midterm up to 24

Question 1

A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should:
administer up to 324 mg of baby aspirin.
assess the adequacy of his respirations.
obtain vital signs and a SAMPLE history.
administer up to three doses of nitroglycerin.

Answer 1

obtain vital signs and a SAMPLE history.

Question 2

A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours’ duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should:
give her one nitroglycerin and reassess her systolic blood pressure.
administer oxygen, give her 324 mg of aspirin, and assess her further.
obtain a SAMPLE history and contact medical control for advice.
give her high-flow oxygen, attach the AED, and transport at once.

Answer 2

administer oxygen

Question 3

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate?
Hypertensive emergency
Unstable angina
Dissecting aortic aneurysm
Acute myocardial infarction

Answer 3

Dissecting aortic aneurysm

Question 4

A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should:
defibrillate with the AED while continuing transport to the hospital.
stop the ambulance, begin CPR, and attach the AED as soon as possible.
alert the receiving hospital and perform CPR for the duration of the transport.
perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED.

Answer 4

stop the ambulance

Question 5

Acute coronary syndrome (ACS) is a term used to describe:
a group of symptoms that are caused by myocardial ischemia.
the exact moment that a coronary artery is completely occluded.
a severe decrease in perfusion caused by changes in heart rate.
the warning signs that occur shortly before a heart attack.

Answer 5

a group of symptoms that are caused by myocardial ischemia.

Question 6

A dissecting aortic aneurysm occurs when:
all layers of the aorta suddenly contract.
the inner layers of the aorta become separated.
a weakened area develops in the aortic wall.
the aorta ruptures, resulting in profound bleeding.

Answer 6

the inner layers of the aorta become separated.

Question 7

After assisting your patient with prescribed nitroglycerin, you should:
avoid further dosing if the patient complains of a severe headache.
perform a secondary assessment before administering further doses.
reassess his or her blood pressure within 5 minutes to detect hypotension.
place the patient in a recumbent position in case of fainting.

Answer 7

reassess his or her blood pressure within 5 minutes to detect hypotension.

Question 8

After the AED has delivered a shock, the EMT should:
transport the patient at once.
assess for a carotid pulse.
re-analyze the cardiac rhythm.
immediately resume CPR.

Answer 8

immediately resume CPR.

Question 9

An acute myocardial infarction (AMI) occurs when:
coronary artery dilation decreases blood flow to the heart.
the heart muscle progressively weakens and dysfunctions.
myocardial tissue dies secondary to an absence of oxygen.
the entire left ventricle is damaged and cannot pump blood.

Answer 9

myocardial tissue dies secondary to an absence of oxygen.

Question 10

Angina pectoris occurs when:
a coronary artery is totally occluded by plaque.
myocardial oxygen supply exceeds the demand.
myocardial oxygen demand exceeds supply.
one or more coronary arteries suddenly spasm.

Answer 10

myocardial oxygen demand exceeds supply.

Question 11

A patient with a left ventricular assist device (LVAD) tells you that the device’s pump flow is continuous. Which of the following should you expect to encounter during your assessment?
Absence of a palpable pulse
Distention of the jugular veins
Low diastolic blood pressure
High systolic blood pressure

Answer 11

Absence of a palpable pulse

Question 12

Blood that is ejected from the right ventricle:
enters the systemic circulation.
flows into the pulmonary arteries.
was received directly from the aorta.
has a high concentration of oxygen.

Answer 12

flows into the pulmonary arteries.

Question 13

Common side effects of nitroglycerin include all of the following, EXCEPT:
hypertension.
bradycardia.
hypotension.
severe headache.

Answer 13

hypertension.

Question 14

Deoxygenated blood from the body returns to the:
left ventricle.
left atrium.
right ventricle.
right atrium.

Answer 14

right atrium.

Question 15

During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a “no shock advised” message. This indicates that:
she is not in ventricular fibrillation.
the AED detected patient motion.
the AED has detected asystole.
she has a pulse and does not need CPR.

Answer 15

she is not in ventricular fibrillation.

Question 16

Most AEDs are set up to adjust the voltage based on the impedance, which is the:
actual amount of energy that the AED will deliver.
direction that the electrical flow takes in the body.
distance between the two AED pads on the chest.
resistance of the body to the flow of electricity.

Answer 16

resistance of the body to the flow of electricity.

Question 17

Nitroglycerin relieves cardiac-related chest pain by:
dilating the coronary arteries and improving cardiac blood flow.
contracting the smooth muscle of the coronary and cerebral arteries.
increasing the amount of stress that is placed on the myocardium.
constricting the coronary arteries and improving cardiac blood flow.

Answer 17

dilating the coronary arteries and improving cardiac blood flow.

Question 18

A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient’s wife tells you that he has an automatic implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do?
Deliver the shock followed by immediate resumption of CPR.
Continue CPR and transport the patient to the closest appropriate hospital.
Avoid defibrillation because this will damage the patient’s AICD.
Contact medical control and request permission to defibrillate.

Answer 18

Deliver the shock followed by immediate resumption of CPR.

Question 19

Cardiac output may decrease if the heart beats too rapidly because:
there is not enough time in between contractions for the heart to refill completely.
a rapid heartbeat causes a decrease in the strength of cardiac contractions.
as the heart rate increases, more blood is pumped from the ventricles than the atria
the volume of blood that returns to the heart is not sufficient with fast heart rates.

Answer 19

there is not enough time in between contractions for the heart to refill completely.

Question 20

Common signs and symptoms of AMI include all of the following, EXCEPT:
sudden unexplained sweating.
irregular heartbeat.
pain exacerbated by breathing.
shortness of breath or dyspnea.

Answer 20

pain exacerbated by breathing.

Question 21

A dissecting aortic aneurysm occurs when:
the aorta ruptures, resulting in profound bleeding.
all layers of the aorta suddenly contract.
the inner layers of the aorta become separated.
a weakened area develops in the aortic wall.

Answer 21

the inner layers of the aorta become separated.

Question 22

A patient with atherosclerotic heart disease experiences chest pain during exertion because:
the coronary arteries suddenly spasm and cause a marked reduction in myocardial blood flow.
tissues of the myocardium undergo necrosis secondary to a prolonged absence of oxygen.
the ragged edge of a tear in the coronary artery lumen causes local blood clotting and arterial narrowing.
the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

Answer 22

the lumen of the coronary artery is narrowed and cannot accommodate increased blood flow.

Question 23

Acute coronary syndrome (ACS) is a term used to describe:
the exact moment that a coronary artery is completely occluded.
a group of symptoms that are caused by myocardial ischemia.
a severe decrease in perfusion caused by changes in heart rate.
the warning signs that occur shortly before a heart attack.

Answer 23

a group of symptoms that are caused by myocardial ischemia.

Question 24

Blood that is ejected from the right ventricle:
has a high concentration of oxygen.
flows into the pulmonary arteries.
was received directly from the aorta.
enters the systemic circulation.

Answer 24

flows into the pulmonary arteries.

Question 25

Deoxygenated blood from the body returns to the:
right ventricle.
right atrium.
left atrium.
left ventricle.

Answer 25

right atrium.

Question 26

Ischemic heart disease is defined as:
absent myocardial blood flow due to a blocked coronary artery.
decreased blood flow to the heart muscle due to coronary dilation.
decreased blood flow to one or more portions of the myocardium.
death of a portion of the heart muscle due to a decrease in oxygen.

Answer 26

decreased blood flow to one or more portions of the myocardium.

Question 27

A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should:
- position her legs well above the level of her heart.
- administer oxygen and transport her to the hospital.
- request a paramedic unit to administer epinephrine.
- advise her to see her physician as soon as possible.

Answer 27

administer oxygen and transport her to the hospital

Question 28

A 38-year-old woman was bitten by fire ants while at the park. Your primary assessment reveals that she is semiconscious; has labored breathing; and has a rapid, thready pulse. She has a red rash on her entire body, and her face is swollen. You should:
- perform a rapid secondary assessment.
- assist her ventilations with 100% oxygen.
- locate the area where the fire ants bit her.
- place her supine with her legs elevated.

Answer 28

assist her ventilations with 100% oxygen

Question 29

A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and his blood pressure is stable. Your next action should be to:
- reassess his breathing and blood pressure in 15 minutes.
- visualize his airway to assess for oropharyngeal swelling.
- notify medical control of the patient’s response to your treatment.
- record the time and dose of the injection and transport promptly.

Answer 29

record the time and dose of the injection and transport promptly

Question 30

A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory distress. You should:
- administer oxygen if needed, transport the patient, and monitor him for signs of deterioration.
- ask him if he has epinephrine and request approval from medical control to administer it to the patient.
- avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.
- begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.

Answer 30

administer oxygen if needed

Question 31

After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old female with an allergic reaction, you note improvement in her breathing and resolution of her hives. However, she is still anxious and tachycardic. You should:
- contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.
- transport her rapidly, because it is obvious that she is having a severe reaction to the epinephrine.
- monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
- consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

Answer 31

monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine

Question 32

Anaphylaxis is MOST accurately defined as a(n):
- moderate allergic reaction that primarily affects the vasculature.
- extreme allergic reaction that may affect multiple body systems.
- severe allergic reaction that typically resolves without treatment.
- allergic reaction that causes bronchodilation and vasoconstriction.

Answer 32

extreme allergic reaction that may affect multiple body systems

Question 33

A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:
- a pustule.
- purpura.
- urticaria.
- a wheal.

Answer 33

a wheal

Question 34

Common side effects of epinephrine include all of the following, EXCEPT:
- drowsiness.
- tachycardia.
- headache.
- dizziness.

Answer 34

drowsiness

Question 35

Epinephrine is indicated for patients with an allergic reaction when:
- wheezing and hypotension are present.
- the patient is anxious and tachycardic.
- a paramedic is present at the scene.
- the reaction produces severe urticaria.

Answer 35

wheezing and hypotension are present

Question 36

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg.
- 0.1; 0.01
- 0.01; 0.1
- 0.03; 0.3
- 0.3; 0.15

Answer 36

0.3; 0.15

Question 37

The foreign substance responsible for causing an allergic reaction is called a(n):
- allergen.
- antibody.
- histamine.
- leukotriene.

Answer 37

allergen

Question 38

Urticaria is the medical term for:
- hives.
- burning.
- swelling.
- a wheal.

Answer 38

hives

Question 39

Which of the following medications blocks the release of histamines?
- Albuterol (Ventolin)
- Epinephrine (Adrenalin)
- Acetaminophen (Tylenol)
- Diphenhydramine (Benadryl)

Answer 39

Diphenhydramine (Benadryl)

Question 40

Which of the following statements regarding fire ants is correct?
- Fire ants often bite a person repeatedly.
- Fire ant bites rarely cause anaphylaxis.
- Fire ant bites typically occur on the face.
- Most people are allergic to fire ant toxin.

Answer 40

Fire ants often bite a person repeatedly

Question 41

Which of the following would MOST likely provide clues regarding the source of a patient’s allergic reaction?
- The patient’s family history
- The patient’s general physical appearance
- The environment in which the patient is found
- The time of year in which the exposure occurred

Answer 41

The environment in which the patient is found

Question 42

While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates:
- rapid swelling of the upper airway tissues.
- a significant amount of fluid in the alveoli.
- narrowing of the bronchioles in the lungs.
- enlargement of the bronchioles in the lungs.

Answer 42

narrowing of the bronchioles in the lungs

Question 43

You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a wheal surrounded by an area of redness. He states that he had a ‘bad reaction’ the last time he was stung by a scorpion, and carries his own epinephrine auto-injector. You should:
- apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once.
- apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and transport.
- assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains stable.
- apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.

Answer 43

apply oxygen as needed

Question 44

You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should:
- monitor her en route to the hospital and call medical control if she worsens.
- crush up an antihistamine tablet and place it in between her cheek and gum.
- request permission from medical control to give another dose of epinephrine.
- administer a nebulized bronchodilator to improve the status of her breathing.

Answer 44

request permission from medical control to give another dose of epinephrine

Question 45

You respond to the residence of a 55-year-old woman with a possible allergic reaction to peanuts that she ate approximately 30 minutes ago. The patient is conscious and alert, but has diffuse urticaria and the feeling that she has a lump in her throat. As your partner applies oxygen to the patient, you should:
- ask her if she has prescribed epinephrine.
- obtain a complete set of baseline vital signs.
- ascertain if she has a family history of allergies.
- ask her when her last allergic reaction occurred.

Answer 45

ask her if she has prescribed epinephrine

Question 46

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:
- abdominal cramps.
- drying of the eyes.
- flushing of the skin.
- persistent dry cough.

Answer 46

drying of the eyes

Question 47

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seems to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min. Treatment should include:
- assisting him with his migraine medication and transporting without lights and siren.
- applying warm compresses to the back of his neck and transporting with lights and siren.
- dimming the lights in the back of the ambulance and transporting without lights and siren.
- placing him in a supine position and transporting with lights and siren to a stroke center.

Answer 47

dimming the lights in the back of the ambulance and transporting without lights and siren

Question 48

A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is:
- intracranial bleeding.
- a serious infection.
- a brain tumor.
- epilepsy.

Answer 48

epilepsy

Question 49

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His airway is patent, and his breathing is adequate. His wife is present and is very upset. Which of the following has the MOST immediate priority?
- Asking his wife when she noticed the symptoms
- Obtaining a complete set of baseline vital signs
- Documenting all of his current medications
- Administering glucose to rule out hypoglycemia

Answer 49

Asking his wife when she noticed the symptoms

Question 50

An area of swelling or enlargement in a weakened arterial wall is called:
- an embolism.
- atherosclerosis.
- a thrombus.
- an aneurysm.

Answer 50

an aneurysm

Question 51

A patient who is experiencing aphasia is:
- experiencing a right hemispheric stroke.
- not able to swallow without choking.
- usually conscious but has slurred speech.
- unable to produce or understand speech.

Answer 51

unable to produce or understand speech

Question 52

A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:
- has bleeding within the brain.
- is older than 60 years of age.
- has a GCS score that is less than 8.
- has had a prior heart attack.

Answer 52

has bleeding within the brain

Question 53

A transient ischemic attack (TIA) occurs when:
- signs and symptoms resolve spontaneously within 48 hours.
- medications are given to dissolve a cerebral blood clot.
- a small clot in a cerebral artery causes temporary symptoms.
- a small cerebral artery ruptures and causes minimal damage.

Answer 53

a small clot in a cerebral artery causes temporary symptoms

Question 54

Components of the Cincinnati Prehospital Stroke Scale include:
- arm drift, memory, and grip strength.
- arm drift, speech, and facial droop.
- speech, pupil reaction, and memory.
- facial droop, speech, and pupil size.

Answer 54

arm drift

Question 55

During the primary assessment of a semiconscious 70-year-old female, you should:
- immediately determine the patient’s blood glucose level.
- insert a nasopharyngeal airway and assist ventilations.
- ensure a patent airway and support ventilation as needed.
- ask family members if the patient has a history of stroke.

Answer 55

ensure a patent airway and support ventilation as needed

Question 56

Febrile seizures:
- occur when a child’s fever rises slowly.
- often result in permanent brain damage.
- are usually benign but should be evaluated.
- are also referred to as absence seizures.

Answer 56

are usually benign but should be evaluated

Question 57

Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the:
- brain.
- pancreas.
- liver.
- kidneys.

Answer 57

liver

Question 58

Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should:
- place a bite block in her mouth in case she has a seizure and transport at once.
- assist ventilations, perform a rapid exam, and prepare for immediate transport.
- apply oxygen via a nonrebreathing mask, place her on her left side, and transport.
- apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.

Answer 58

assist ventilations

Question 59

Status epilepticus is characterized by:
- prolonged seizures without a return of consciousness.
- an absence seizure that is not preceded by an aura.
- profound tachycardia and total muscle flaccidity.
- generalized seizures that last less than 5 minutes.

Answer 59

prolonged seizures without a return of consciousness

Question 60

The left cerebral hemisphere controls:
- the right side of the body.
- breathing and blood pressure.
- the right side of the face.
- heart rate and pupil reaction.

Answer 60

the right side of the body

Question 61

The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the:
- brain stem.
- cerebral cortex.
- cerebellum.
- cerebrum.

Answer 61

brain stem

Question 62

The MOST significant risk factor for a hemorrhagic stroke is:
- diabetes mellitus.
- hypertension.
- severe stress.
- heavy exertion.

Answer 62

hypertension

Question 63

When assessing for arm drift of a patient with a suspected stroke, you should:
- ask the patient to hold his or her arms up with the palms down.
- expect to see one arm slowly drift down to the patient’s side.
- observe movement of the arms for approximately 2 minutes.
- ask the patient to close his or her eyes during the assessment.

Answer 63

ask the patient to close his or her eyes during the assessment

Question 64

When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine:
- the patient’s overall medication compliance.
- when the patient last appeared normal.
- if there is a family history of a stroke.
- if the patient has been hospitalized before.

Answer 64

when the patient last appeared normal

Question 65

Which of the following MOST accurately describes the cause of an ischemic stroke?
- Blockage of a cerebral artery
- Narrowing of a carotid artery
- Acute atherosclerotic disease
- Rupture of a cerebral artery

Answer 65

Blockage of a cerebral artery

Question 66

You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should:
- assist her ventilations with a bag-valve mask.
- administer one tube of oral glucose and transport.
- suction her oropharynx and transport immediately.
- insert an oral airway, apply oxygen, and transport.

Answer 66

suction her oropharynx and transport immediately

Question 67

A 19-year-old male complains of ‘not feeling right.’ His insulin and a syringe are on a nearby table. The patient says he thinks he took his insulin and cannot remember whether he ate. He is also unable to tell you the time or what day it is. The glucometer reads ‘error’ after several attempts to assess his blood glucose level. You should:
- request a paramedic ambulance to administer IV glucose.
- transport only with close, continuous monitoring en route.
- contact medical control and administer oral glucose.
- assist him with his insulin injection and reassess him.

Answer 67

contact medical control and administer oral glucose

Question 68

A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient’s clinical presentation, you should suspect that she:
- is significantly hyperglycemic.
- has a urinary tract infection.
- has overdosed on her insulin.
- has a low blood glucose level.

Answer 68

is significantly hyperglycemic.

Question 69

A 29-year-old female presents with confusion and disorientation. Her respirations are rapid and shallow, and her pulse is 120 beats/min and thready. She is markedly diaphoretic and has an oxygen saturation of 89%. You should:
- administer oral glucose.
- provide ventilatory support.
- transport immediately.
- treat her for hyperglycemia.

Answer 69

provide ventilatory support.

Question 70

A 31-year-old male with a history of diabetes had a seizure that stopped prior to EMS arrival. He is unresponsive and has rapid, shallow breathing. His pulse is rapid and weak, and his skin is cyanotic. The EMT should:
- administer oxygen by nasal cannula and assess his blood glucose level.
- position the patient on his side and give oxygen via nonrebreathing mask.
- assist the patient’s ventilations with a bag-valve mask.
- place a thin layer of oral glucose between his cheek and gums.

Answer 70

assist the patient’s ventilations with a bag-valve mask.

Question 71

A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days’ duration. Her blood glucose level reads 320 mg/dL. If this patient’s condition is not promptly treated, she will MOST likely develop:
- hypoxia and overhydration.
- acidosis and dehydration.
- irreversible renal failure.
- severe insulin shock.

Answer 71

acidosis and dehydration.

Question 72

A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma, and the patient’s blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should:
- suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.
- administer high-flow oxygen, perform a detailed secondary assessment at the scene, and transport promptly.
- administer oxygen via a nonrebreathing mask, apply oral glucose in between his cheek and gum, and transport.
- suspect that he has internal bleeding and is in shock, administer high-flow oxygen, and transport at once.

Answer 72

suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.

Question 73

A 50-year-old man with diabetes has an altered mental status and is unable to tell you when he last ate or took his insulin. Your glucometer keeps malfunctioning and you are unable to determine his blood glucose level. Which of the following clinical signs would MOST likely lead you to the correct diagnosis?
- Deep and rapid breathing
- Restlessness and irritability
- Rapid and weak pulse
- Hypotension and tachycardia

Answer 73

Deep and rapid breathing

Question 74

A 66-year-old woman experienced a sudden onset of difficulty breathing. She has a history of type 2 diabetes and deep vein thrombosis (DVT). On the basis of her medical history, which of the following should the EMT suspect?
- Congestive heart failure
- Severe hypoglycemia
- Pulmonary embolism
- Diabetic ketoacidosis

Answer 74

Pulmonary embolism

Question 75

A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing:
- hypoglycemia
- an acute stroke.
- hyperglycemia.
- a heart attack.

Answer 75

a heart attack.

Question 76

A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2 diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your assessment reveals that the patient is unresponsive. You should:
- assess for the presence of a medical identification tag.
- administer oral glucose between her cheek and gum.
- open and maintain her airway and assess breathing.
- administer 100% oxygen via a nonrebreathing mask.

Answer 76

open and maintain her airway and assess breathing.

Question 77

Classic signs and symptoms of hypoglycemia include:
- warm, dry skin; irritability; bradycardia; and rapid respirations.
- cool, clammy skin; weakness; tachycardia; and rapid respirations.
- cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.
- warm, dry skin; hunger; abdominal pain; and deep, slow respirations.

Answer 77

cool, clammy skin; weakness; tachycardia; and rapid respirations.

Question 78

Common signs and symptoms of severe hyperglycemia include all of the following, EXCEPT:
- rapid, thready pulse.
- acetone breath odor.
- cool, clammy skin.
- warm, dry skin.

Answer 78

cool, clammy skin.

Question 79

Diabetic ketoacidosis occurs when:
- insulin is not available in the body.
- the cells rapidly metabolize glucose.
- blood glucose levels rapidly fall.
- the pancreas produces excess insulin.

Answer 79

insulin is not available in the body.

Question 80

During your assessment of a 70-year-old woman, she tells you that she takes blood-thinning medication and has to wear compression stockings around her legs. This information should make you suspect that she has:
- severe hyperglycemia.
- sickle-cell disease
- deep vein thrombosis.
- hemophilia

Answer 80

deep vein thrombosis.

Question 81

Excessive eating caused by cellular ‘hunger’ is called:
- dyspepsia.
- dysphasia.
- polydipsia.
- polyphagia.

Answer 81

polyphagia.

Question 82

In contrast to hypoglycemia, hyperglycemia:
- is rapidly reversible if oral glucose is given.
- is a rapidly developing metabolic disturbance.
- can only be corrected in the hospital setting.
- commonly results in excess water retention.

Answer 82

can only be corrected in the hospital setting.

Question 83

In contrast to type 1 diabetes, type 2 diabetes:
- is commonly diagnosed in children and young adults.
- is caused by a complete lack of insulin in the body.
- is caused by resistance to insulin at the cellular level.
- occurs when antibodies attack insulin-producing cells.

Answer 83

is caused by resistance to insulin at the cellular level.

Question 84

In general, oral glucose should be given to any patient who:
- has an altered mental status and a history of diabetes.
- has a blood glucose level that is less than 100 mg/dL.
- is unresponsive, even in the absence of a history of diabetes.
- has documented hypoglycemia and an absent gag reflex.

Answer 84

has an altered mental status and a history of diabetes.

Question 85

Ketone production is the result of:
- rapid entry of glucose across the cell membrane.
- blood glucose levels higher than 120 mg/dL.
- acidosis when blood glucose levels are low.
- fat metabolization when glucose is unavailable.

Answer 85

fat metabolization when glucose is unavailable.

Question 86

Patients with uncontrolled diabetes experience polyuria because:
- excess glucose in the blood is excreted by the kidneys.
- high blood sugar levels cause permanent kidney damage.
- low blood glucose levels result in cellular dehydration.
- they drink excess amounts of water due to dehydration.

Answer 86

excess glucose in the blood is excreted by the kidneys.

Question 87

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should:
- administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.
- administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly.
- administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport.
- assist her ventilations with a bag-valve mask, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

Answer 87

administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

Question 88

As a woman approaches menopause:
- she usually experiences abdominal cramping without vaginal bleeding.
- her menstrual periods may become irregular and vary in severity.
- she cannot become pregnant because of fluctuating hormone levels.
- her risk of developing pelvic inflammatory disease lowers significantly.

Answer 88

her menstrual periods may become irregular and vary in severity.

Question 89

Bacterial vaginosis is a condition that occurs when:
- normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.
- numerous bacteria enter the uterus through the cervix and cause severe tissue damage.
- abnormal bacteria enter the vagina and cause damage without causing any symptoms.
- harmful bacteria infect and cause damage to the uterus, cervix, and fallopian tubes.

Answer 89

normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.

Question 90

During your assessment of a young female with nontraumatic vaginal bleeding, you note that her level of consciousness is decreased, her respirations are rapid and shallow, her skin is cool and moist, and her pulse is rapid and weak. You should:
- assess her blood pressure and elevate her legs.
- assist her ventilations with a bag-mask device.
- perform a visual assessment of her vaginal area.
- perform a rapid secondary assessment.

Answer 90

perform a rapid secondary assessment.

Question 91

Each ovary produces an ovum in alternating months and releases it into the:
- uterus.
- cervical os.
- fallopian tube.
- vagina.

Answer 91

fallopian tube.

Question 92

EMTs receive a call for a possible sexual assault. The patient is a young female who is conscious and alert and has no apparent injuries. She states, ‘I can’t remember anything, but I know I was raped.’ The EMTs should suspect that:
- the patient knew her attacker, but is afraid to say.
- the traumatic experience has created a mental block.
- an underlying head injury is causing her amnesia.
- the patient was given a drug prior to the incident.

Answer 92

the patient was given a drug prior to the incident.

Question 93

General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT:
- carefully removing any foreign bodies from the vagina.
- supplemental oxygen and keeping the patient supine.
- treating external lacerations with sterile compresses.
- refraining from placing any dressings into the vagina.

Answer 93

carefully removing any foreign bodies from the vagina.

Question 94

In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer:
- is typically not as severe.
- can be controlled in the field.
- may be relatively painless.
- often presents with acute pain.

Answer 94

may be relatively painless.

Question 95

Law enforcement personnel request your assistance to assess a 31-year-old female who was sexually assaulted. When you arrive at the scene, you find the patient sitting on a curb outside her apartment. She is conscious, alert, and crying. When you ask her what happened, she tells you that she does not want to be treated or transported to the hospital. She further tells you that all she wants to do is clean up. You should:
- ask her if there is anyone you can contact, such as a friend or relative.
- defer any physical assessment so that you do not destroy potential evidence.
- advise her that she cannot clean herself up because this will destroy evidence.
- provide emotional support and visually assess her for obvious trauma.

Answer 95

advise her that she cannot clean herself up because this will destroy evidence.

Question 96

Potentially life-threatening consequences of pelvic inflammatory disease (PID) include:
- ovarian cysts and gonorrhea.
- ovarian abscess and ectopic pregnancy.
- uterine rupture with severe bleeding.
- bacterial vaginosis and chlamydia.

Answer 96

ovarian abscess and ectopic pregnancy.

Question 97

The onset of menstruation usually occurs in females who are:
- between 18 and 23 years of age.
- between 11 and 16 years of age.
- between 25 and 28 years of age.
- between 8 and 10 years of age.

Answer 97

between 11 and 16 years of age.

Question 98

The physical examination of a sexual assault victim should be:
- as detailed as possible so all injuries can be documented.
- limited to a brief survey for life-threatening injuries.
- deferred until the patient can be evaluated by a physician.
- performed in the presence of at least two police officers.

Answer 98

limited to a brief survey for life-threatening injuries.

Question 99

When a woman presents with abdominal pain or other vague symptoms, the EMT is often unable to determine the nature of the problem until he or she:
- has formed a general impression of the patient.
- ascertains if the patient was ever pregnant.
- has obtained a complete set of vital signs.
- has gathered patient history information.

Answer 99

has gathered patient history information.

Question 100

When caring for a woman who is experiencing a gynecologic emergency, the EMT’s main focus should be to:
- maintain her ABCs and transport without delay.
- determine the underlying cause of her problem.
- ask questions related to her gynecologic history.
- keep assessment and treatment to a minimum.

Answer 100

maintain her ABCs and transport without delay.

Question 101

When documenting a call in which a female was sexually assaulted, you should:
- only use quotation marks when recording any statements made by witnesses.
- translate the patient’s words or statements using proper medical terminology.
- keep the report concise and record only what the patient stated in her own words.
- record your opinion only if you have reasonable proof to justify the statement.

Answer 101

keep the report concise and record only what the patient stated in her own words.

Question 102

Whenever possible, a female sexual assault victim should be:
- encouraged to take a shower and change her clothes.
- given the option of being treated by a female EMT.
- thoroughly assessed, even if no signs of injury exist.
- asked to provide a brief description of the perpetrator.

Answer 102

thoroughly assessed, even if no signs of injury exist.

Question 103

Which of the following conditions would MOST likely lead to pelvic inflammatory disease if left untreated?
- Ovarian cysts
- Ectopic pregnancy
- Genital herpes
- Chlamydia

Answer 103

Chlamydia

Question 104

Which of the following drugs is commonly referred to as ‘roofies’?
- MDMA
- GHB
- Rohypnol
- Ketamine

Answer 104

Rohypnol

Question 105

Which of the following statements regarding rape is correct?
- Rape causes more physical than emotional harm.
- Rape is a legal term, not a medical diagnosis.
- Only a licensed physician can make a diagnosis of rape.
- The EMT should try to determine if rape occurred.

Answer 105

Rape is a legal term, not a medical diagnosis.

Question 106

You are dispatched to a residence for a 40-year-old female who complains of lower abdominal pain, fever and chills, and a foul-smelling vaginal discharge. Which of the following additional assessment findings would increase your index of suspicion for pelvic inflammatory disease?
- Bright red blood in the urine
- A history of ectopic pregnancy
- A shuffling gait when walking
- Vaginal passage of blood clots

Answer 106

A history of ectopic pregnancy