homework week 14

Question 1

You arrive at the scene of an unknown drug-related emergency. Law enforcement is present and has ensured scene safety. The patient, a young female, is found sitting at the kitchen table. She is laughing uncontrollably and tells you, “Life sure is good!” Your partner finds a basin of water and an empty box of baking soda on the counter. You should be MOST suspicious that this patient:
Select one:
a. is speedballing.
b. has injected heroin.
c. was snorting cocaine.
d. has smoked crack cocaine.

Answer 1

d. has smoked crack cocaine.

Question 2

Which of the following drugs is classified as an anticholinergic?
Select one:
a. Diazinon
b. Atropine 
c. Thiopental
d. Phenylephrine

Answer 2

b. Atropine

Question 3

You are dispatched to a residence for a 61-year-old woman with flu-like symptoms. Upon your arrival, the patient greets you at the door. She complains of a headache and nausea, and tells you that she has vomited twice. Her husband, who is lying on the couch in the living room, began experiencing the same symptoms at about the same time. You should:
Select one:
a. remove both patients from the residence at once.
b. immediately open all of the windows in the house.
c. carefully assess the residence for any unusual findings.
d. suspect that both patients have been exposed to cyanide.

Answer 3

a. remove both patients from the residence at once.

Question 4

A 29-year-old woman was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patient’s respirations are slow and shallow, her pulse is slow and weak, and her pupils are dilated. Your partner begins assisting the patient’s ventilations as you assess her blood pressure, which is 70/48 mm Hg. The patient’s husband hands you an empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should:
Select one:
a. administer crystalloid fluid boluses to improve her blood pressure.
b. give her up to 10 mg of naloxone to reverse the effects of the drug.
c. instruct your partner to hyperventilate the patient at 24 breaths/min.
d. begin a dopamine infusion at 10 µg/kg/min and titrate as needed.

Answer 4

a. administer crystalloid fluid boluses to improve her blood pressure.

Question 5

You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm Hg, a pulse rate of 140 beats/min, and a respiratory rate of 24 breaths/min. The patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. After asking your partner to stop the ambulance to assist you with the patient, you should:
Select one:
a. assess his blood glucose level.
b. administer 4 mg/kg of ketamine IM.
c. start an IV line and give him morphine.
d. administer a beta blocker and reassess.

Answer 5

b. administer 4 mg/kg of ketamine IM.

Question 6

You respond to a local motel for a young woman who was sexually assaulted. Upon your arrival, you find the patient sitting on the bed talking to a police officer. The last thing she remembers is meeting “some guy” at a nightclub the evening before and then having a few drinks with him. She is conscious, but sleepy. Her respirations are 12 breaths/min and regular, pulse rate is 56 beats/min and strong, and blood pressure is 102/58 mm Hg. The cardiac monitor reveals sinus bradycardia at 50 to 60 beats/min. You should:
Select one:
a. assist her ventilations with a bag-mask device, start an IV line, administer 0.5 mg of atropine, and transport.
b. give her supplemental oxygen, conduct a secondary assessment at the scene to collect evidence, and transport her.
c. administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital.
d. conclude that she was unknowingly administered a narcotic analgesic, start an IV line, and give her 2 mg of naloxone.

Answer 6

c. administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital.

Question 7

Drug abuse is MOST accurately defined as:
Select one:
a. the habitual use of illicit drugs for the purpose of inducing a euphoric feeling.
b. any use of a drug 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 7

b. any use of a drug that causes physical, psychological, or legal harm to the user.

Question 8

During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was “listening to the painting on the wall” before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is MOST consistent with the use of:
Select one:
a. LSD. 
b. PCP.
c. marijuana.
d. methamphetamine.

Answer 8

a. LSD.

Question 9

An unresponsive middle-aged man ingested a half-full bottle of Valium approximately 20 minutes ago. His respirations are slow and shallow, his pulse is slow and weak, and his blood pressure is significantly low. The cardiac monitor reveals sinus bradycardia. You should:
Select one:
a. insert a Combitube, establish vascular access, administer up to 4 liters of normal saline, and give him 0.1 mg/kg of naloxone.
b. administer oxygen via nonrebreathing mask, start an IV line, and give 150 mg of amiodarone to prevent lethal ventricular dysrhythmias.
c. immediately intubate his trachea, hyperventilate him to minimize acidosis, establish vascular access, and administer up to 10 mg of flumazenil.
d. assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

Answer 9

d. assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

Question 10

An acetone breath odor is common following exposure to all of the following toxins, EXCEPT:
Select one:
a. aspirin.
b. isopropyl alcohol.
c. camphor. 
d. methyl alcohol.

Answer 10

c. camphor.

Question 11

You would expect a person to be hypertensive and tachycardic following exposure to all of the following, EXCEPT:
Select one:
a. cocaine.
b. bath salts.
c. phenobarbital. 
d. pseudoephedrine.

Answer 11

c. phenobarbital.

Question 12

You are transporting a chronic heroin abuser to whom you have just administered naloxone. The patient is responsive to verbal stimuli, and her respirations, blood pressure, and pulse rate have improved following your treatment. With an estimated time of arrival at the hospital of 20 minutes, which of the following should concern you the MOST?
Select one:
a. There is a high potential that the patient will suddenly become violent.
b. The patient will require immediate intubation if her respirations decrease.
c. The patient may deteriorate and require further naloxone administration.
d. Low doses of naloxone often precipitate seizures in chronic heroin abusers.

Answer 12

c. The patient may deteriorate and require further naloxone administration.

Question 13

You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for:
Select one:
a. QRS widening. 
b. AV heart block.
c. QT interval narrowing.
d. a prolonged PR interval.

Answer 13

a. QRS widening.

Question 14

A 69-year-old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he has an odd odor on his breath; however, he denies being diabetic. You should:
Select one:
a. start an IV line of normal saline and administer 10 mL of a 10% solution of calcium chloride.
b. administer 1 to 2 g of pralidoxime infused with normal saline solution over a 5- to 10-minute period.
c. start an IV line, sedate and chemically paralyze the patient, and then perform endotracheal intubation.
d. have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

Answer 14

d. have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

Question 15

Most ingested poisons will cause:
Select one:
a. headache and seizures.
b. tremors and weakness.
c. salivation and coma.
d. nausea and vomiting.

Answer 15

d. nausea and vomiting.

Question 16

A woman drives her husband to your EMS station after he was exposed to a large amount of pesticide. Your assessment reveals that he is responsive to pain only, is hypoventilating, is markedly bradycardic, and is incontinent of urine and feces. The cardiac monitor reveals marked sinus bradycardia. As your partner assists the patient’s ventilations, you should:
Select one:
a. establish vascular access and begin administering atropine sulfate.
b. administer 1 to 2 mg of pralidoxime IM and transport immediately.
c. obtain a 12-lead ECG tracing to detect signs of myocardial injury.
d. start an IV line and give sodium bicarbonate to alkalinize his urine.

Answer 16

a. establish vascular access and begin administering atropine sulfate.

Question 17

Any sympathomimetic drug will cause:
Select one:
a. ataxia.
b. tachycardia. 
c. hallucinations.
d. hypothermia.

Answer 17

b. tachycardia.

Question 18

The emotional state of craving a drug to maintain a feeling of well-being is called:
Select one:
a. addiction.
b. habituation.
c. physical dependence.
d. psychological dependence.

Answer 18

d. psychological dependance.

Question 19

A poison is a substance:
Select one:
a. whose chemical action could damage structures or impair function, even in small amounts.
b. that is damaging to the tissues and cells, especially if injected or taken in large quantities.
c. that is legal or illegal, and has the potential of causing permanent damage if it is ingested.
d. that is capable of making a person ill, at a minimum, and has a great chance of causing death.

Answer 19

a. whose chemical action could damage structures or impair function, even in small amounts.

Question 20

You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should:
Select one:
a. insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport.
b. continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
c. insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital.
d. insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.

Answer 20

b. continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.

Question 21

The odor of bitter almonds on a patient's breath should make you suspicious for exposure to:
Select one:
a. cyanide. 
b. arsenic.
c. phosphorus.
d. turpentine.

Answer 21

a. cyanide.

Question 22

A 22-year-old woman experienced an acid chemical burn to her left forearm. She complains of intense pain and tingling in her fingers. She is conscious and alert, and denies any other symptoms. You should:
Select one:
a. cover the burn and transport at once.
b. begin immediate irrigation with water.
c. apply a light coat of baking soda to the burn.
d. administer oxygen via nonrebreathing mask.

Answer 22

b. begin immediate irrigation with water.

Question 23

You are dispatched to an apartment complex for a suicide attempt. While you are en route, an on-scene law enforcement officer advises you that the patient, who is unresponsive, ingested an unknown quantity of an unknown drug. Upon arriving at the scene, you should:
Select one:
a. identify what the patient took before providing treatment.
b. gain rapid access to the patient and begin your assessment.
c. safely gain access to the patient while looking for an egress route.
d. ask the police officer to bring the patient to the ambulance.

Answer 23

c. safely gain access to the patient while looking for an egress route.

Question 24

Signs and symptoms of serotonin syndrome include:
Select one:
a. myoclonus. 
b. hypotension.
c. bradycardia.
d. hypothermia.

Answer 24

a. myoclonus.

Question 25

A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should:
Select one:
a. start an IV line and give 1 mEq/mg of sodium bicarbonate.
b. assess his blood glucose level and apply a cardiac monitor.
c. start an IV line and begin administering a saline fluid bolus.
d. give him 100 mg of thiamine IM and assess his blood pressure.

Answer 25

b. assess his blood glucose level and apply a cardiac monitor.