ans: C Page: 863 Type: General Knowledge

Question 355

11. ________ 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

Answer 355

Ans: D Page: 857 Type: General Knowledge

Question 356

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.

Answer 356

Ans: B Page: 1053 Type: General Knowledge

Question 357

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.

Answer 357

Ans: D Page: 1050 Type: General Knowledge

Question 358

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

Answer 358

Ans: A Page: 863 Type: General Knowledge

Question 359

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.

Answer 359

Ans: D Page: 1061 Type: General Knowledge

Question 360

11. The ________________ secretes and drains tears from the eye. A) nasolacrimal duct B) conjunctiva C) aqueous humor D) nasolacrimal apparatus

Answer 360

Ans: D Page: 1092 Type: General Knowledge

Question 361

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.

Answer 361

Ans: A Page: 865 Type: General Knowledge

Question 362

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.

Answer 362

Ans: B Page: 865 Type: General Knowledge

Question 363

42. Hepatomegaly and jugular venous distention are MOST suggestive of: A) left heart failure. B) right heart failure. C) pulmonary edema. D) severe pneumonia.

Answer 363

Ans: B Page: 873 Type: General Knowledge

Question 364

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.

Answer 364

Ans: B Page: 1105 Type: General Knowledge

Question 365

13. 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.

Answer 365

Ans: C Page: 858 Type: General Knowledge

Question 366

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.

Answer 366

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

Question 367

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

Answer 367

Ans: A Page: 866 Type: General Knowledge

Question 368

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.

Answer 368

Ans: D Page: 891-892 Type: Critical Thinking

Question 369

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

Answer 369

Ans: A Page: 1044 Type: General Knowledge

Question 370

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

Answer 370

Ans: C Page: 1108 Type: General Knowledge

Question 371

27. The by-product of cellular respiration is: A) oxygen. B) lactic acid. C) pyruvic acid. D) carbon dioxide.

Answer 371

Ans: D Page: 861 Type: General Knowledge

Question 372

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.

Answer 372

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

Question 373

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.

Answer 373

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

Question 374

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.

Answer 374

Ans: B Page: 888 Type: General Knowledge

Question 375

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.

Answer 375

Ans: D Page: 1100 Type: Critical Thinking

Question 376

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

Answer 376

Ans: B Page: 861 Type: General Knowledge

Question 377

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.

Answer 377

Ans: B Page: 885 Type: General Knowledge

Question 378

64. Patients with epiglottitis present with: A) dysphagia. B) wheezing. C) dentalgia. D) hyperosmia.

Answer 378

Ans: A Page: 1113 Type: General Knowledge

Question 379

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

Answer 379

Ans: A Page: 1054 Type: General Knowledge

Question 380

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.

Answer 380

Ans: A Page: 1058 Type: General Knowledge

Question 381

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

Answer 381

Ans: D Page: 1060 Type: General Knowledge

Question 382

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.

Answer 382

Ans: D Page: 875 Type: General Knowledge

Question 383

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.

Answer 383

Ans: D Page: 1100 Type: Critical Thinking

Question 384

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

Answer 384

Ans: C Page: 891 Type: General Knowledge

Question 385

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.

Answer 385

Ans: C Page: 1102 Type: General Knowledge

Question 386

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%.

Answer 386

Ans: A Page: 875 Type: General Knowledge

Question 387

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.

Answer 387

Ans: C Page: 877 Type: General Knowledge

Question 388

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.

Answer 388

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

Question 389

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.

Answer 389

Ans: D Page: 892 Type: General Knowledge

Question 390

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

Answer 390

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

Question 391

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.

Answer 391

Ans: D Page: 868 Type: General Knowledge

Question 392

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.

Answer 392

Ans: D Page: 1075 Type: General Knowledge

Question 393

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

Answer 393

Ans: D Page: 1053 Type: General Knowledge

Question 394

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.

Answer 394

Ans: B Page: 890 Type: General Knowledge

Question 395

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.

Answer 395

Ans: B Page: 889 Type: General Knowledge

Question 396

3. Icteric sclera are: A) white. B) cloudy. C) yellow. D) bloodshot.

Answer 396

Ans: C Page: 1091 Type: General Knowledge

Question 397

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.

Answer 397

Ans: A Page: 883-884 Type: General Knowledge

Question 398

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.

Answer 398

Ans: C Page: 896 Type: Critical Thinking

Question 399

5. The most obvious external landmark of the larynx is the:

A) cricoid cartilage.

B) hyoid bone.

C) arytenoid cartilage.

D) thyroid cartilage.

Answer 399

Ans: D Page: 854 Type: General Knowledge

Question 400

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.

Answer 400

Ans: C Page: 886 Type: General Knowledge

Question 401

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.

Answer 401

Ans: B Page: 884 Type: Critical Thinking

Question 402

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.

Answer 402

Ans: C Page: 1077 Type: Critical Thinking

Question 403

8. The __________ are cone-shaped fossae that enclose and protect the eyes. A) zygomas B) orbits C) condyles D) crista galli

Answer 403

Ans: B Page: 1091 Type: General Knowledge

Question 404

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.

Answer 404

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

Question 405

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.

Answer 405

Ans: D Page: 1112 Type: General Knowledge

Question 406

20. 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.

Answer 406

Ans: A Page: 862 Type: General Knowledge

Question 407

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.

Answer 407

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

Question 408

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.

Answer 408

Ans: B Page: 1061 Type: General Knowledge

Question 409

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.

Answer 409

Ans: A Page: 1067 Type: General Knowledge

Question 410

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.

Answer 410

Ans: A Page: 1111 Type: General Knowledge

Question 411

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.

Answer 411

Ans: B Page: 1114 Type: Critical Thinking

Question 412

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.

Answer 412

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

Question 413

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.

Answer 413

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

Question 414

1. 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

Answer 414

Ans: B Page: 854 Type: General Knowledge

Question 415

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.

Answer 415

Ans: D Page: 892 Type: General Knowledge

Question 416

1. The _______, also called the eyeball, is a spherical structure measuring about 1 inch in diameter. A) iris B) globe C) retina D) cornea

Answer 416

Ans: B Page: 1091 Type: General Knowledge

Question 417

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.

Answer 417

Ans: A Page: 884, 888-889 Type: Critical Thinking

Question 418

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

Answer 418

Ans: C Page: 1113 Type: General Knowledge

Question 419

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.

Answer 419

Ans: B Page: 1100 Type: General Knowledge

Question 420

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.

Answer 420

Ans: A Page: 1044 Type: General Knowledge

Question 421

8. The __________ are cone-shaped fossae that enclose and protect the eyes. A) zygomas B) orbits C) condyles D) crista galli

Answer 421

Ans: B Page: 1091 Type: General Knowledge

Question 422

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.

Answer 422

Ans: C Page: 892 Type: Critical Thinking

Question 423

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.

Answer 423

Ans: B Page: 892 Type: General Knowledge

Question 424

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.

Answer 424

Ans: B Page: 1061 Type: General Knowledge

Question 425

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

Answer 425

Ans: D Page: 1053 Type: General Knowledge

Question 426

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

Answer 426

Ans: A Page: 866 Type: General Knowledge

Question 427

5. In dark-skinned patients, cyanosis can be detected in the: A) sclera. B) iris. C) cornea. D) conjunctiva.

Answer 427

Ans: D Page: 1091-1092 Type: General Knowledge

Question 428

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.

Answer 428

Ans: A Page: 884, 888-889 Type: Critical Thinking

Question 429

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.

Answer 429

Ans: A Page: 1100 Type: General Knowledge

Question 430

43. Digital clubbing is MOST indicative of: A) acute hypoxemia. B) chronic hypoxia. C) right heart failure. D) peripheral vascular disease.

Answer 430

Ans: B Page: 874 Type: General Knowledge

Question 431

9. 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.

Answer 431

Ans: A Page: 860 Type: General Knowledge

Question 432

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

Answer 432

Ans: C Page: 868-869 Type: General Knowledge

Question 433

55. The bony sockets for the teeth that reside in the mandible and maxilla are called: A) cusps. B) pulp. C) dentin. D) alveoli.

Answer 433

Ans: D Page: 1109 Type: General Knowledge

Question 434

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.

Answer 434

Ans: C Page: 1095-1097 Type: Critical Thinking

Question 435

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

Answer 435

Ans: B Page: 1056 Type: General Knowledge

Question 436

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.

Answer 436

Ans: C Page: 1113 Type: General Knowledge

Question 437

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.

Answer 437

Ans: C Page: 1093 Type: General Knowledge

Question 438

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.

Answer 438

Ans: D Page: 1098-1099 Type: General Knowledge

Question 439

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.

Answer 439

Ans: B Page: 1041 Type: General Knowledge

Question 440

22. The ___________ nerve provides motor function to the muscles of the tongue. A) hypoglossal B) trigeminal C) accessory D) glossopharyngeal

Answer 440

Ans: A Page: 1110 Type: General Knowledge

Question 441

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

Answer 441

Ans: B Page: 1041 Type: General Knowledge

Question 442

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.

Answer 442

Ans: C Page: 879 Type: General Knowledge

Question 443

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.

Answer 443

Ans: A Page: 1058 Type: General Knowledge

Question 444

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.

Answer 444

Ans: A Page: 1094 Type: General Knowledge

Question 445

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.

Answer 445

Ans: B Page: 1100 Type: General Knowledge

Question 446

13. Common symptoms of diabetic retinopathy include all of the following, EXCEPT: A) floaters. B) blurred vision. C) yellow vision. D) blind spots.

Answer 446

Ans: C Page: 1093 Type: General Knowledge

Question 447

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.

Answer 447

Ans: D Page: 1098 Type: Critical Thinking

Question 448

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.

Answer 448

Ans: C Page: 896-897 Type: Critical Thinking

Question 449

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.

Answer 449

Ans: D Page: 1098-1099 Type: General Knowledge

Question 450

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.

Answer 450

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

Question 451

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.

Answer 451

Ans: B Page: 1053 Type: General Knowledge

Question 452

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.

Answer 452

Ans: B Page: 1113 Type: General Knowledge

Question 453

21. _________ forms the principal mass of the tooth and is much denser and stronger than bone. A) Pulp B) Dentin C) Enamel D) Gingiva

Answer 453

Ans: B Page: 1109 Type: General Knowledge

Question 454

59. Pneumonitis is especially common in older patients with: A) frequent infections. B) a history of a stroke. C) immunocompromise. D) chronic food aspiration.

Answer 454

Ans: D Page: 887 Type: General Knowledge

Question 455

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.

Answer 455

Ans: B Page: 891 Type: Critical Thinking

Question 456

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.

Answer 456

Ans: C Page: 1093 Type: General Knowledge

Question 457

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

Answer 457

Ans: A Page: 1077 Type: General Knowledge

Question 458

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.

Answer 458

Ans: D Page: 889 Type: General Knowledge

Question 459

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.

Answer 459

Ans: D Page: 891-892 Type: Critical Thinking

Question 460

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

Answer 460

Ans: C Page: 868-869 Type: General Knowledge

Question 461

63. The primary treatment of bronchospasm is: A) assisted ventilation. B) humidified oxygen. C) bronchodilator therapy. D) corticosteroid therapy.

Answer 461

Ans: C Page: 889 Type: General Knowledge

Question 462

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

Answer 462

Ans: A Page: 1055 Type: General Knowledge

Question 463

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.

Answer 463

Ans: C Page: 1092 Type: General Knowledge

Question 464

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

Answer 464

Ans: D Page: 1106 Type: General Knowledge

Question 465

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.

Answer 465

Ans: B Page: 887 Type: General Knowledge

Question 466

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.

Answer 466

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

Question 467

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.

Answer 467

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

Question 468

4. Cataracts are caused by clouding of the: A) iris. B) cornea. C) retina. D) sclera.

Answer 468

Ans: B Page: 1091 Type: General Knowledge

Question 469

76. Bedridden patients with excessive pulmonary secretions are MOST prone to developing: A) pneumonia. B) bronchospasm. C) a pneumothorax. D) a pulmonary embolism.

Answer 469

Ans: A Page: 893 Type: General Knowledge

Question 470

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%

Answer 470

Ans: A Page: 876 Type: General Knowledge

Question 471

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.

Answer 471

Ans: A Page: 1094-1095 Type: Critical Thinking

Question 472

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.

Answer 472

Ans: D Page: 1078 Type: General Knowledge

Question 473

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

Answer 473

Ans: B Page: 1095 Type: General Knowledge

Question 474

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.

Answer 474

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

Question 475

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.

Answer 475

Ans: A Page: 888 Type: General Knowledge

Question 476

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

Answer 476

Ans: B Page: 1060 Type: General Knowledge

Question 477

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.

Answer 477

Ans: A Page: 1042 Type: General Knowledge

Question 478

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.

Answer 478

Ans: C Page: 877 Type: General Knowledge

Question 479

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

Answer 479

Ans: C Page: 1040 Type: General Knowledge

Question 480

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.

Answer 480

Ans: C Page: 1092 Type: General Knowledge

Question 481

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.

Answer 481

Ans: A Page: 881 Type: General Knowledge

Question 482

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

Answer 482

Ans: B Page: 1095 Type: General Knowledge

Question 483

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

Answer 483

Ans: C Page: 1092 Type: General Knowledge

Question 484

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.

Answer 484

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

Question 485

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.

Answer 485

Ans: A Page: 1092 Type: General Knowledge

Question 486

19. 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.

Answer 486

Ans: B Page: 852-853 Type: General Knowledge

Question 487

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

Answer 487

Ans: D Page: 1092 Type: General Knowledge

Question 488

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.

Answer 488

Ans: A Page: 1094-1095 Type: Critical Thinking

Question 489

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.

Answer 489

Ans: A Page: 889 Type: General Knowledge

Question 490

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.

Answer 490

Ans: C Page: 1045 Type: General Knowledge

Question 491

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

Answer 491

Ans: A Page: 1073 Type: General Knowledge

Question 492

59. Pneumonitis is especially common in older patients with: A) frequent infections. B) a history of a stroke. C) immunocompromise. D) chronic food aspiration.

Answer 492

Ans: D Page: 887 Type: General Knowledge

Question 493

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

Answer 493

Ans: D Page: 869 Type: General Knowledge

Question 494

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.

Answer 494

Ans: B Page: 1055 Type: General Knowledge

Question 495

21. 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.

Answer 495

Ans: A Page: 861-862 Type: General Knowledge

Question 496

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

Answer 496

Ans: D Page: 1106 Type: General Knowledge

Question 497

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.

Answer 497

Ans: A Page: 883-884 Type: General Knowledge

Question 498

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

Answer 498

Ans: D Page: 869 Type: General Knowledge

Question 499

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.

Answer 499

Ans: A Page: 1042 Type: General Knowledge

Question 500

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.

Answer 500

Ans: A Page: 853 Type: General Knowledge

Question 501

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

Answer 501

Ans: C Page: 1054 Type: General Knowledge

Question 502

3. The oropharynx and nasopharynx meet in the back of the throat at the:

A) larynx.

B) hyoid bone.

C) hypopharynx.

D) glottic opening.

Answer 502

Ans: C Page: 854 Type: General Knowledge

Question 503

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.

Answer 503

Ans: C Page: 896-897 Type: General Knowledge

Question 504

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%.

Answer 504

Ans: A Page: 875 Type: General Knowledge

Question 505

41. Retinal detachment is especially common in: A) boxing. B) football. C) diabetics. D) water sports.

Answer 505

Ans: A Page: 1101 Type: General Knowledge

Question 506

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.

Answer 506

Ans: D Page: 1051 Type: General Knowledge

Question 507

2. 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.

Answer 507

Ans: A Page: 854 Type: General Knowledge

Question 508

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.

Answer 508

Ans: D Page: 891 Type: General Knowledge

Question 509

16. 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.

Answer 509

Ans: A Page: 859 Type: General Knowledge

Question 510

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

Answer 510

Ans: A Page: 1068 Type: Critical Thinking

Question 511

10. The mainstem bronchus ends at the level of the: A) lobar bronchi. B) bronchioles. C) segmental bronchi. D) subsegmental bronchi.

Answer 511

Ans: B Page: 856 Type: General Knowledge

Question 512

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.

Answer 512

Ans: C Page: 896-897 Type: Critical Thinking

Question 513

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.

Answer 513

Ans: A Page: 1104 Type: General Knowledge

Question 514

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

Answer 514

Ans: C Page: 1054 Type: General Knowledge

Question 515

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.

Answer 515

Ans: B Page: 888 Type: General Knowledge

Question 516

52. Causes of rhinitis may include all of the following, EXCEPT: A) chemical irritants. B) high humidity. C) antihypertensives. D) cold temperature.

Answer 516

Ans: B Page: 1107 Type: General Knowledge

Question 517

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.

Answer 517

Ans: D Page: 864-865 Type: General Knowledge

Question 518

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.

Answer 518

Ans: A Page: 881 Type: General Knowledge

Question 519

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

Answer 519

Ans: A Page: 1092 Type: General Knowledge

Question 520

11. The ________________ secretes and drains tears from the eye. A) nasolacrimal duct B) conjunctiva C) aqueous humor D) nasolacrimal apparatus

Answer 520

Ans: D Page: 1092 Type: General Knowledge