Exit Exam

Question 1

1. The release of glucagon into the bloodstream stimulates:
   a) the liver to convert glycogen to glucose.
   b) the liver to take in and store more glucose.
   c) the cells to uptake sugar from the bloodstream.
   d) the vessels to constrict, thus increasing blood pressure.

Answer 1

a) the liver to convert glycogen to glucose.

Question 2

2) Which of the following statements regarding insulin is MOST correct?
a) Insulin stimulates the conversion of glycogen to glucose.
b) An increase in insulin levels causes an increase in blood glucose.
c) Insulin is a pancreatic hormone that performs exocrine functions.
d) Insulin is the only hormone that decreases blood glucose levels.

Answer 2

d) Insulin is the only hormone that decreases blood glucose levels.

Question 3

3) Diabetes is MOST accurately defined as:
a) inadequate insulin secretion, which leads to increased circulating blood glucose levels.
b) a decrease in circulating insulin levels, which results in a drop in serum blood sugar levels.
c) a metabolic disorder in which the body’s ability to metabolize simple carbohydrates is impaired.
d) an endocrine disorder in which the liver is unable to produce and store adequate amounts of glycogen.

Answer 3

c) a metabolic disorder in which the body’s ability to metabolize simple carbohydrates is impaired.

Question 4

4) A person with type 1 diabetes:

a) is often an older person whose pancreas does not produce adequate insulin.
b) can often control his or her diabetes with a proper diet and regular exercise.
c) is not as likely to experience hypoglycemia as a person with type 2 diabetes.
d) generally does not produce any insulin and requires daily insulin injections.

Answer 4

d) generally does not produce any insulin and requires daily insulin injections.

Question 5

5) Diabetic patients would MOST likely present with atypical signs and symptoms of:
a) bacterial pneumonia.
b) acute coronary syndrome.
c) an acute ischemic stroke.
d) viral or fungal meningitis.

Answer 5

b) acute coronary syndrome

Question 6

6) Common symptoms of type 2 diabetes include all of the following, EXCEPT:
a) thirst.
b) dysuria.
c) fatigue.
d) blurred vision.

Answer 6

b) dysuria.

Question 7

7) Prior to administering 50% dextrose (D50) via IV push, it is MOST important to:

a) protect the airway with an endotracheal tube.
b) ensure that the IV line is patent and freely flowing.
c) confirm a blood glucose reading of less than 40 mg/dL.
d) draw blood for later analysis in the emergency department.

Answer 7

b) ensure that the IV line is patent and freely flowing

Question 8

8) Hyperglycemia is characterized by:

a) a gradual onset and warm, dry skin.
b) shallow respirations and bradycardia.
c) a rapid onset and cool, clammy skin.
d) a blood glucose level above 110 mg/dL.

Answer 8

a) a gradual onset and warm, dry skin

Question 9

9) An illness or infection would MOST likely cause:

a) diabetic ketoacidosis.
b) acute hyperglycemia.
c) blood glucose above 500 mg/dL.
d) a slow onset of hyperglycemia.

Answer 9

d) a slow onset of hyperglycemia

Question 10

10) Diabetic ketoacidosis (DKA) occurs when:

a) blood glucose levels rise above 250 mg/dL.
b) the renal system begins to excrete ketones.
c) the cells metabolize fat and produce ketones.
d) insulin production exceeds glucagon production.

Answer 10

c) the cells metabolize fat and produce ketones.

Question 11

11) Unlike the patient with hypoglycemia, the patient with severe hyperglycemia:

a) usually does not vomit.
b) has a normal breath odor.
c) rapidly improves with treatment.
d) is tachypneic and hyperpneic.

Answer 11

d) is tachypneic and hyperpneic.

Question 12

12) Which of the following interventions would the paramedic LEAST likely perform on a patient with diabetic ketoacidosis?
a) Insulin administration
b) Endotracheal intubation
c) Sodium bicarbonate administration
d) Infusion of 1 to 2 L of normal saline

Answer 12

a) Insulin administration

Question 13

13) Prehospital treatment for patients with hyperosmolar hyperglycemic nonketotic coma (HHNC) focuses on:
a) intubation and insulin administration.
b) correction of electrolyte abnormalities.
c) high-flow oxygen and IV or IM glucagon.
d) airway management and fluid rehydration.

Answer 13

d) airway management and fluid rehydration

Question 14

14) Which of the following statements regarding Addison’s disease is MOST correct?
a) It most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex.
b) Addison’s disease is also known as secondary adrenal insufficiency and is most often the result of a viral infection.
c) The signs and symptoms of Addison’s disease are a direct result of the overproduction of cortisol and aldosterone.
d) Hallmark signs of Addison’s disease are hypertension and fluid retention that result from excess sodium reabsorption.

Answer 14

a) It most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex.

Question 15

15) A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he is a type 1 diabetic, and that he took his insulin today. During your assessment, you will MOST likely find that the patient is:

a) dehydrated.
b) tachypneic.
c) hyperglycemic.
d) breathing deeply.

Answer 15

b) tachypneic.

Question 16

16) You are dispatched to the residence of a 60-year-old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several “small strokes.” In addition to properly managing her airway, you should:

a) perform a field glucose test to rule out hypoglycemia.
b) start an IV line and give her 50 mL of 50% dextrose.
c) avoid giving her glucose because of her small strokes.
d) start an IV line and give her a 20 mL/kg fluid bolus.

Answer 16

a) perform a field glucose test to rule out hypoglycemia.

Question 17

17) A 30-year-old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm Hg, her pulse is 110 beats/min and full, and her respirations are increased and somewhat deep. On the basis of this patient’s clinical presentation, she will MOST likely require oxygen and:

a) 25 g of 50% dextrose.
b) in-hospital antibiotics.
c) 0.5 to 1 mg of glucagon.
d) crystalloid fluid hydration.

Answer 17

d) crystalloid fluid hydration.

Question 18

18) A 68-year-old obese woman presents with a markedly decreased level of consciousness. She was found in bed by her husband. Your initial assessment reveals that her respirations are slow and shallow, her pulse is slow and weak, and her skin is cold and dry. According to the patient’s husband, she has had a recent infection, but he cannot remember what the doctor called it. You should be MOST suspicious that this patient is experiencing:

a) myxedema coma.
b) Addisonian crisis.
c) diabetic ketoacidosis.
d) acute hypothyroidism.

Answer 18

a) myxedema coma.

Question 19

19) When transferring a patient between medical facilities, it is MOST important for the paramedic to:

a) ensure that all appropriate paperwork, x-rays, and lab results are delivered to the receiving facility.
b) request another paramedic if the patient’s clinical condition is too unstable for one paramedic to manage effectively.
c) request that a member of the patient’s family accompanies the patient in case the patient cannot speak for himself or herself.
d) ensure that a physician or nurse accompanies the patient if the patient requires care beyond the paramedic’s scope of practice.

Answer 19

d) ensure that a physician or nurse accompanies the patient if the patient requires care beyond the paramedic’s scope of practice.

Question 20

20) Scope of practice is defined as:
A. protocols agreed upon by a consensus of emergency physicians.
B. the level of care that a paramedic’s employer allows the paramedic to provide.
C. national patient care guidelines established by the federal government.
D. care that a paramedic is permitted to perform under the certifying state.

Answer 20

D. care that a paramedic is permitted to perform under the certifying state.

Question 21

21) Abandonment occurs when:
a. a patient is released and did not require further medical care.
b. an emergency nurse takes a verbal report from a paramedic.
c. care of a patient was terminated without his or her consent.
d. a patient refuses care and subsequently dies of his condition.

Answer 21

c. care of a patient was terminated without his or her consent.

Question 22

22) Patients with decision-making capacity:
a) cannot refuse EMS treatment and transport after they have given consent for it.
b) have the right to refuse all or part of the emergency medical care offered to them.
c) must agree to EMS transport if they give consent for emergency medical treatment.
d) cannot withdraw consent unless their conditions are deemed to be non-life-threatening.

Answer 22

b) have the right to refuse all or part of the emergency medical care offered to them.

Question 23

23) If a mentally competent adult refuses emergency medical treatment, your FIRST action should be to:
a) call medical control and seek further guidance.
b) determine if his or her condition is life-threatening.
c) assume the refusal is from fear and begin treatment.
d) try to determine why he or she is refusing treatment.

Answer 23

d) try to determine why he or she is refusing treatment.

Question 24

24) Which of the following statements regarding documentation is MOST correct?
a) The paramedic’s personal opinion is an important part of the patient care report.
b) A thorough and accurate medical record is the paramedic’s best protection in court.
c) Pertinent negatives are of minimal value and should not be part of the patient report.
d) Never quote bystanders directly regarding statements made about the patient’s history.

Answer 24

b) A thorough and accurate medical record is the paramedic’s best protection in court.

Question 25

25) The MOST appropriate way to wash your hands following patient care involves:
a) soaking your hands in warm water and rinsing with clean water.
b) washing vigorously with antibacterial soap for at least 30 seconds.
c) using waterless hand cleaner gels or wipes instead of antibacterial soap.
d) applying isopropyl alcohol and then rinsing your hands with clean water.

Answer 25

b) washing vigorously with antibacterial soap for at least 30 seconds.

Question 26

26) During an emergency call, you begin experiencing a significant amount of anxiety. The patient’s family is present and the patient’s condition is critical. You should:
a) request a relief paramedic and disengage from patient care at once.
b) tighten and then relax specific muscle groups to initiate relaxation.
c) try to ignore the anxiety as best you can and take care of the patient.
d) take deep breaths in through your nose and out through your mouth.

Answer 26

d) take deep breaths in through your nose and out through your mouth.

Question 27

27) You are driving the ambulance to the hospital as your team is caring for a critically injured patient in the back. As you approach a car in front of you, the driver appears to panic. You should:
a) turn your siren off, turn on your public address (PA) system, and kindly ask the driver to pull over to the right and stop.
b) keep your siren on, remain at least 20 feet behind the vehicle, and then carefully pull around him on the right side.
c) turn your lights and siren off, quickly pass the vehicle on the left side, and then turn your lights and siren back on.
d) keep your lights and siren on, remain a safe distance behind the vehicle, and use your PA system to tell him to stop.

Answer 27

a) turn your siren off, turn on your public address (PA) system, and kindly ask the driver to pull over to the right and stop.

Question 28

28) Dr. Eugene Nagel advanced emergency medical treatment in 1969 by:
a) training paramedics to administer certain medications directly though the chest wall and into the left ventricle.
b) developing and implementing closed-chest cardiac massage (CPR) in order to pump blood in a patient without a pulse.
c) implementing the “golden hour,” which dramatically increased survival rates of patients who experienced severe trauma.
d) developing a telemetry system that enabled fire fighters to transmit a patient’s electrocardiogram to the physician at the hospital.

Answer 28

d) developing a telemetry system that enabled fire fighters to transmit a patient’s electrocardiogram to the physician at the hospital.

Question 29

29) The chemical sign for sodium bicarbonate is:
a) NaCl.
b) H2CO3.
c) NaHCO3.
d) KCl.

Answer 29

c) NaHCO3.

Question 30

30) The net effect of osmosis is to:
a) balance the concentration of water on both sides of the cell wall.
b) equalize solute concentrations on both sides of the cell membrane.
c) utilize ATP to actively move solutes across the cell membrane.
d) maintain a higher concentration of solutes outside of the cell.

Answer 30

b) equalize solute concentrations on both sides of the cell membrane.

Question 31

31) The cardinal sign of overhydration is:
a) edema.
b) oliguria.
c) weight gain.
d) shortness of breath.

Answer 31

a) edema.

Question 32

32) How many mg/mL are contained in a prefilled syringe of 50% dextrose with a concentration of 25 g/50 mL?
a) 100
b) 250
c) 500
d) 1,000

Answer 32

c) 500

Question 33

33) When a drug’s specific action is a negative Chronotropic effect, what effect will it have on the heart?
a) Increased heart rate
b) Decrease heart rate
c) Increase force of muscular contractility
d) Decrease force of muscular contractility

Answer 33

b) Decrease heart rate

Question 34

34) A drug that influences the rate of the heart is referred to as being
a) Isotropic.
b) Phototropic.
c) Inotropic
d) Chronotropic

Answer 34

d) Chronotropic

Question 35

35) An exaggerated response by the immune system to a foreign substance is called:
a) an allergic reaction
b) an allergy
c) thyrotoxicolosis
d) an immune response

Answer 35

a) an allergic reaction

Question 36

36) One kilogram equals:
a) 2 pounds.
b) 2.1 pounds.
c) 2.2 pounds.
d) 2.3 pounds.

Answer 36

c) 2.2 pounds.

Question 37

37) What is the antagonist for an overdose of a benzodiazapine?
a) narcan
b) mag sulfate
c) romazicon
d) labatelol

Answer 37

c) romazicon

Question 38

The majority of ischemic strokes are caused by:
a) Thromboembolism
b) Atherosclerotic occlusion
c) Aneurysmal rupture
d) Acute hypertension

Answer 38

a) Thromboembolism

Question 39

One of the most common causes of PEA is?
a) Pneumothorax
b) Hyperkalemia
c) Hypovolemia
d) Drug Overdose

Answer 39

c) Hypovolemia

Question 40

40) Which of the following is NOT a risk factor for ischemic stroke?
a) Cigarette smoking
b) Hypertension
c) Diabetes mellitus
d) Chronic obstructive pulmonary disease

Answer 40

d) Chronic obstructive pulmonary disease

Question 41

41) Which of the following personnel are ultimately responsible for the scene of a multiple casualty incident?
a) Incident commander
b) Triage officer
c) Operations Chief
d) Staging officer

Answer 41

a) Incident commander

Question 42

42) The maximum amount of fluid given to a trauma patient should be no more than_____.
a) 500 ml’s
b) 1000 ml’s
c) 2000 ml’s
d) 3000 ml’s

Answer 42

d) 3000 ml’s

Question 43

43) The ligament that suspends the liver and can cause massive bleeding in trauma known as the:
a) Ligimentum arteriosum
b) Ligimentum venosum
c) Ligimentum teres
d) Ligimentum liverosum

Answer 43

c) Ligimentum teres

Question 44

44) In any hazmat incident, your vehicle and crew should always be ___________ from the incident.
a) Uphill, Upwind
b) Uphill, Downwind
c) Downhill, Upwind
d) Downhill, Downwind

Answer 44

a) Uphill, Upwind

Question 45

45) . The endocrine system comprises a network of ___________ that produce and secrete chemical messengers called ____________.

a) glands, hormones
b) nodes, catecholamines
c) vessels, leukotrienes
d) synapses, neurotransmitters

Answer 45

a) glands, hormones

Question 46

46) Molecules that bind to a cell’s receptor and trigger a response, resulting in some kind of action or biologic effect, are called:

a) agonists.
b) mediators.
c) antagonists.
d) neurotransmitters.

Answer 46

a) agonists.

Question 47

47) The primary anatomic link between the endocrine system and the nervous system is/are the:

a) thalamus.
b) adrenal glands.
c) hypothalamus.
d) adrenal cortex.

Answer 47

c) hypothalamus.

Question 48

48) The adrenal cortex produces hormones called _______________, which:

a) catecholamines, increase the blood pressure.
b) glucocorticoids, stimulate energy production.
c) gonadotropin, regulate testosterone production.
d) corticosteroids, regulate the body’s metabolism.

Answer 48

d) corticosteroids, regulate the body’s metabolism.

Question 49

49) If the body experiences a drop in volume or blood pressure:

a) aldosterone stimulates the sweat glands, resulting in diaphoretic skin.
b) adrenocorticotropic hormone causes a reduction in the secretion of cortisol.
c) aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.
d) catecholamine release inhibits the conversion of glycogen to glucose in the liver.

Answer 49

c) aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine.

Question 50

50) The adrenal medulla secretes norepinephrine following stimulation from the:

a) brain stem.
b) diencephalon.
c) hypothalamus.
d) pituitary gland.

Answer 50

c) hypothalamus.

Question 51

51) When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced:

a) the cells will metabolize oxygen and function normally.
b) glucose levels in the blood and urine will be elevated.
c) serum glucose levels will fall and brain damage may occur.
d) the body will stop making glucose as a protective mechanism.

Answer 51

b) glucose levels in the blood and urine will be elevated.

Question 52

52) Type 1 diabetes that is secondary to an autoimmune disorder occurs when:

a) the body builds up antibodies that destroy the islets of Langerhans.
b) insufficient white blood cells predispose the pancreas to infection.
c) glucagon and insulin are destroyed by phagocytic white blood cells.
d) the patient experiences an allergic reaction to his or her own glucose.

Answer 52

a) the body builds up antibodies that destroy the islets of Langerhans.

Question 53

53) Patients with hyperosmolar hyperglycemic nonketotic coma (HHNC):

a) present with severe dehydration and neurologic deficits.
b) experience more severe acidosis than patients with DKA.
c) typically require prehospital sodium bicarbonate therapy.
d) most commonly have a history of type 1 diabetes mellitus.

Answer 53

a) present with severe dehydration and neurologic deficits.

Question 54

54) Adrenal insufficiency is characterized by decreased function of the ______________ and consequent underproduction of:

a) adrenal glands, catecholamines.
b) adrenal medulla, norepinephrine.
c) adrenal cortex, cortisol and aldosterone.
d) adrenal glands, epinephrine and norepinephrine.

Answer 54

c) adrenal cortex, cortisol and aldosterone.

Question 55

55) The primary role of cortisol is to:

a) Maintain an adequate blood pressure.
b) Assist with the body’s response to stress.
c) Regulate the metabolism of carbohydrates.
d) Decrease the body’s inflammatory response.

Answer 55

b) Assist with the body’s response to stress.

Question 56

56) Which of the following would MOST likely cause Cushing’s syndrome?

a) Abrupt termination of steroids such as prednisone and hydrocortisone
b) Administration of large amounts of methylprednisolone to an asthma patient
c) An acute decrease in cortisol secretion secondary to an infection or malignancy
d) Underuse of corticosteroids for illnesses such as rheumatoid arthritis and asthma

Answer 56

b) Administration of large amounts of methylprednisolone to an asthma patient

Question 57

57) Signs and symptoms of hypothyroidism include:

a) tachycardia and hypertension.
b) hot, flushed skin and restlessness.
c) diarrhea and emotional lability.
d) bradycardia and sluggish reflexes.

Answer 57

d) bradycardia and sluggish reflexes.

Question 58

58) Unlike hypothyroidism, hyperthyroidism:

a) results in a decreased cardiac output.
b) causes a decrease in the metabolic rate.
c) causes an increase in oxygen demand.
d) often results in acute myxedema coma.

Answer 58

c) causes an increase in oxygen demand.

Question 59

59) An antigen is MOST accurately defined as a:
a) chemical the immune system produces to destroy an allergen.
b) substance that causes the immune system to produce antibodies.
c) chemical mediator that deactivates foreign substances in the body.
d) harmless substance that the body does not recognize as being foreign.

Answer 59

b) substance that causes the immune system to produce antibodies.

Question 60

60) An abnormal immune response that the body develops when it is reexposed to an allergen is called:

a) anaphylaxis.
b) secondary response.
c) hypersensitivity.
d) an allergic reaction.

Answer 60

d) an allergic reaction.

Question 61

61) Physiological effects of histamine include all of the following, EXCEPT:

a) systemic vasodilation.
b) pulmonary vasodilation.
c) severe bronchoconstriction.
d) increased vascular permeability.

Answer 61

b) pulmonary vasodilation.

Question 62

62) When a person is vaccinated against a disease:

a) the body develops antibodies in response to the vaccine and produces an immune response before the disease can enter the body and cause damage.
b) the immune system does not produce any antibodies against that particular disease unless he or she is directly or indirectly exposed to it.
c) a secondary response occurs, as antibodies are produced and the vaccinated person experiences a milder form of the disease against which he or she has been vaccinated.
d) smaller titers of the disease are injected into the person, which results in the production of antibodies that cause histamine release and a mild allergic reaction.

Answer 62

a) the body develops antibodies in response to the vaccine and produces an immune response before the disease can enter the body and cause damage.

Question 63

63) Histamine release causes all of the following effects, EXCEPT:

a) vasodilation, which results in flushed skin and hypotension.
b) contraction of the smooth muscles of the respiratory system.
c) increased cardiac contractility, which results in hypertension.
d) increased vascular permeability, which results in tissue edema.

Answer 63

c) increased cardiac contractility, which results in hypertension.

Question 64

64) Hypotension secondary to histamine release is due to:

a) profound bradycardia and vascular dilation.
b) decreased cardiac filling because of tachycardia.
c) vasodilation and decreased cardiac contractility.
d) capillary leakage and increased cardiac afterload.

Answer 64

c) vasodilation and decreased cardiac contractility.

Question 65

65) Early clinical manifestations of an allergic reaction include all of the following, EXCEPT:

a) pruritis.
b) stridor.
c) urticaria.
d) coughing.

Answer 65

b) stridor.

Question 66

66) The three MOST significant indicators of anaphylactic shock are:

A. hives, chest tightness, and restlessness.
B. dyspnea, hypotension, and tachycardia.
C. pruritis, peripheral swelling, and urticaria.
D. dizziness, flushed skin, and abdominal pain.

Answer 66

B. dyspnea, hypotension, and tachycardia.

Question 67

67) The MOST ominous respiratory sign in a patient with anaphylactic shock is:

A. diminished lung sounds.
B. loud expiratory wheezing.
C. diffuse coarse crackles.
D. labored tachypnea.

Answer 67

A. diminished lung sounds.

Question 68

68) In the absence of IV or IO access, the ____ route is the MOST appropriate route for the administration of an adrenergic agonist to a patient in anaphylactic shock.
A. IM
B. ET
C. SC
D. intradermal

Answer 68

A. IM

Question 69

69) Diphenhydramine (Benadryl) is used to treat allergic reactions because it:

A. binds to H2 receptors and blocks histamine release.
B. blocks the histamine effects at the H1 receptor sites.
C. destroys histamines and blocks their further release.
D. reverses the vasodilatory and bronchoconstrictive effects.

Answer 69

B. blocks the histamine effects at the H1 receptor sites.

Question 70

70) Which of the following medications has the SLOWEST onset of action when given to a patient with a severe allergic reaction?

A. Albuterol
B. Glucagon
C. Diphenhydramine
D. Methylprednisolone

Answer 70

D. Methylprednisolone

Question 71

71) Which of the following statements regarding the renal system is MOST correct?

A. Urinary tract infections are more prevalent in men.
B. The kidneys are located in the retroperitoneal space.
C. Urinary tract infections are the most common renal disease.
D. The urethra transports urine from the kidneys to the bladder.

Answer 71

B. The kidneys are located in the retroperitoneal space.

Question 72

72) Angiotensin II:

A. relaxes smooth muscle.
B. decreases sodium resorption.
C. decreases blood pressure.
D. is a potent vasoconstrictor.

Answer 72

D. is a potent vasoconstrictor.

Question 73

73) Acute pulmonary edema:
A) commonly results from right-sided heart failure.
B) results in excess elimination of carbon dioxide.
C) is characterized by progressively worsening dyspnea.
D) impairs oxygen diffusion into the pulmonary capillaries.

Answer 73

D) impairs oxygen diffusion into the pulmonary capillaries.

Question 74

74) Baroreceptors, which are located in the carotid artery, aorta, and kidneys, are MOST sensitive to changes in:
A) fluid volume.
B) blood pressure.
C) acid-base balance.
D) sodium concentrations.

Answer 74

B) blood pressure.

Question 75

75) The MOST prevalent cation of the extracellular fluid is:
A) sodium.
B) chloride.
C) potassium.
D) bicarbonate.

Answer 75

A) sodium.

Question 76

76) When renin is released:
A) the conversion of angiotensin I to angiotensin II is inhibited, which facilitates excretion of sodium via the kidneys.
B) the lungs convert the plasma protein angiotensinogen to angiotensin I, which dilates the renal blood vessels and increases kidney function.
C) the pancreatic alpha cells secrete the hormone glucagon, which facilitates the conversion of glycogen to glucose in the liver.
D) the angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates sodium reabsorption by the renal tubules.

Answer 76

D) the angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates sodium reabsorption by the renal tubules.

Question 77

77) Patients with type 1 diabetes mellitus:
A) need exogenous insulin to survive.
B) are less likely to develop ketoacidosis.
C) experience excessive cellular uptake of glucose.
D) control their disease with dietary modification.

Answer 77

A) need exogenous insulin to survive.

Question 78

78) Unlike an allergic reaction, an autoimmune reaction:
A) targets an antigen or allergen.
B) is generally predictable.
C) targets a person’s own tissues.
D) does not involve antibodies.

Answer 78

C) targets a person’s own tissues.

Question 79

79) All of the following diseases are autoimmune diseases, EXCEPT:
A) rheumatoid arthritis.
B) type 1 diabetes.
C) HIV infection.
D) myasthenia gravis.

Answer 79

C) HIV infection.

Question 80

80) The resistance stage of the stress reaction is characterized by:
A) an immediate release of the catecholamines epinephrine and norepinephrine, which causes the fight or flight response
B) a reduction of cortisol in the body, which predisposes the person to acute inflammatory processes.
C) stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure.
D) adrenal gland depletion, which leads to decreased blood glucose levels, physical exhaustion, and immunocompromise.

Answer 80

C) stimulation of the adrenal glands to secrete hormones that increase blood glucose levels and maintain blood pressure.

Question 81

81) Severe, prolonged stress:
A) is frequently a direct cause of death.
B) results in the destruction of cholesterol and fat.
C) causes the body to lose its ability to fight disease.
D) results in chronically low levels of cortisol.

Answer 81

C) causes the body to lose its ability to fight disease.

Question 82

82) In contrast to ethics, morality is:
A) how you expect a person to behave.
B) what you think about a given issue.
C) the foundation for the actions you take.
D) your perception of what the patient thinks.

Answer 82

B) what you think about a given issue.

Question 83

83) Patient autonomy is MOST accurately defined as the:
A) court’s support and upholding of the rights of a patient with regard to health care decisions.
B) patient’s right to direct his or her own care and to decide how end-of-life care should be provided.
C) inability of the patient to refuse medical treatment once he or she has given appropriate consent.
D) right of the patient to determine which medications the paramedic should administer for a given situation.

Answer 83

B) patient’s right to direct his or her own care and to decide how end-of-life care should be provided.

Question 84

84) The first rule of medical practice is to:
A) do no harm.
B) provide medical care.
C) maintain a sympathetic attitude
D) recognize critically ill patients.

Answer 84

A) do no harm.

Question 85

85) One of the major differences between laws and ethics is that laws:
A) allow a person to determine right from wrong.
B) are usually broken because of an unethical act.
C) have sanctions for violation that are enforceable.
D) are reflective of a person’s moral responsibilities.

Answer 85

C) have sanctions for violation that are enforceable.

Question 86

86) The BEST legal protection for the paramedic is to:
A) always transport the patient to the hospital of the patient’s choice, regardless of the patient’s clinical condition.
B) provided a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.
C) routinely obtain more than the minimum number of continuing education credits required by the state department of health.
D) treat all patients with respect and remain aware that patients’ cultural beliefs may differ from those of the paramedic.

Answer 86

B) provided a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.

Question 87

87) Functionally, the nervous system is divided into the:
A) brain and spinal cord.
B) somatic and autonomic nervous system.
C) central and peripheral nervous system.
D) sympathetic and parasympathetic nervous system.

Answer 87

C) central and peripheral nervous system.

Question 88

88) The two major types of peripheral nerves are the:
A) afferent and efferent nerves.
B) sensory and afferent nerves.
C) motor and efferent nerves.
D) spinal and cranial nerves.

Answer 88

A) afferent and efferent nerves.

Question 89

89) Stimulation of the sympathetic nervous system produces all of the following effects, EXCEPT:
A) increases in the heart rate and blood pressure.
B) a release of energy stores throughout the body.
C) dilation of the bronchioles and pupils.
D) diversion of blood flow to the periphery of the body.

Answer 89

D) diversion of blood flow to the periphery of the body.

Question 90

90) Adrenergic nerve fibers release:
A) acetylcholine.
B) acetylcholinesterase.
C) glycogen and glucagon.
D) epinephrine and norepinephrine.

Answer 90

D) epinephrine and norepinephrine.

Question 91

91) Epinephrine stimulates beta-1 receptors, resulting in:
A) an increase in gastrointestinal function.
B) an increase in ventricular contractile force.
C) an overall decrease in systemic blood pressure.
D) decreased cardiac electrical conduction velocity.

Answer 91

B) an increase in ventricular contractile force.

Question 92

92) When administered, epinephrine produces a/an _____________ effect.
A) anticholineric
B) sympathomimetic
C) sympatholytic
D) parasympatholytic

Answer 92

B) sympathomimetic

Question 93

93) The parasympathetic nervous system is:
A) the prevailing system during periods of stress.
B) responsible for increasing cardiac contractility.
C) the dominant system during rest and relaxation.
D) regulated by epinephrine and norepinephrine.

Answer 93

C) the dominant system during rest and relaxation.

Question 94

94) The process of chemical signaling between cells is called:
A) antagonism.
B) neurotransmission.
C) chemotransmission.
D) nerve innervation.

Answer 94

B) neurotransmission.

Question 95

95) The term affinity, as it applies to pharmacology, is MOST accurately defined as the:
A) ability of a medication to bind to a receptor.
B) process of a medication binding to a receptor.
C) attraction between a medication and its receptor.
D) strength of the bond between a medication and its receptor.

Answer 95

C) attraction between a medication and its receptor.

Question 96

96) A medication that stimulates a response in a receptor site is said to be:
A) synergistic.
B) an agonist.
C) an antagonist.
D) a competitive binder.

Answer 96

B) an agonist.

Question 97

97) The rate of absorption of medications given via the IO route:
A) is identical to that of the IV route because the medication enters a noncollapsible channel with rapid flow into the central circulation.
B) is relatively unpredictable compared to that of the IV route because the intraosseous space is a low-pressure space.
C) is just as fast as that of the IV route, but only if the patient has adequate circulation and a systolic BP of at least 90 mm Hg.
D) is somewhat slower than that of the IV route because the medication must first pass through the microvasculature before entering the central circulation.

Answer 97

A) is identical to that of the IV route because the medication enters a noncollapsible channel with rapid flow into the central circulation.

Question 98

98) Medication administration via the subcutaneous or intramuscular route is LEAST effective in patients who:
A) are hypertensive and tachycardic.
B) have decreased liver or renal function.
C) require less than 5 mL of medication.
D) have inadequate peripheral perfusion.

Answer 98

D) have inadequate peripheral perfusion.

Question 99

99) A medication is called an antagonist if:
A) it has a higher affinity for the receptor site than the chemical mediator.
B) it stimulates a receptor site to cause the response that receptor normally causes.
C) it attaches to a receptor site and produces an effect or series of effects.
D) the chemical mediator of a receptor has a higher affinity than the medication.

Answer 99

A) it has a higher affinity for the receptor site than the chemical mediator.

Question 100

100) Sympatholytic medications:
A) selectively block alpha receptors.
B) produce tachycardia and hypertension.
C) inhibit the sympathetic nervous system.
D) stimulate the sympathetic nervous system.

Answer 100

C) inhibit the sympathetic nervous system.

Question 101

101) Stimulation of beta-1 adrenergic receptors would produce all of the following effects, EXCEPT:
A) an increase in heart rate.
B) enhanced cardiac automaticity.
C) increased cardiac electrical conduction.
D) decreased cardiac contractility.

Answer 101

D) decreased cardiac contractility.

Question 102

102) Which adrenergic receptor controls the release of norepinephrine?
A) Beta-1
B) Alpha-1
C) Alpha-2
D) Beta-2

Answer 102

C) Alpha-2

Question 103

103) When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a/an _____________ effect.
A) inotropic
B) dromotropic
C) chronotropic
D) alpha agonistic

Answer 103

B) dromotropic

Question 104

104) A medication that possesses a negative chronotropic effect will:
A) cause a decrease in the heart rate.
B) cause an increase in blood pressure.
C) decrease myocardial contractile force.
D) increase cardiac electrical conduction velocity.

Answer 104

A) cause a decrease in the heart rate.

Question 105

105) Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by:
A) blocking angiotensin II from binding to its receptor sites.
B) competitively binding to alpha-1 receptors in the vasculature.
C) suppressing the conversion of angiotensin I to angiotensin II.
D) lowering cardiac output secondary to diminished renin production.

Answer 105

C) suppressing the conversion of angiotensin I to angiotensin II.

Question 106

106) Epinephrine stimulation of beta-2 receptors will cause:
A) bronchoconstriction.
B) the airway diameter to dilate.
C) vasoconstriction and hypertension.
D) a decreased release of norepinephrine.

Answer 106

B) the airway diameter to dilate.

Question 107

107. Which of the following organs lies within the retroperitoneal space?

A. Liver
B. Kidneys
C. Spleen
D. Ovaries

Answer 107

B. Kidneys

Question 108

108. What do the spleen and liver have in common?

A. They are both highly vascular and bleed profusely when injured.
B. The liver and spleen are well protected by the abdominal muscles.
C. They are less likely to be crushed by blunt trauma than other organs.
D. The liver and spleen are the only solid organs in the abdominal cavity.

Answer 108

A. They are both highly vascular and bleed profusely when injured.

Question 109

109. Grey Turner’s sign is defined as ecchymosis to the _________ and is indicative of:

A. umbilicus, peritoneal bleeding.
B. epigastrium, stomach rupture.
C. flank, retroperitoneal bleeding.
D. back, traumatic aortic dissection.

Answer 109

C. flank, retroperitoneal bleeding.

Question 110

110. Periumbilical ecchymosis is:

A. commonly observed in the prehospital setting following blunt force trauma to the abdomen.
B. referred to as Cullen’s sign and may take hours or days to develop following abdominal trauma.
C. usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen.
D. also called Grey Turner’s sign and manifests almost immediately following blunt abdominal trauma.

Answer 110

B. referred to as Cullen’s sign and may take hours or days to develop following abdominal trauma.

Question 111

111. A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to:

A. perform intubation to secure the patient’s airway.
B. rapidly assess the chest for signs of a sternal fracture.
C. start an IV line and administer an antiarrhythmic drug.
D. attach the ECG leads and be prepared to defibrillate.

Answer 111

D. attach the ECG leads and be prepared to defibrillate.

Question 112

112. In contrast to alpha radiation, beta radiation:

A. is easily stopped by a piece of paper.
B. travels slowly and is less penetrating.
C. can easily penetrate the human body.
D. requires a layer of clothing to stop it.

Answer 112

D. requires a layer of clothing to stop it

Question 113

113. The BEST way to protect yourself from the effects of radiation is to:

A. wear a suit designed to completely shield yourself.
B. use time, distance, and shielding to your advantage.
C. wear a lead suit and self-contained breathing apparatus.
D. limit your exposure at an incident to less than 10 minutes.

Answer 113

B. use time, distance, and shielding to your advantage.

Question 114

114. In contrast to dementia, delirium:

A. generally results from conditions such as Alzheimer’s disease.
B. is characterized by acute global impairment of cognitive function.
C. is an irreversible process caused by premature cerebral deterioration.
D. is a chronic process that causes deficits in memory and abstract thinking.

Answer 114

B. is characterized by acute global impairment of cognitive function.

Question 115

115. Common signs and symptoms of tuberculosis (TB) include all of the following, EXCEPT:

A. hemoptysis.
B. photophobia.
C. weight loss.
D. a persistent cough.

Answer 115

B. photophobia.

Question 116

116. Hepatitis B is also referred to as:

A. CSF hepatitis.
B. fecal hepatitis.
C. enteral hepatitis.
D. serum hepatitis.

Answer 116

D. serum hepatitis.

Question 117

117. Occupationally acquired hepatitis C virus infection:

A. is not possible because an effective one-series vaccine is available.
B. is most commonly contracted via blood exposure to nonintact skin.
C. occurs by ingestion of food that is contaminated with infected feces.
D. is related to a contaminated needlestick with visible blood on the sharp.

Answer 117

D. is related to a contaminated needlestick with visible blood on the sharp.

Question 118

118. The MOST important treatment for a patient experiencing heat stroke involves:

A. antipyretic administration and high-flow oxygen.
B. rehydration with IV fluids and ice water submersion.
C. rapid transport and cooling to the point of shivering.
D. removal from the hot environment and rapid cooling.

Answer 118

D. removal from the hot environment and rapid cooling.

Question 119

119. A “dry drowning” occurs when:

A. less than 200 mL of water enters the lungs.
B. the victim dies during the laryngospasm phase.
C. submersion in freshwater exceeds 45 minutes.
D. fluid is pulled from the lungs into the alveoli

Answer 119

B. the victim dies during the laryngospasm phase.

Question 120

120. 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 120

B. controls blood pressure and heart rate.

Question 121

121. Chemicals that relay electrically conducted signals from one neuron to another are called:

A. hormones.
B. endorphins.
C. catecholamines.
D. neurotransmitters

Answer 121

D. neurotransmitters

Question 122

122. A staggering gait is MOST suggestive of damage to the:

A. medulla.
B. cerebrum.
C. brain stem.
D. cerebellum.

Answer 122

D. cerebellum.

Question 123

123. Which of the following is NOT one of the three major elements that the brain needs to function?

A. Oxygen
B. Glucose
C. Thiamine
D. Normal temperature

Answer 123

C. Thiamine

Question 124

124. Secretion of the parathyroid hormone (PTH) is regulated by blood levels of:

A. sodium.
B. calcium.
C. potassium.
D. phosphorus.

Answer 124

B. calcium.

Question 125

125. The clinical presentation of a hypoglycemic patient would MOST likely resemble that of a patient with:

A. classic heatstroke.
B. an opiate overdose.
C. alcohol intoxication.
D. a hemorrhagic stroke.

Answer 125

C. alcohol intoxication.

Question 126

126. Thirty minutes of hypoglycemia in a patient:

A. will generally not result in permanent neurological damage.
B. is more dangerous than an equivalent period of hyperglycemia.
C. is only life-threatening if the blood glucose is less than 40 mg/dL.
D. is less dangerous than an equivalent period of hyperglycemia.

Answer 126

B. is more dangerous than an equivalent period of hyperglycemia.

Question 127

127. The primary role of cortisol is to:

A. maintain an adequate blood pressure.
B. assist with the body’s response to stress.
C. regulate the metabolism of carbohydrates.
D. decrease the body’s inflammatory response.

Answer 127

B. assist with the body’s response to stress.

Question 128

128. Burnout is a consequence of:
     A) a high call volume.
     B) many years in EMS.
     C) underlying depression.
     D) chronic, unrelieved stress.

Answer 128

D) chronic, unrelieved stress.

Question 129

130. Burnout is MOST accurately defined as:
     A) an acute reaction to an overwhelming situation.
     B) the exhaustion of physical or emotional strength.
     C) cynicism after being a paramedic for many years.
     D) a person’s emotional reaction to a stressful event.

Answer 129

B) the exhaustion of physical or emotional strength.

Question 130

131. Nerve agents block _______________, an essential enzyme of the nervous system.
     A. epinephrine.
     B. acetylcholine.
     C. norepinephrine.
     D. cholinesterase.

Answer 130

D. cholinesterase.

Question 131

132. Signs and symptoms of nerve agent exposure include all of the following, EXCEPT:
     A. tachycardia.
     B. bronchorrhea.
     C. constricted pupils.
     D. excessive salivation.

Answer 131

A. tachycardia.

Question 132

133. The tissues of the central nervous system:
     A. can metabolize fat and proteins to make energy.
     B. are able to store glucose and use just what is needed.
     C. can only survive for about an hour without glucose.
     D. depend entirely on glucose as their source of energy.

Answer 132

D. depend entirely on glucose as their source of energy.

Question 133

134. The movement of water and a dissolved substance from an area of high pressure to an area of low pressure is called:
     A) filtration.
     B) active transport.
     C) facilitated diffusion.
     D) passive transport diffusion.

Answer 133

A) filtration.

Question 134

135. Renin is a protein that is released into the bloodstream by the _________ in response to changes in __________.
     A) kidneys, blood pressure.
     B) liver, acid-base balance.
     C) pancreas, insulin levels.
     D) hypothalamus, body temperature.

Answer 134

A) kidneys, blood pressure.

Question 135

136. Aldosterone acts on the kidneys by:
     A) increasing potassium reabsorption into the blood and enhancing sodium elimination in the urine.
     B) dilating the renal vasculature, thus enhancing renal blood flow and facilitating sodium excretion.
     C) increasing sodium reabsorption into the blood and enhancing potassium elimination in the urine.
     D) constricting the renal vasculature, thus slowing renal blood flow and decreasing the glomerular filtration rate.

Answer 135

C) increasing sodium reabsorption into the blood and enhancing potassium elimination in the urine.

Question 136

137. Hyperkalemia is MOST accurately defined as:
     A) excess potassium in the cells.
     B) a relative deficit of sodium.
     C) an elevated serum potassium level.
     D) a critically low magnesium level.

Answer 136

C) an elevated serum potassium level.

Question 137

138. A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness is MOST likely:
     A) hypocalcemic.
     B) hyperkalemic.
     C) hypokalemic.
     D) hypoglycemic.

Answer 137

B) hyperkalemic.

Question 138

139. The __________ name of a medication is generally derived from the chemical name, but is shorter and simpler.
     A) trade
     B) official
     C) chemical
     D) generic

Answer 138

D) generic

Question 139

140. Medications that are manufactured synthetically:
     A) do not use animal, mineral, or vegetable sources.
     B) include insulin, digitalis, and thyroid medications.
     C) are derived from certain plants and animal organs.
     D) include calcium, iron, magnesium, and other minerals

Answer 139

A) do not use animal, mineral, or vegetable sources.

Question 140

141. The Narcotic Control Act of 1956:
     A) regulated the import, manufacture, prescription, and sale of several nonnarcotic medications and cocaine, opium, and their derivatives.
     B) was aimed at protecting the public from mislabeled, poisonous, or otherwise harmful food, medications, and alcoholic beverages.
     C) increased the penalties for violation of the Harrison Narcotic Act, made the possession of heroin illegal, and outlawed the acquisition and transportation of marijuana.
     D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

Answer 140

C) increased the penalties for violation of the Harrison Narcotic Act, made the possession of heroin illegal, and outlawed the acquisition and transportation of marijuana.

Question 141

142. Unlike Schedule I drugs, Schedule II drugs have:
     A) accepted medical uses.
     B) a higher abuse potential.
     C) limited dependence potential.
     D) no accepted medical application.

Answer 141

A) accepted medical uses.

Question 142

143. When considering administering a medication to a pregnant woman in the prehospital setting, the paramedic must:
     A) give the medication to save the fetus, even if it means causing harm to the mother.
     B) ensure that the mother is at least 30 weeks’ gestation prior to giving the medication.
     C) determine if the potential benefit to the mother outweighs the risk to the fetus.
     D) recall that the vast majority of emergency medications will precipitate preterm labor.

Answer 142

C) determine if the potential benefit to the mother outweighs the risk to the fetus.

Question 143

144. If another paramedic prepares a medication and hands you the syringe for administration to a patient:
     A) you cannot be held legally accountable if the medication or dose is inappropriate for the patient.
     B) you are legally responsible for the appropriate use and documentation of the medication.
     C) you should dispose of the dose and prepare another dose of the medication in a new syringe.
     D) the paramedic who prepared the medication must sign a form witnessing that you gave the medication.

Answer 143

B) you are legally responsible for the appropriate use and documentation of the medication.

Question 144

145. When preparing to administer an emergency medication to a patient, you should obtain a list of the patient’s prescribed medications because:
     A) doing so may avoid potentially dangerous medication interactions.
     B) most emergency medications are incompatible with prescribed medications.
     C) the side effects of the emergency medication can be anticipated better.
     D) emergency medications are not indicated for patients taking prescribed medications.

Answer 144

A) doing so may avoid potentially dangerous medication interactions.

Question 145

146. After acetylcholine (ACh) is synthesized and used by the body:
     A) acetylcholinesterase breaks the ACh down into choline and acetate.
     B) it arrives at the nerve ending, where it stimulates voltage-sensitive channels.
     C) the physiologic effects of tachycardia and hypertension are observed.

Answer 145

A) acetylcholinesterase breaks the ACh down into choline and acetate.

Question 146

147. Nicotinic receptors are stimulated by ______________, resulting in:
     A) acetylcholinesterase; bradycardia, hypotension, and weakness.
     B) epinephrine; hypertension, tachycardia, and pupillary dilation.
     C) norepinephrine; vasoconstriction, bradycardia, and fasciculations.
     D) acetylcholine; tachycardia, hypertension, and pupillary dilation.

Answer 146

D) acetylcholine; tachycardia, hypertension, and pupillary dilation.

Question 147

148. Overstimulation of muscarinic receptors results in:
     A) excessive lacrimation, bradycardia, diarrhea, and miosis.
     B) tachycardia, hypertension, dilated pupils, and nervousness.
     C) dehydration, decreased urine production, and double vision.
     D) muscle fasciculations, generalized weakness, and bradycardia.

Answer 147

A) excessive lacrimation, bradycardia, diarrhea, and miosis.

Question 148

149. The onset of action of a medication administered via the intravenous route is just as fast as a medication administered via the ___________ route.
     A) inhalation
     B) intraosseous
     C) endotracheal
     D) intramuscular

Answer 148

B) intraosseous

Question 149

150. Medications given via intramuscular (IM) injection have a longer duration of action than medications given via the intravenous (IV) route because:
     A) they are absorbed gradually during a period of minutes to hours.
     B) they remain within the muscle for a few hours after administration.
     C) the dose of most medications is higher if given via intramuscular injection.
     D) medications given via intramuscular injection bypass all barriers to absorption.

Answer 149

A) they are absorbed gradually during a period of minutes to hours.

Question 150

151. The ultimate goal of administering any emergency medication is:
     A) to administer the medication as rapidly as possible to achieve a therapeutic level.
     B) definitively cure the patient’s condition by administering the correct dose.
     C) for the medication to reach a therapeutic concentration in the bloodstream.
     D) to achieve a therapeutic blood level within 2 minutes after giving the medication.

Answer 150

C) for the medication to reach a therapeutic concentration in the bloodstream.

Question 151

152. Compared to the maintenance dose of a particular medication, a loading dose is:
     A) a smaller dose, of a different concentration, and intended to achieve a therapeutic blood level slowly.
     B) a larger dose, of the same concentration, and intended to achieve a therapeutic blood level quickly.
     C) a smaller dose, of the same concentration, and intended to achieve a therapeutic blood level slowly.
     D) a larger dose, of a different concentration, and intended to achieve a therapeutic blood level quickly.

Answer 151

B) a larger dose, of the same concentration, and intended to achieve a therapeutic blood level quickly.

Question 152

153. Bioavailability is MOST accurately defined as the:
     A) process by which a medication moves throughout the body.
     B) period of time it takes for a medication to achieve a therapeutic level.
     C) manner in which the body metabolizes a particular medication.
     D) amount of medication that is still active when it reaches its target organ.

Answer 152

D) amount of medication that is still active when it reaches its target organ.

Question 153

154. If a medication is administered to a patient with renal insufficiency:
     A) it may take hours before the medication is absorbed and exerts its effect.
     B) the process of biotransformation will be completely unpredictable.
     C) the dose should be doubled in order to achieve a therapeutic effect.
     D) it may not be excreted efficiently and may accumulate to toxic levels.

Answer 153

D) it may not be excreted efficiently and may accumulate to toxic levels.

Question 154

155. The interaction between medications that causes one medication to enhance the effects of the other is called:
     A) synergism.
     B) potentiation.
     C) habituation.
     D) a summation effect.

Answer 154

B) potentiation.

Question 155

156. Most psychotherapeutic medications work by blocking __________ receptors in the brain.
     A) melatonin
     B) dopamine
     C) epinephrine
     D) norepinephrine

Answer 155

B) dopamine

Question 156

157. Which of the following is a physiologic effect of tricyclic antidepressants?
     A) Selectively blocks serotonin from being reabsorbed in the brain
     B) Blocks norepinephrine and serotonin from being reabsorbed in the brain
     C) Blocks epinephrine from reaching its receptors, resulting in bradycardia
     D) Blocks alpha-2 receptors, resulting in decreased secretion of norepinephrine

Answer 156

B) Blocks norepinephrine and serotonin from being reabsorbed in the brain

Question 157

158. Muscarinic cholinergic antagonists:
     A) include medications such as atropine and cause an increase in heart rate.
     B) cause excessive salivation and lacrimation and decrease the heart rate.
     C) are found in pesticides and effectively deactivate acetylcholinesterase.
     D) include medications such as epinephrine and cause an increase in blood pressure.

Answer 157

A) include medications such as atropine and cause an increase in heart rate.

Question 158

159. All neuromuscular blocking agents:
     A) bind to sympathetic nervous system neurotransmitter receptors.
     B) affect the parasympathetic nervous system and induce paralysis.
     C) cause depolarization of the muscle cells, resulting in fasciculations.
     D) paralyze and sedate a patient by depressing the central nervous system.

Answer 158

B) affect the parasympathetic nervous system and induce paralysis.

Question 159

160. In order to cause a negative inotropic effect on the heart, you would have to administer a/an:
     A) beta-1 adrenergic antagonist.
     B) alpha-2 adrenergic agonist.
     C) beta-2 adrenergic agonist.
     D) alpha-1 adrenergic antagonist.

Answer 159

A) beta-1 adrenergic antagonist.

Question 160

161. Which of the following antiarrhythmic medications reduces the adrenergic stimulation of receptors that are responsible for increasing heart rate and cardiac contractility?
     A) Alpha blockers
     B) Calcium channel blockers
     C) Sodium channel blockers
     D) Beta blockers

Answer 160

D) Beta blockers

Question 161

162. In general, diuretic medications:
     A) lower blood pressure by causing the kidneys to remove excess amounts of salt and water from the body.
     B) increase cardiac preload and stroke volume by increasing the force of myocardial contraction.
     C) lower blood pressure through their effects of negative inotropy, negative chronotropy, and negative dromotropy.
     D) cause a mild increase in blood pressure by lowering the quantity of sodium and calcium ions in the body.

Answer 161

A) lower blood pressure by causing the kidneys to remove excess amounts of salt and water from the body.

Question 162

163. A patient who has undergone a kidney transplant would MOST likely be prescribed a/an:
     A) bactericidal agent.
     B) antineoplastic medication.
     C) immunosuppressant agent.
     D) immunobiologic medication

Answer 162

C) immunosuppressant agent.

Question 163

164. Ethics is MOST accurately defined as:
     A) the philosophy of right and wrong, of moral duties, and of ideal professional behavior.
     B) the professional behavior that a person’s peers as well as the general public expect.
     C) behavior that is consistent with the law and an attitude that society in general expects.
     D) a code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

Answer 163

A) the philosophy of right and wrong, of moral duties, and of ideal professional behavior.

Question 164

165. When caring for any patient, it is important to remember that:
     A) the patient likely shares the same moral standards that you do.
     B) your moral standards should affect the way you treat the patient.
     C) the patient’s wishes and your moral standards are often the same.
     D) your moral standards may conflict with the patient’s best interests.

Answer 164

D) your moral standards may conflict with the patient’s best interests.

Question 165

166. If a patient makes a decision regarding his or her own health care and the paramedic does not agree with that decision, the paramedic should:
     A) ensure that the EMS medical director agrees with the patient’s decision.
     B) accept the patient’s decision, but advise him or her that you do not agree.
     C) try to convince the patient that the decision is not in his or her best interest.
     D) respect the patient’s wishes, assuming he or she has decision-making capacity.

Answer 165

D) respect the patient’s wishes, assuming he or she has decision-making capacity.

Question 166

167. A do not resuscitate (DNR) order is MOST accurately defined as a:
     A) written order designed to tell health care providers when resuscitation is or is not appropriate.
     B) legal document that is executed by the patient while he or she still has decision-making capacity.
     C) written or oral directive that stipulates the care that a patient should receive at the end of his or her life.
     D) legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients.

Answer 166

A) written order designed to tell health care providers when resuscitation is or is not appropriate.

Question 167

168. The surrogate decision maker:
     A) must be an immediate family member of the patient.
     B) is legally obligated to make decisions as the patient would want.
     C) must recertify his or her decision-making status every 10 years
     D) can make decisions for a patient who has decision-making capacity.

Answer 167

B) is legally obligated to make decisions as the patient would want.

Question 168

169. Resuscitation efforts would most likely NOT be initiated on a patient with:
     A) blunt trauma arrest.
     B) witnessed cardiac arrest.
     C) an extensive cardiac history.
     D) hypothermic cardiac arrest.

Answer 168

A) blunt trauma arrest.

Question 169

170. Components of the diencephalon include the:
     A. pons and medulla.
     B. brain stem and midbrain.
     C. thalamus and hypothalamus.
     D. cerebellum and cerebral cortex.

Answer 169

C. thalamus and hypothalamus.

Question 170

171. A loss of balance and equilibrium is MOST suggestive of injury to the:
     A. midbrain.
     B. cerebrum.
     C. thalamus.
     D. cerebellum.

Answer 170

D. cerebellum.

Question 171

172. 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 171

A. allowing the neuron to send its signal consistently along the axon without losing its electricity.

Question 172

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

Answer 172

A. they convert to anaerobic metabolism.

Question 173

174. 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 173

D. increased intracranial pressure.

Question 174

175. 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 174

A. Hypotension

Question 175

176. 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 175

C. maintain an adequate blood pressure.

Question 176

177. 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 176

B. constrict the cerebral vasculature and decrease cerebral perfusion.

Question 177

178. 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 177

C. a widened pulse pressure.

Question 178

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

Answer 178

D. apraxic.

Question 179

180. 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 monitor 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 179

B. assist his ventilations and monitor his oxygen saturation.

Question 180

181. You are dispatched to a residence for a middle-aged woman with generalized weakness of approximately 18 hours’ duration. Your initial 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 MOST 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 180

C. Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.

Question 181

182. 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, 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 181

D. open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam.

Question 182

183. 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 182

B. an intracranial neoplasm.

Question 183

184. The structural and functional unit of the kidney is the:
     A. nephron.
     B. medulla.
     C. renal cortex.
     D. podocyte.

Answer 183

A. nephron.

Question 184

185. When triggered by changes in the blood pressure, the juxtaglomerular cells release:

A. renin.
B. aldosterone.
C. angiotensin I.
D. angiotensinogen.

Answer 184

A. renin.

Question 185

186. When the solute concentration of the blood increases:
     A. water is excreted from the body by the kidneys.
     B. antidiuretic hormone is released into the bloodstream.
     C. the release of angiotensin II causes the blood pressure to fall.
     D. the distal convoluted tubule becomes less permeable to water.

Answer 185

B. antidiuretic hormone is released into the bloodstream.

Question 186

187. Aldosterone produces all of the following physiologic effects, EXCEPT:
     A. increased water resorption in the kidneys.
     B. excretion of potassium from the body.
     C. increased sodium and chloride resorption.
     D. decreased resorption of potassium ions.

Answer 186

B. excretion of potassium from the body.

Question 187

188. Furosemide (Lasix) causes diuresis by:
     A. increasing circulating blood glucose.
     B. converting angiotensin I to angiotensin II.
     C. inhibiting sodium resorption in the kidneys.
     D. inhibiting the production of antidiuretic hormone.

Answer 187

C. inhibiting sodium resorption in the kidneys.

Question 188

189. Which of the following statements regarding pyelonephritis is MOST correct?
     A. Untreated pyelonephritis typically heals spontaneously.
     B. Most cases of pyelonephritis occur in the lower urinary tract.
     C. Pyelonephritis is an inflammation of the linings of the kidney.
     D. In pyelonephritis, the ureters become inflamed and infected.

Answer 188

C. Pyelonephritis is an inflammation of the linings of the kidney.

Question 189

190. A marked decrease in urinary output is called:
     A. anuria.
     B. oliguria.
     C. dysuria.
     D. polyuria.

Answer 189

B. oliguria.

Question 190

191. Clinical manifestations of chronic renal failure include all of the following, EXCEPT:
     A. dehydration.
     B. hyperkalemia.
     C. hypotension.
     D. QT prolongation.

Answer 190

A. dehydration.

Question 191

192. Patients requiring chronic dialysis:
     A. are typically not able to ambulate.
     B. are usually dialyzed every 2 or 3 days.
     C. are almost always inpatients in a hospital.
     D. stay on the dialysis machine for 6 to 8 hours.

Answer 191

B. are usually dialyzed every 2 or 3 days.

Question 192

193. Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of:
     A. hypovolemia.
     B. hypokalemia.
     C. hyperkalemia.
     D. air embolism.

Answer 192

B. hypokalemia.

Question 193

194. Disequilibrium syndrome is a condition in which:
     A. large amounts of water move by osmosis into the brain, resulting in an acute subdural hematoma.
     B. dialysis patients miss one or two of their treatments, resulting in hyperkalemia, azotemia, and hypotension.
     C. water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.
     D. the concentration of urea in the bloodstream is lowered slowly, while the solute concentration of the cerebrospinal fluid remains high.

Answer 193

C. water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.

Question 194

195. A young woman presents with left-sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. This patient is MOST likely experiencing:
     A. renal failure.
     B. a renal calculus.
     C. kidney stones.
     D. pyelonephritis.

Answer 194

D. pyelonephritis.

Question 195

196. The exocrine function of the pancreas produces:
     A. insulin.
     B. glucagon.
     C. enzymes.
     D. somatostatin.

Answer 195

C. enzymes.

Question 196

197. Chronic use of nonsteroidal anti-inflammatory drugs would MOST likely result in:
     A. diverticulitis.
     B. esophageal varices.
     C. acute gastroenteritis.
     D. peptic ulcer disease.

Answer 196

D. peptic ulcer disease.

Question 197

198. Common signs of bleeding in the upper gastrointestinal tract include all of the following, EXCEPT:
     A. melena.
     B. hematochezia.
     C. hematemesis.
     D. dark, tarry stools.

Answer 197

B. hematochezia.

Question 198

199. Which of the following types of hepatitis is NOT transmitted parenterally?
     A. D
     B. C
     C. B
     D. A

Answer 198

D. A

Question 199

200. Intravenous drug abusers are at HIGHEST risk for developing hepatitis:
     A. A
     B. B
     C. F
     D. G

Answer 199

B. B

Question 200

201. The LEAST practical abdominal exam technique in the prehospital setting is:
     A. palpation.
     B. inspection.
     C. percussion.
     D. auscultation.

Answer 200

D. auscultation.

Question 201

202. In contrast to somatic pain, visceral pain:
     A. is well-localized.
     B. indicates peritonitis.
     C. is difficult to localize.
     D. increases with movement

Answer 201

C. is difficult to localize.

Question 202

203. Irritation or injury to abdominal tissue, causing activation of peripheral nerve tracts, would MOST likely result in ___________ pain.
     A. visceral
     B. somatic
     C. rebound
     D. parietal

Answer 202

B. somatic

Question 203

204. The bioavailability and excretion rate of a toxin are influenced MOST by the:
     A. amount of toxin and the relative speed at which it is metabolized.
     B. type of toxin and the condition of the patient’s underlying health.
     C. route by which the toxin entered the body and the age of the patient.
     D. the presence of other substances in the body at the time of exposure.

Answer 203

A. amount of toxin and the relative speed at which it is metabolized.

Question 204

205. Any sympathomimetic drug will cause:
     A. ataxia.
     B. tachycardia.
     C. hallucinations.
     D. hypothermia.

Answer 204

B. tachycardia.

Question 205

206. Most ingested poisons will cause:
     A. headache and seizures.
     B. tremors and weakness.
     C. salivation and coma.
     D. nausea and vomiting.

Answer 205

D. nausea and vomiting.

Question 206

207. Drug abuse is MOST accurately defined as:
     A. the habitual use of illicit drugs for the purpose of inducing a euphoric feeling.
     B. any use of drugs that causes physical, psychological, or legal harm to the user.
     C. the use of legal medications that is not in accordance with a physician’s order.
     D. inadvertent misuse of a licit or illicit drug that causes physical harm to the user.

Answer 206

B. any use of drugs that causes physical, psychological, or legal harm to the user.

Question 207

208. Alcohol potentiates Valium. This means that:
     A. Valium makes alcohol a toxic substance.
     B. alcohol antagonizes the effects of Valium.
     C. alcohol enhances the effects of the Valium.
     D. the use of alcohol negates the use of Valium.

Answer 207

C. alcohol enhances the effects of the Valium.

Question 208

209. Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity?
     A. Narrowing of the PR interval
     B. Marked flattening of the T wave
     C. Narrowing of the QRS complex
     D. Prolongation of the QT interval

Answer 208

D. Prolongation of the QT interval

Question 209

210. Organophosphates exert their effect by:
     A. destroying the body’s acetylcholine.
     B. agonizing the sympathetic nervous system.
     C. stimulating the cholinergic nervous system.
     D. blocking the parasympathetic nervous system.

Answer 209

C. stimulating the cholinergic nervous system.

Question 210

211. Which of the following statements regarding the black widow spider is MOST correct?
     A. The venom of a black widow spider contains a necrotoxin, which results in local tissue necrosis.
     B. Because the mortality rate from a black widow spider bite is about 40%, a prehospital antidote is crucial.
     C. Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.
     D. The male black widow spider, which is the sex that poses a danger to humans, contains a red hourglass on its back.

Answer 210

C. Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.

Question 211

212. The bite of a brown recluse spider:
     A. may not result in immediate symptoms, but generally presents as a painful, reddened area with an overlying blister.
     B. manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia.
     C. most often causes severe central nervous system depression because its venom contains a powerful neurotoxin.
     D. results in a local reaction only because the spider’s venom is cytotoxic and spreads slowly throughout the bloodstream.

Answer 211

A. may not result in immediate symptoms, but generally presents as a painful, reddened area with an overlying blister.