exam 2 Immunology

Question 1

Which of the following best describes the position or bearing of the body?

Answer 1

Posture

Question 2

Your patient is a 76-year-old male who is alert and oriented. The patient’s neighbor called EMS because of general concern about the patient’s health. He states that the patient hasn’t been himself since his wife’s death six months ago. He hasn’t taken care of his usually meticulous lawn and house, and he has lost a lot of weight. The patient says he misses his wife but doesn’t need medical care. Which of the following is the best course of action?

Answer 2

Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital

Question 3

Which of the following is NOT an organic cause of a behavioral emergency?

Answer 3

Hypoglycemia

Question 4

A 19-year-old female states that she is addicted to Vicodin because it makes her feel good, and she cannot stop taking the pills. She states that she craves them all the time, and when she runs out she does not feel sick but becomes preoccupied with how she can get more. Assessment reveals no abnormalities, and vital signs are within acceptable limits. This patient’s condition is most consistent with

Answer 4

Psychological dependence

Question 5

Which of the following is MOST likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations?

Answer 5

Asking the patient’s permission to examine him

Question 6

Which of the following is NOT a common pathophysiological cause of behavioral emergencies?

Answer 6

The environment

Question 7

Which of the following best describes the correct positioning of a restrained patient?

Answer 7

Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing

Question 8

Which of the following patients is most likely to be considered competent to refuse transport?

Answer 8

A 20-year-old male who is alert and oriented and in no distress but who states he stopped taking his lithium because of the undesirable side effects

Question 9

Which of the following is described as the visible indication of mood?

Answer 9

Affect

Question 10

You are on the scene of an agitated male patient with a history of alcohol abuse. He is threatening to “knock your head off” if you get close to him. While you are getting a history from the patient’s wife, she states that, “He had something wrong with his EKG. A long QRS, or something like that.” Which of the following should you avoid in the treatment of this patient?

Answer 10

Droperidol

Question 11

Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder?

Answer 11

Noncompliance with medications

Question 12

Which of the following is the least appropriate method of controlling a combative patient in the prehospital setting?

Answer 12

Pepper spray

Question 13

Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient’s wife called EMS because he has refused to take his lithium and is “driving her crazy with his hyperactive attitude.” She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating, “I didn’t like the way it made me feel.” He denies any suicidal thoughts and states that he has not felt “this good for a long time.” He is curious about your job and wants to know how he could get into a paramedic class. He states that he’s also thinking about going to law school but wants to finish his Ph.D. first. The physical examination is unremarkable. HR = 82, BP = 122/80, RR = 10, SaO2 = 99%. He says, “See, I told you I’m fine. I don’t need to go to the hospital.” Which of the following is the best course of action?

Answer 13

Contact medical control.

Question 14

Your patient is a 27-year-old female who is distraught and crying after having her children taken by child protective services. Her sister called EMS because the patient threatened to cut her wrists. On your arrival you find that she has not attempted to harm herself and has no weapons within reach. However, she does not wish to speak with you. Which of the following actions is most likely to be effective when communicating with this patient?

Answer 14

Sit down so that you are at eye level with the patient.

Question 15

Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder?

Answer 15

Following the same routine daily

Question 16

You have been called to a college dormitory where campus police are talking to a 20-year-old male who was threatening to jump from his eighteenth-floor window. The patient admits that he was upset because he is failing most of his courses and his girlfriend broke up with him but says he was just “psyching out” his roommate and had no intention of jumping. Campus police tell you that the patient was sitting on the balcony railing with his feet over the edge when they arrived. The patient was cooperative when they asked him to come back inside the room. Which of the following is the best patient care option?

Answer 16

Tell the patient you must take his suicide threat seriously and transport him for evaluation.

Question 17

An example of a direct injury that may be sustained by a behavioral patient who has been tasered would be

Answer 17

The damage caused by the impact of the electrical probe

Question 18

Which of the following best describes a person’s state of cognitive functioning?

Answer 18

Mental status

Question 19

Your patient is a 28-year-old male who tells you his hands and arms are turning green. He states that he was held captive by some people for a month and forced to make movies. While the patient is undoubtedly convinced he is turning green, you cannot see it. The patient’s brother tells you that he has not been missing for the past month but that he has stopped taking his medication. Which of the following is MOST consistent with this situation?

Answer 19

Schizophrenia

Question 20

Your patient is a 34-year-old male who is threatening to kill himself. Which of the following does NOT indicate an increased risk for suicide?

Answer 20

The patient’s being married

Question 21

Which of the following is most relevant to your decisions about how to handle a potentially violent patient?

Answer 21

The patient’s current behavior

Question 22

Your patient is in four-point restraints and starts to spit at you during transport. You should

Answer 22

Place a surgical mask over the patient’s mouth and nose

Question 23

Which of the following best describes a feeling of alarm at the expectation of danger

Answer 23

Fear

Question 24

Which of the following is NOT associated with anorexia nervosa?

Answer 24

Intentionally inducing vomiting after eating

Question 25

Your patient is a 32-year-old female who is depressed and tearful after a fight with her ex-husband. Which of the following would NOT increase the risk of or indicate an increased risk of the patient committing suicide?

Answer 25

The paramedic is using direct questioning about suicidal intentions

Question 26

A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment?

Answer 26

The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.

Question 27

Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first:

Answer 27

Assist ventilations with 100 percent oxygen via a BVM

Question 28

An allergen’s most common route of entry in an anaphylactic reaction is:

Answer 28

Injection

Question 29

Which of the following is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions?

Answer 29

IV

Question 30

Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway?

Answer 30

Angioedema

Question 31

Which of the following best describes why the secondary response to an antigen is faster than the primary response?

Answer 31

The secondary response uses memory cells, which immediately release antibodies specific to the antigen.

Question 32

Which of the following is considered an ominous sign late in anaphylaxis?

Answer 32

Bradycardia

Question 33

Your patient is a 60-year-old male who is conscious and alert and sitting on a toilet. He appears to be in moderate distress and complains of nausea and diarrhea. The patient states that he is allergic to eggs and accidentally ate pancakes made with eggs this morning. He describes a 4-hour history of severe diarrhea and vomiting. HR = 124, BP = 92/60, RR = 16, SaO2 = 98%. The physical examination reveals no urticaria or angioedema; his skin is cool and clammy, and his lung sounds are clear. Based on these findings, what should be your greatest concern?

Answer 33

Acute dehydration

Question 34

Epinephrine administration results in all of the following EXCEPT:

Answer 34

Hypotension

Question 35

Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, lung sounds that are clear and equal bilaterally. HR = 100, BP = 132/78, RR = 14, SaO2 = 98%. Which of the following is the most appropriate treatment for this patient?

Answer 35

Oxygen via nonrebreather mask, IV of NS KVO, 0.3 mg epinephrine SQ, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer

Question 36

Which of the following best describes the difference between an anaphylactic and an anaphylactoid reaction?

Answer 36

An anaphylactoid reaction may happen with no prior sensitization.

Question 37

The first medication administered to a patient experiencing an anaphylactic reaction should be:

Answer 37

High-concentration oxygen

Question 38

Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient’s bronchospasm?

Answer 38

Epinephrine 1:1000 SQ

Question 39

Which is the most concerning sign associated with an allergic reaction?

Answer 39

Stridor

Question 40

Which of the following findings would differentiate an allergic reaction from an anaphylactic reaction?

Answer 40

Hypotension

Question 41

Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE?

Answer 41

A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.

Question 42

The ___________ system is a complicated body system responsible for combating infection.

Answer 42

Immune

Question 43

The two most common causes of fatal anaphylaxis are ________ and ________.

Answer 43

Hymenoptera stings, injected penicillin

Question 44

Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has “allergies to bee stings” and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 112 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include:

Answer 44

IV of NS KVO

Question 45

Your patient is a 19-year-old female who called EMS because she awoke with “itchy red patches” on her chest, back, and arms that “seem to come and go.” As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate?

Answer 45

“These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking.”

Question 46

Which of the following medications is NOT used as a first-line drug to counter the physiologic effects of the release of slow-reacting substance of anaphylaxis (SRS-A)?

Answer 46

Dopamine

Question 47

Which medication is best for improving hypotension secondary to anaphylactic shock?

Answer 47

Epinephrine

Question 48

Which of the following signs indicates the need for aggressive airway management in a patient experiencing an anaphylactic reaction?

Answer 48

Stridor

Question 49

Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate?

Answer 49

Diphenhydramine IM

Question 50

You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should include all of the following EXCEPT:

Answer 50

Administration of an IV beta-blocker