Paramedic School FINAL final Flashcards by Ernest Just

While starting an IV on a patient complaining of abdominal pain, you inadvertently get stuck with the needle before you can place it in the sharps container. You should:
A) continue with patient care, report the incident to your infection control officer, and schedule an appointment with your physician.
B) complete your care of the patient, wash the affected area as soon as you reach the hospital, and report the incident to your supervisor.
C) ask the driver to pull over, assume the role of driver, continue on to the hospital, and see a physician in the emergency department.
D) immediately clean the affected area with isopropyl alcohol, ask the patient if he has any infectious diseases, and report the incident to your supervisor.

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A 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.

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The husband of a terminally ill woman called 9-1-1 because he thinks his wife is about to die. The patient has a valid living will and an out-of-hospital DNR order. You should:
A) ask the husband why he called EMS if his wife is not to be resuscitated.
B) assume that the husband has revoked the DNR order and begin treatment.
C) contact medical control and request permission to provide emergency care.
D) treat the husband and his wife with respect and provide emotional support.

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A 77-year-old man with end-stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apneic and pulseless. The daughter presents you with an out-of-hospital DNR order; however, the document expired 3 months ago. You should:
A) begin CPR only and contact medical control for further guidance.
B) realize that the patient cannot be resuscitated and notify the coroner.
C) begin full resuscitative efforts because the DNR order is no longer valid.
D) confirm that the order has expired before initiating any patient treatment.

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During the attempted resuscitation of a 79-year-old man in cardiac arrest, a young man arrives at the scene and asks you to cease resuscitative efforts. He further tells you that the patient has entrusted him to make all of his medical decisions. You should:
A) continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions.
B) limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive.
C) cease all resuscitative efforts, contact medical control, and advise medical control that a surrogate decision maker is present and has requested you to stop.
D) advise the man that, because he does not have valid documentation that he is authorized to make decisions for the patient, you must continue resuscitation.

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Although the technicalities of EMS DNR orders vary from state to state, they all:
A) are completely irrevocable by the patient’s immediate family members.
B) require the patient to wear a DNR insignia such as a bracelet or necklace.
C) are designed to tell EMS providers when resuscitation is or is not appropriate.
D) must be renewed every 5 years or they will expire and become null and void.

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You are caring for a 66-year-old man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating “Just let me die with dignity!” You should:
A) tell him that the oxygen is crucial in preventing him from experiencing cardiac arrest.
B) respect the patient’s wishes and ask him if he wants to be transported to the hospital.
C) contact medical control and request permission to treat without the patient’s consent.
D) recognize that patients with terminal illnesses do not have decision-making capacity.

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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.

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Because minors have no legal status:
A) they can neither consent to nor refuse medical care.
B) you must obtain consent from both parents before treating.
C) they must always be treated under the law of implied consent.
D) you must obtain a court order before you can legally treat them.

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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.

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Before asking a patient to sign a refusal form, the paramedic must:
A) ask an impartial observer to sign the refusal form first.
B) tell the patient that he or she will die without treatment.
C) ensure the patient is aware of the risks of his or her refusal.
D) ask a police officer to determine if the patient is competent.

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Health care powers of attorney are also called “durable” powers of attorney because they:
A) must be in the patient’s possession at all times.
B) can only be revoked by the patient’s personal physician.
C) remain in effect once a patient loses decision-making capacity.
D) do not require anyone to make decisions on the patient’s behalf.

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When functioning at a crime scene, it is important for the paramedic to:
A) collect and safeguard any and all evidence.
B) carefully question witnesses as to what they saw.
C) use caution and not disturb the scene unnecessarily.
D) avoid performing patient care until cleared by the police.

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If the paramedic is unable to complete his or her patient care report before departing the emergency department, he or she should:
A) leave, at a minimum, the patient’s name and age, but recognize that the physician will perform his or her own exam.
B) leave an abbreviated form with pertinent data with the receiving provider and complete the patient care report as soon as possible.
C) obtain the emergency department fax number and transmit the completed patient care report within 12 hours after delivering the patient.
D) advise the receiving provider that he or she will return to the emergency department with the completed patient care report within 24 hours.

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HIPAA mandates that:
A) a patient’s personal information must be shared with the patient’s immediate family members.
B) patient information shall not be shared with entities or persons not involved in the care of the patient.
C) a penalty will be imposed for any release of any portion of a patient’s personal information to any entity.
D) patient information can only be shared with the receiving physician in the emergency department.

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According to HIPAA, it is acceptable and permissible for hospitals to:
A) disclose information to a patient’s family member, provided the family member has proper identification.
B) release patient information to the public health department, regardless of the patient’s medical condition.
C) share information with the EMS providers about patient outcome for purposes of quality assurance and education.
D) release patient information to the media only if the hospital feels that the patient’s condition may cause an epidemic.

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The hypoxic drive, a backup system to control breathing, is stimulated when:
A)  arterial PaO2 levels decrease.
B)  arterial PaCO2 levels increase.
C)  arterial PaO2 levels increase.
D)  arterial PaCO2 levels decrease.

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What happens when the PaCO2 of the arterial blood increases?
A) pH increases and respirations increase
B) pH decreases and respirations decrease
C) pH increases and respirations decrease
D) pH decreases and respirations increase

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The primary respiratory stimulus in a healthy adult is a(n):
A) decreased arterial oxygen level.
B) increased arterial carbon dioxide level.
C) increased pH level of the venous blood.
D) decreased venous level of carbon dioxide.

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What happens when systemic vasoconstriction occurs?
A)  Preload decreases.
B)  Afterload increases.
C)  Afterload and preload increase.
D)  Afterload and preload decrease.

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What physiologic reaction occurs when a person’s blood sugar level falls?
A) The pancreas secretes more insulin.
B) More glycogen is stored in the liver.
C) Glucagon production is increased.
D) The pancreatic beta cells become hyperactive.

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Insulin and glucagon are produced in specialized groups of cells in the pancreas known as the:
A)  adrenal islets.
B)  islets of Langerhans.
C)  medullary cortex.
D)  adrenal medulla.

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In response to shock or stress, sympathetic nervous system stimulation causes:
A) vasoconstriction.
B) slowing of the heart rate.
C) increased gastrointestinal function.
D) shunting of blood to the body’s periphery.

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All of the following are functions of the parasympathetic nervous system, EXCEPT: A) constriction of the pupils. B) lowering of the blood pressure. C) decreased gastrointestinal function. D) mediating arousal in males and females.

During your assessment of a patient, you note that he is bradycardic, hypotensive, and salivating. These clinical findings suggest: A) sympathetic nervous system stimulation. B) parasympathetic nervous system stimulation. C) sympathetic nervous system depression. D) parasympathetic nervous system depression.

``` Excessive stimulation of the parasympathetic nervous system will result in: A) hypertension. B) bradycardia. C) hyperactivity. D) diaphoresis. ```

``` Stimulation of alpha receptors of the sympathetic nervous system results in: A) tachycardia. B) bronchodilation. C) peripheral vasodilation. D) peripheral vasoconstriction ```

Which of the following statements regarding type O blood is correct? A) It contains no surface antigens. B) It contains type A surface antigens. C) It contains type B surface antigens. D) It contains both type A and B surface antigens.

``` A protein of the immune system that recognizes foreign substances is called a(n): A) bilirubin. B) antigen. C) pathogen. D) antibody. ```

``` Decreases in the PaCO2 result in _____________ pH levels in the respiratory center and a(n) _____________ in ventilation. A) decreased, decrease B) increased, increase C) decreased, increase D) increased, decrease ```

The primary respiratory stimulus in a healthy adult is a(n): A) decreased arterial oxygen level. B) increased arterial carbon dioxide level. C) increased pH level of the venous blood. D) decreased venous level of carbon dioxide.

What happens when the PaCO2 of the arterial blood increases? A) pH increases and respirations increase B) pH decreases and respirations decrease C) pH increases and respirations decrease D) pH decreases and respirations increase

``` Oxygen and carbon dioxide pass across the alveolar capillary membrane through a process called: A) diffusion. B) osmosis. C) perfusion. D) metabolism. ```

``` The movement of a solute from an area of higher concentration to an area of lower concentration is called: A) osmosis. B) endocytosis. C) exocytosis. D) diffusion. ```

Efferent nerves of the peripheral nervous system are responsible for: A) carrying impulses from the body to the brain. B) sensations such as pain, temperature, and pressure. C) involuntary functions such as breathing and heart rate. D) carrying commands from the brain to the muscles.

``` A loss of normal sympathetic nervous system tone causes: A) neurogenic shock. B) obstructive shock. C) profound vasoconstriction. D) a reduced absolute blood volume. ```

``` The two MOST common causes of inflammation are: A) fever and phagocytosis. B) infection and injury. C) hypercarbia and hypoxemia. D) immunosuppression and fever. ```

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

``` 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. ```

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

``` When comparing two solutions, the solution that has a higher solute concentration and a higher osmotic pressure is referred to as a(n) __________ solution. A) isotonic B) hypotonic C) hypertonic D) crystalloid ```

The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include: A) increased myocardial oxygen consumption. B) decreased preload and coronary vasodilation. C) coronary vasoconstriction and increased preload. D) increased afterload and peripheral vasodilation.

At 5 to 10 g/kg/min, dopamine: A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility. B) activates dopaminergic receptor sites, causing renal and mesenteric artery vasodilation. C) no longer activates dopaminergic receptor sites and predominately activates alpha-1 receptor sites. D) has a negative chronotropic effect on the heart, but an increased inotropic effect.

``` At 15 g/kg/min, dopamine: A) reduces cardiac contractility. B) antagonizes alpha-1 receptors. C) activates beta-2 receptor sites. D) causes vigorous vasoconstriction. ```

Catecholamines and sympathomimetic medications should be administered with caution because they: A) can increase cardiac workload and myocardial oxygen demand. B) have an average duration of action of between 24 and 48 hours. C) are associated with paradoxical bradycardia in younger patients. D) have a tendency to cause a significant decrease in cardiac output.

Under normal conditions, the renin-angiotensin system functions by: A) dilating the systemic vasculature and reducing cardiac afterload when arterial blood pressure increases. B) stimulating alpha-1 receptors, thereby increasing the blood pressure in response to acute blood loss. C) blocking alpha-2 receptors, thereby increasing the release of norepinephrine and raising blood pressure. D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion

The desired clinical effect after administering a beta-2 agonist medication is: A) dilation of the systemic vasculature. B) relaxation of bronchiole smooth muscle. C) increased cardiac contractility D) contraction of vascular smooth muscle.

Beta blockers should be used with extreme caution in patients with reactive airway because: A) beta-1 receptor antagonism will result in profound bronchoconstriction. B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm. C) there are no beta-blockers that selectively target beta-1 receptors only. D) they inhibit catecholamine release, potentially causing bronchoconstriction.

``` In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist. ```

Compared to succinylcholine, rocuronium: A) has a rapid (30 to 60 seconds) onset of action and a relatively brief (3 to 8 minutes) duration of action. B) binds with nicotinic receptors on muscles and causes a brief activation known as fasciculation. C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects. D) does not bind with nicotinic receptor sites on muscle cells and does not antagonize acetylcholine.

``` The peak of a medication's effect depends on _____________, whereas the duration of effect depends on ______________. A) distribution, absorption B) absorption, metabolism C) elimination, absorption D) metabolism, distribution ```

``` In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n): A) alpha-1 agonist. B) beta-2 agonist. C) beta-1 agonist. D) alpha-2 agonist. ```

Which of the following statements regarding the endotracheal route of medication administration is correct? A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given. B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level. C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water. D) The endotracheal route is no longer considered a reliable method of medication administration.

When a patient needs rapid fluid replacement, you should: A) use a microdrip administration set because you can deliver more precise volumes of IV fluid. B) choose an administration set that delivers the least amount of volume per the most number of drops. C) select an administration set that contains a large opening between the piercing spike and drip chamber. D) use a microdrip administration set in order to avoid inadvertently overloading the patient with fluid.

``` To administer a drug, you must know the weight of the drug that is present in: A) 1 L. B) 1 mL. C) 100 mL. D) 0.1 mL. ```

``` If a 10-mL vial contains 1 mg of a drug, how many mg/mL are present? A) 0.1 B) 0.01 C) 0.001 D) 0.0001 ```

``` 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 ```

``` A 1% lidocaine (Xylocaine) concentration contains: A) 1 mg/10 mL. B) 100 mg/100 mL. C) 500 mg/50 mL. D) 1,000 mg/100 mL. ```

``` Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A) 0.5 mL B) 5 mL C) 0.25 mL D) 10 mL ```

``` A hypoglycemic patient requires IV dextrose. Medical control orders you to administer 25 mL. You have a prefilled syringe of 50% dextrose that contains 25 g/50 mL. How much dextrose will you give? A) 500 mg B) 12.5 g C) 5,000 mg D) 50 g ```

``` A 2-year-old girl in cardiac arrest requires epinephrine at a dose of 0.01 mg/kg. The mother tells you that her daughter weighs about 25 lb. How much epinephrine will you administer? A) 0.1 mg B) 0.15 mg C) 0.01 mg D) 0.2 mg ```

``` Following return of spontaneous circulation, you are ordered to begin a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 15 B) 30 C) 45 D) 60 ```

``` A nonhypovolemic patient is severely hypotensive and requires a dopamine infusion at 5 µg/kg/min. The patient's estimated weight is 190 lb. You add 800 mg of dopamine to a 500-mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate? A) 10 B) 12 C) 14 D) 16 ```

Ipratropium (Atrovent) dilates the bronchioles by: A) inhibiting the interaction of acetylcholine at bronchial smooth muscle receptors. B) selectively stimulating beta-2 receptors found in the bronchial smooth muscle. C) competitively binding to beta-2 receptors found in the bronchial smooth muscle. D) increasing the interaction of acetylcholine at bronchial smooth muscle receptors.

``` Glucagon can be classified as all of the following, EXCEPT as a(n): A) pancreatic hormone. B) hypoglycemic agent. C) insulin antagonist. D) hyperglycemic agent. ```

Glucagon increases the blood glucose level by: A) stimulating glycogenesis. B) inhibiting gluconeogenesis. C) agonizing the effects of insulin. D) facilitating glucose entry into the cell.

``` Glucagon may be indicated for all of the following conditions, EXCEPT: A) hypoglycemia. B) beta-blocker overdose. C) hyperglycemia. D) calcium channel blocker overdose. ```

``` Glucagon would be ineffective in patients with: A) significant hypertension. B) low serum glucose levels. C) severe beta-blocker toxicity. D) depleted glycogen stores. ```

``` Diltiazem is commonly used for patients with: A) rapid atrial fibrillation. B) ventricular tachycardia. C) high-grade AV heart block. D) heart failure and hypotension. ```

``` If an initial dose of diltiazem is ineffective, a second dose of ____ can be given. A) 5 to 10 mg B) 10 to 20 mg C) 0.25 mg/kg D) 0.35 mg/kg ```

``` Atropine sulfate is classified as a(n) __________________ medication. A) adrenergic B) anticholinergic C) sympatholytic D) sympathomimetic ```

``` Atropine should NOT be given to patients with: A) hypothermic bradycardia. B) nerve agent exposure. C) beta-blocker overdose. D) calcium channel blocker overdose. ```

What is the mechanism of action of adenosine (Adenocard)? A) Inhibits the action of acetylcholine at postganglionic parasympathetic neuroeffector sites; increases heart rate B) Slows conduction through the AV node; can interrupt re-entrant pathways; slows heart rate by acting directly on sinus pacemaker cells C) Blocks sodium channels and myocardial potassium channels; delays repolarization; increases the duration of the action potential D) Decreases heart rate, myocardial contractility, and cardiac output; inhibits dilation of bronchial smooth muscle

``` Adenosine is contraindicated for patients with: A) reentry tachycardia. B) narrow-complex tachycardia. C) wide-complex tachycardia. D) drug-induced tachycardia. ```

``` If an initial dose of adenosine is ineffective for a 130-pound patient, you should: A) give 6 mg rapid IV/IO push. B) give the second dose more slowly. C) give 12 mg after 1 to 2 minutes. D) give a second dose after 10 minutes. ```

``` The correct second dose of adenosine for a 50-pound child is: A) 2.3 mg. B) 4.6 mg. C) 6 mg. D) 12 mg. ```

The side effects of adenosine are limited in most patients because: A) adenosine has such a short half-life. B) the doses of adenosine are relatively small. C) patients who receive adenosine are stable. D) adenosine is subject to first-pass metabolism.

The MOST reliable means of attempting to determine an unresponsive medical patient's problem is: A) a thorough head-to-toe physical examination. B) cardiac monitoring and blood glucose assessment. C) pulse oximetry, capnography, and serial vital signs. D) information provided by the patient's family members.

Upon completing your rapid exam of an unresponsive trauma patient's head and neck, you should next: A) log roll the patient onto a long backboard. B) assess the integrity of the 12 cranial nerves. C) ventilate the patient at 12 to 20 breaths/min. D) apply a properly sized rigid cervical collar.

A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary assessment, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should: A) apply a rigid cervical collar, start an IV of normal saline, and perform immediate endotracheal intubation. B) apply supplemental oxygen via nonrebreathing mask, place her in a lateral recumbent position, and transport. C) insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions. D) quickly place her on the stretcher, obtain a 12-lead ECG tracing, and perform a detailed physical exam.

You are caring for an unresponsive 54-year-old man with an apparent isolated head injury after he fell from a standing position. Your partner is maintaining manual stabilization of the patient's head while assisting his breathing. Your rapid head-to-toe exam reveals only a large hematoma to the patient's forehead. Further assessment reveals that the patient is wearing a medical alert bracelet that reads “allergic to codeine.” You should: A) instruct your partner to ventilate the patient at 24 breaths/min. B) perform a detailed secondary assessment and transport at once. C) assess his blood glucose reading and give dextrose if necessary. D) give epinephrine in case he is experiencing an allergic reaction.

You are transporting a conscious middle-aged woman who fell from a second-story balcony while watering her plants. Full spinal motion restriction precautions have been implemented, supplemental oxygen is being administered, and an IV line of normal saline is in place. With a 15-minute estimated time of arrival at the hospital, the patient's mental status markedly decreases and her respirations become shallow and are making a gurgling sound. Your FIRST action should be to: A) immediately suction her oropharynx. B) perform immediate endotracheal intubation. C) insert a nasal airway and assist ventilations. D) contact the receiving facility to update them.

Which of the following statements regarding the rapid exam of a trauma patient is correct? A) The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport. B) Any trauma patient should receive a rapid head-to-toe exam, even if his or her injury is minor and the mechanism of injury is not significant. C) The rapid exam is the first assessment you will perform on a trauma patient and is designed to find and treat immediate threats to life. D) The rapid exam is a detailed exam that should take between 1 and 2 minutes and should primarily focus on the patient's chief complaint.

The rapid exam of a patient is usually performed: A) as soon as your general impression of the patient suggests that he or she is critically injured. B) immediately after determining that the patient has experienced a significant mechanism of injury. C) after all life-threatening conditions have been identified and addressed in the primary assessment. D) following at least one complete set of vital signs, including assessment of the pupils and blood glucose.

``` The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT: A) heart failure. B) bronchospasm. C) toxic inhalation. D) pulmonary edema. ```

When replacing a dislodged tracheostomy tube, it is MOST important that you: A) insert the tube 2 cm beyond the cuff. B) take appropriate standard precautions. C) lubricate the tube before insertion. D) use a tracheostomy tube of the same size.

In order for a tracheostomy tube to be compatible with a mechanical ventilator or bag-mask device: A) it should have a stylet that can be removed easily. B) it should have an internal diameter of at least 6.0 mm. C) the patient's head must be in a hyperextended position. D) it must be equipped with a 15/22-mm proximal adaptor.

You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and is on a mechanical ventilator. According to the patient's mother, he began experiencing difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally diminished breath sounds, and his oxygen saturation is 90%. You disconnect the patient from the mechanical ventilator and begin bag-mask ventilations; however, you meet significant resistance. You should: A) suspect that he has bilateral pneumothoraces. B) ventilate with a demand valve and transport at once. C) remove the bag-mask and suction his tracheostomy tube. D) remove his tracheostomy tube and replace it with a new one.

Before intubating a patient who has been chemically sedated and paralyzed, it is MOST important for the paramedic to: A) administer 0.5 mg of atropine sulfate. B) hyperventilate the patient at 24 breaths/min. C) adequately preoxygenate with 100% oxygen. D) suction the oropharynx to clear any secretions.

You are assessing a young woman who was struck in the head with a baseball bat. The patient is semiconscious and has slow, irregular respirations. Further assessment reveals CSF drainage from her nose and periorbital ecchymosis. She has blood in her mouth, but clenches her teeth and becomes combative when you attempt to suction her oropharynx. The MOST appropriate airway management for this patient involves: A) sedating her with a benzodiazepine, chemically paralyzing her with a neuromuscular blocker, and intubating her trachea. B) suctioning along the inside of her cheek with a whistle-tip catheter and then performing blind nasotracheal intubation. C) opening her mouth with a dental prod, suctioning her oropharynx for 15 seconds, and intubating her trachea via direct laryngoscopy. D) inserting a nasopharyngeal airway, administering supplemental oxygen via nonrebreathing mask, and continuing suction attempts.

If the patient's oxygen saturation drops at any point during rapid-sequence intubation, you should: A) stop and hyperventilate the patient at a rate of 24 breaths/min. B) abort the intubation attempt and ventilate with a bag-mask device. C) apply posterior cricoid pressure and continue the intubation attempt. D) continue the intubation attempt and monitor the cardiac rhythm closely.

You are caring for a 69-year-old man with congestive heart failure. His breathing is profoundly labored, his oxygen saturation reads 79% on oxygen via nonrebreathing mask, and he is showing signs of physical exhaustion. Considering that your protocols do not allow you to perform rapid-sequence intubation, you should: A) insert an oral airway, assist ventilations with a bag-mask device, and transport at once. B) preoxygenate him with a bag-mask device and then perform blind nasotracheal intubation. C) give him Valium for sedation, perform orotracheal intubation, and transport to the hospital at once. D) insert a nasopharyngeal airway and ensure that the nonrebreathing mask is tightly secured to his face.

After inserting the Combitube to the proper depth, you should next: A) inflate the distal cuff with 5 mL of air. B) ventilate through the pharyngeal tube. C) inflate the pharyngeal cuff with 100 mL of air. D) apply a cervical collar to minimize head movement.

You have just inserted a Combitube in a 59-year-old cardiac arrest patient. You attach the bag-mask device to the pharyngeal (blue) tube, begin ventilations, and note the presence of bilaterally equal breath sounds, absent epigastric sounds, and visible chest rise. You should: A) perform laryngoscopy to visualize placement of the Combitube. B) continue to ventilate and use additional confirmation techniques. C) continue ventilating the patient at a rate of 10 to 12 breaths/min. D) ventilate through the clear tube and auscultate all four lung fields.

``` When intubating a 3-year-old child, you would MOST likely use a: A) size 2 straight blade. B) 6.5-mm uncuffed ET tube. C) 5.0-mm cuffed ET tube. D) size 1 curved blade. ```

When intubating a 3-year-old child, you should insert the ET tube until: A) the distal cuff is 1 to 2 cm beyond the vocal cords. B) you meet resistance, and then withdraw the tube 2 cm. C) the vocal cord mark is 2 to 3 cm beyond the vocal cords. D) the cm marking on the tube reads 15 cm at the child's lips.

The MOST effective way to minimize the risk of hypoxia while intubating a child is to: A) limit your intubation attempt to 20 seconds. B) monitor the child's cardiac rhythm at all times. C) premedicate the child with 0.02 mg/kg of atropine. D) not allow the oxygen saturation to fall below 100%.

In which of the following situations would ET intubation of a pediatric patient be LEAST necessary? A) Traumatic brain injury with unconsciousness B) Administration of certain resuscitative medications C) Cardiopulmonary arrest due to respiratory failure D) Difficulty effectively ventilating with a bag-mask

When preoxygenating an uninjured child prior to ET intubation, you should: A) place the child's head in the sniffing position, insert an oral airway if needed, and ventilate with a bag-mask for at least 2 minutes. B) hyperextend the child's head, insert an oral airway if needed, and hyperventilate the child at 40 breaths/min for at least 2 to 3 minutes. C) maintain the child's head in a neutral position, insert an oral airway if needed, and deliver 1 breath every 10 seconds for at least 3 minutes. D) place the child's head in the sniffing position, insert an oral airway if needed, and moderately hyperventilate the child at 24 breaths/min for 30 seconds.

If intubation of a child is unsuccessful after two attempts, your MOST appropriate action is to: A) have your partner attempt to intubate as you apply gentle posterior pressure to the cricoid cartilage. B) insert a multilumen airway device and confirm placement by means of auscultation of breath sounds and capnography. C) turn the child on his or her side, apply manual pressure to the epigastrium to relieve distension, and reattempt intubation. D) discontinue attempts to intubate, ventilate the child with a bag-mask device, and transport immediately.

``` Which of the following is NOT a contraindication for nasotracheal intubation? A) Apnea B) Spinal injury C) Frequent use of cocaine D) Patients taking an anticoagulant ```

Which of the following is NOT a step that is performed during nasotracheal intubation? A) Advancing the ET tube as the patient inhales B) Preoxygenating with a bag-mask as necessary C) Ensuring that the patient's head is hyperflexed D) Placing the patient's head in a neutral position

The paramedic should be especially diligent when confirming tube placement following blind nasotracheal intubation because: A) the ET tube cannot be secured effectively when it is in the nose. B) most patients who are intubated nasally are extremely combative. C) he or she did not visualize the tube passing between the vocal cords. D) most nasotracheal intubation attempts result in esophageal placement.

``` The MOST common complication associated with nasotracheal intubation is: A) bleeding. B) aspiration. C) hypoxemia. D) regurgitation. ```

``` When nasally intubating a patient, the ET tube is advanced: A) as the patient exhales. B) when the patient inhales. C) when the patient swallows. D) in between the patient's breaths. ```

When performing nasotracheal intubation, you should use an ET tube that is: A) equipped with a stylet in order to make the tube formfitting. B) uncuffed so as to avoid unnecessary damage to the nasal mucosa. C) slightly larger than the nostril into which the tube will be inserted. D) 1 to 1.5 mm smaller than you would use for orotracheal intubation.

The use of phenylephrine hydrochloride (Neo-Synephrine) during nasotracheal intubation will: A) reduce the likelihood and severity of nasal bleeding. B) sedate the patient and facilitate his or her compliance. C) dilate the nasal vasculature and facilitate tube insertion. D) anesthetize the nasopharynx and reduce patient discomfort.

Which of the following clinical findings is LEAST suggestive of a pneumothorax in an intubated child? A) Decreased ventilation compliance B) Stronger breath sounds on the right side C) Persistent cyanosis despite ventilations D) Stronger breath sounds on the left side

``` Because the high-pressure ventilator used with needle cricothyrotomy would cause an increase in intrathoracic pressure, ___________ and ___________ may result. A) hypercarbia, hypoxia B) barotrauma, pneumothorax C) hypoventilation, hypocarbia D) esophageal rupture, hemorrhage ```

After you have intubated an apneic patient with chest trauma, your partner is auscultating breath sounds and tells you that breath sounds are faint on the right side of the chest. You should: A) slightly withdraw the tube as your partner auscultates breath sounds. B) suspect that the patient has a pneumothorax on the right side of the chest. C) immediately remove the ET tube and oxygenate the patient for 30 seconds. D) increase the force of your ventilations as your partner reauscultates the lungs.

You respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient's daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should: A) apply a nonrebreathing mask, assess his oxygen saturation level, and prepare for immediate transport. B) provide aggressive airway management unless the daughter can produce a valid DNR order. C) intubate him at once, begin transport, and advise the daughter to notify the hospital when she finds the DNR order. D) recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by: A) improving patency of the lower airway through the use of positive-end expiratory pressure. B) maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction. C) increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia. D) delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.

A critical step when using a CPAP unit to treat a patient with severe respiratory distress is: A) ensuring an adequate mask seal with minimal leakage. B) holding the mask to the noncompliant patient's face. C) starting with CPAP levels above 10 to 15 cm of water. D) setting the oxygen flow rate to at least 6 L/min.

A 29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should: A) apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital. B) begin assisting her ventilations with a bag-mask device and 100% oxygen and prepare to intubate her trachea. C) start an IV of normal saline, administer methylprednisolone via IV push, and transport as soon as possible. D) attempt to slow her breathing with respiratory coaching, administer a nebulized bronchodilator, and transport.

You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. C) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. D) decrease the amount of positive-end expiratory pressure that you are delivering and reassess

A patient with status asthmaticus commonly presents with: A) compensatory respiratory alkalosis and stridor. B) accessory muscle use and inspiratory wheezing. C) audible expiratory wheezing and severe cyanosis. D) physical exhaustion and inaudible breath sounds.

A patient with a history of asthma is at GREATEST risk for respiratory arrest if he or she: A) takes a bronchodilator and a corticosteroid. B) was previously intubated for his or her condition. C) was recently evaluated in an emergency department. D) has used his or her inhaler twice in the previous week.

Patients with decompensated asthma or COPD who require positive-pressure ventilation: A) should be ventilated routinely at a rate that is slightly faster than the rate for a patient without an underlying pulmonary disease. B) may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly. C) should be intubated promptly and ventilated at a rate of 20 to 24 breaths/min to eliminate excess carbon dioxide. D) should be given forceful positive-pressure breaths because their primary problem is difficulty with inhalation.

Intubation of a patient with severe asthma: A) is clearly indicated if the patient's condition does not resolve following field corticosteroid therapy. B) is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces. C) should only be performed after hyperventilating the patient with a bag-mask device for 2 to 3 minutes. D) is generally contraindicated because weaning the patient off of a ventilator can take several days.

A 36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should: A) assist his ventilations and establish vascular access. B) start an IV of normal saline and administer a steroid. C) apply high-flow oxygen via a nonrebreathing mask. D) assist him with a metered-dose inhaler bronchodilator.

``` A patient with respiratory distress who is willing to lie flat: A) should be intubated at once. B) may be acutely deteriorating. C) has minimal fluid in the lungs. D) likely has basilar pneumonia. ```

``` Which of the following conditions would LEAST likely present with an acute onset of respiratory distress? A) Pneumonia B) Anaphylaxis C) Pneumothorax D) Pulmonary embolism ```

``` A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress? A) Oxygen noncompliance B) Recent antitussive use C) An underlying infection D) Acute right heart failure ```

``` A patient experiencing an acute coronary syndrome should receive morphine sulfate in an initial dose of: A) 0.5 mg/kg. B) 1 to 2 mg. C) 2 to 4 mg. D) 5 to 10 mg. ```

When performing CPR on an adult patient in cardiac arrest, it is important to: A) deliver at least 80 to 90 compressions per minute. B) limit interruptions in chest compressions to 20 seconds. C) deliver forceful ventilations between compressions. D) allow the chest to fully recoil between compressions.

``` The proper compression-to-ventilation ratio for two-rescuer adult CPR when an oropharyngeal airway is in place is: A) 5:1. B) 15:2. C) 30:2. D) asynchronous. ```

Once an advanced airway device has been inserted into a cardiac arrest patient: A) you should deliver one breath every 5 to 6 seconds. B) ventilations are delivered at a rate of 8 to 10 breaths/min. C) the compressor should pause so ventilations can be given. D) chest compressions should be increased to 120 per minute.

The MOST important initial pieces of equipment to bring to the side of an unresponsive patient are the: A) drug kit and stretcher with a long backboard. B) defibrillator and airway management equipment. C) intubation kit and equipment for vascular access. D) pocket face mask and equipment for intubation.

``` If you are using a biphasic defibrillator, but are unsure of the appropriate starting energy setting, you should set the defibrillator to: A) 120 J. B) 150 J. C) 200 J. D) 360 J. ```

``` After delivering a shock to a patient in pulseless ventricular tachycardia, you should: A) resume CPR. B) check for a pulse. C) reassess the cardiac rhythm. D) deliver two effective ventilations. ```

When managing cardiac arrest, the appropriate dosing regimen for epinephrine is: A) 1 mL of a 1:10,000 solution every 3 to 5 minutes. B) 0.1 mg/kg of a 1:10,000 solution every 3 minutes. C) 10 mL of a 1:1,000 solution every 3 to 5 minutes. D) 1 mg of a 1:10,000 solution every 3 to 5 minutes.

Which of the following statements regarding the use of vasopressin when managing cardiac arrest is correct? A) If the initial drug you give is epinephrine, vasopressin should not be administered to the patient. B) Vasopressin and epinephrine should be given together to achieve a more potent vasopressor effect. C) Unlike epinephrine, vasopressin provides greater alpha and beta adrenergic stimulation. D) A one-time dose of 40 units of vasopressin may be given to replace the first or second dose of epinephrine.

``` The preferred antiarrhythmic medication and initial dose for a patient with refractory ventricular fibrillation or pulseless ventricular tachycardia is: A) lidocaine, 1.5 mg/kg. B) amiodarone, 300 mg. C) lidocaine, 0.75 mg/kg. D) procainamide, 20 mg/min. ```

``` What is the approximate maximum dose of lidocaine for a 200-pound patient? A) 275 mg B) 300 mg C) 325 mg D) 350 mg ```

``` Which of the following pulseless rhythms is NOT treated as pulseless electrical activity? A) Sinus bradycardia B) Idioventricular rhythm C) Ventricular tachycardia D) Junctional escape rhythm ```

``` Regardless of the patient's presenting cardiac arrest rhythm, the first IV or IO drug that should be given is: A) a vasopressor. B) calcium chloride. C) an inotrope. D) an antidysrhythmic. ```

``` In which of the following situations would you likely NOT be able to palpate a pulse despite effective chest compressions? A) Profound hypoxia B) Severe acidosis C) Hyperkalemia D) Tension pneumothorax ```

``` Which of the following actions should NOT occur while CPR is in progress? A) Advanced airway placement B) Cardiac rhythm assessment C) Assessment for a palpable pulse D) Establishment of vascular access ```

``` Common causes of cardiac arrest include all of the following, EXCEPT: A) hypovolemia. B) hyperglycemia. C) cardiac tamponade. D) pulmonary embolism. ```

``` If a patient remains comatose following return of spontaneous circulation, you should: A) provide mild hyperventilation. B) begin hypothermia treatment. C) immediately obtain a 12-lead. D) begin an infusion of dopamine. ```

``` Treatment for a patient with bradycardia and significantly compromised cardiac output includes: A) 1 mg of epinephrine 1:10,000. B) 1 mg of atropine via IV push. C) transcutaneous cardiac pacing. D) a dopamine infusion at 20 mg/min. ```

Electrical capture during transcutaneous cardiac pacing is characterized by: A) the presence of a strong pulse, despite a slow rate. B) a pacemaker spike followed by a wide QRS complex. C) narrow QRS complexes that are preceded by a pacemaker spike. D) low-amplitude QRS complexes preceded by a pacemaker spike.

``` The recommended first-line treatment for third-degree heart block associated with bradycardia and hemodynamic compromise is: A) atropine sulfate. B) a dopamine infusion. C) an epinephrine infusion. D) transcutaneous pacing. ```

When assessing an anxious patient who presents with tachycardia, you must: A) obtain a 12-lead ECG tracing before initiating any treatment. B) determine if the tachycardia is causing hemodynamic instability. C) prepare for cardioversion if the rate is less than 150 beats/min. D) administer diazepam or midazolam to facilitate your assessment.

``` Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia? A) Aberrant conduction B) Absence of P waves C) Retrograde conduction D) The rate of the rhythm ```

``` A 56-year-old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and type 2 diabetes. His airway is patent and his breathing is adequate. You should: A) establish vascular access. B) obtain baseline vital signs. C) administer supplemental oxygen. D) acquire a 12-lead ECG tracing. ```

Patients with Wolff-Parkinson-White syndrome: A) have a diseased SA node, resulting in ectopic atrial pacemakers and abnormal AV nodal conduction. B) are highly susceptible to a variety of bradycardic rhythms due to an abnormal delay at the AV node. C) have an accessory pathway that bypasses the AV node and causes early ventricular depolarization. D) experience independent atrial depolarization due to failure of the Bachmann bundle between the atria.

``` A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called __________ activity. A) tonic B) clonic C) hypertonic D) myoclonic ```

``` You arrive at the scene shortly after a 7-year-old girl experienced a seizure. According to the child's mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child's condition rapidly improved. This clinical presentation is consistent with a(n) _____________ seizure. A) absence B) tonic-clonic C) simple partial D) complex partial ```

``` During a generalized tonic/clonic seizure, the patient is rigid and his back is arched. This represents the _________ phase of the seizure. A) tonic B) clonic C) hypertonic D) postictal ```

A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure: A) dilates the blood vessels and can cause brain herniation. B) lowers intracranial pressure and oxygenates the brain. C) increases intracranial pressure, but oxygenates the brain. D) causes vasoconstriction and can impair brain perfusion.

``` 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. ```

``` 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 ```

A 39-year-old woman presents with signs and symptoms of an acute hemorrhagic stroke. She is responsive to deep painful stimuli only and has bilaterally dilated and sluggishly reactive pupils. Her respirations are slow and irregular, blood pressure is 80/50 mm Hg, and pulse is 40 and bounding. Initial treatment for this patient involves: A) positive-pressure ventilatory support. B) rapid infusion of a crystalloid solution. C) high-flow oxygen via nonrebreathing mask. D) immediate transcutaneous cardiac pacing.

A woman brings her 18-year-old son to your EMS station. The patient is actively seizing and, according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, is breathing erratically, and has generalized muscle twitching to all extremities. You should: A) place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM. B) protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium. C) hyperventilate him with a bag-mask to eliminate excess carbon dioxide, establish vascular access, and give lorazepam. D) open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam.

``` An idiopathic seizure is one in which: A) the cause is not known. B) the entire brain is affected. C) a part of the brain is affected. D) a postictal phase is not present. ```

You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient's supervisor states that she has a history of seizures and takes Tegretol. The patient's blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes: A) administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. B) establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. C) giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. D) administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting.

In contrast to syncope, a seizure: A) is less commonly observed in older patients. B) can occur when the patient is in any position. C) most often occurs when the patient is standing. D) is characterized by a quick return of orientation.

You are caring for a middle-aged man with severe abdominal pain and dark, tarry stools. He is conscious but very restless. His blood pressure is 78/52 mm Hg, pulse rate is 130 beats/min and weak, and respirations are 24 breaths/min and shallow. Further assessment reveals that his skin is cool and clammy and his radial pulses are weakly present. You should: A) apply a nasal cannula in case he vomits, start at least one large-bore IV line, and administer up to 3 liters of normal saline solution. B) administer high-flow oxygen, start two large-bore IV lines, and administer 20-mL/kg normal saline boluses until his radial pulses strengthen. C) apply supplemental oxygen, establish vascular access, and give isotonic crystalloid boluses until his systolic BP is at least 110 mm Hg. D) administer high-flow oxygen, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and give 1 µg/kg of fentanyl for pain.

The presentation of Mallory-Weiss syndrome is linked to _________ and is caused by _________. A) eating spicy foods, erosion of the lining of the gastrointestinal tract B) spastic coughing, rupture of esophageal veins due to portal hypertension C) severe vomiting, a tear at the junction between the esophagus and stomach D) blunt trauma, rupture of hollow organs with resultant peritoneal inflammation

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

``` You are dispatched to a residence for an elderly man with an altered mental status. As you are assessing the patient, his wife tells you that he goes to dialysis several times a week, but has missed his last three treatments because their car broke down. The patient's skin is yellow, his blood pressure is 98/60 mm Hg, and his pulse rate is 118 beats/min. The ECG reveals sinus tachycardia with peaked T waves. You should be MOST concerned with the potential for: A) severe hypovolemia. B) acute bradycardia or heart block. C) lethal ventricular dysrhythmias. D) hypokalemia-induced cardiac arrest. ```

``` 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. ```

``` Secretion of the parathyroid hormone is regulated by blood levels of: A) sodium. B) calcium. C) potassium. D) phosphorus. ```

When the body's metabolic rate decreases: A) the thyroid gland secretes thyroxine. B) oxygen demand increases accordingly. C) the kidneys excrete more sodium and water. D) thyroid-stimulating hormone secretion is reduced.

Which of the following statements regarding sickle cell disease is correct? A) Sickle cell disease is an acquired blood disorder that exclusively affects the African American population. B) When the defective HbA gene is inherited from both parents, the patient will not develop the sickle cell trait. C) Patients with sickle cell disease become hypoxic because their misshapen red blood cells are poor carriers of oxygen. D) Patients with sickle cell disease are at a lower risk for thrombotic diseases because their blood contains fewer platelets.

A 23-year-old woman with sickle cell disease presents with severe joint pain and a fever of 102.5°F. She is conscious and alert, and tells you that her symptoms began yesterday and suddenly worsened today. Her blood pressure is 118/76 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 24 breaths/min with adequate depth. After applying high-flow oxygen and initiating transport, you should: A) obtain a 12-lead ECG tracing, start a large-bore IV line, administer a 20-mL/kg normal saline bolus, and reassess her blood pressure. B) monitor her oxygen saturation and cardiac rhythm, start an IV line with normal saline, administer 1 µg/kg of fentanyl, and reassess her vital signs. C) establish vascular access, administer 2 to 5 mg of midazolam, monitor her cardiac rhythm, and notify the receiving facility as soon as possible. D) ensure that she is in a comfortable position, cover her with a blanket, start an IV line at a keep-vein-open rate, and monitor her throughout transport.

``` Which of the following is NOT a major component of the hematologic system? A) Liver B) Spleen C) Pancreas D) Bone marrow ```

During your primary assessment of a patient with a hematologic disorder, your priority should be to: A) perform a rapid head-to-toe exam to look for spontaneous hemorrhage. B) note any signs and symptoms that may be immediately life threatening. C) specifically inquire if the patient complains of dyspnea or chest pressure. D) apply a cardiac monitor to detect the presence of lethal cardiac dysrhythmias.

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 the person 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.

When administering an EpiPen to a 30-year-old man with a severe allergic reaction, you should recall that: A) a 1:2,000 solution is used because the patient is an adult. B) the SQ route is used in order to achieve a rapid effect. C) 0.15 mg is the usual dose delivered by the adult EpiPen. D) the drug cartridge contains 0.3 mg of a 1:1,000 solution.

``` 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 ```

You have treated the same patient several times for a severe allergic reaction. While educating him about the prevention of future reactions, you should advise him to: A) wear an identification bracelet. B) avoid the substance he is allergic to. C) carry at least two EpiPen injectors. D) call 9-1-1 as soon as he is exposed.

``` A 56-year-old man is experiencing a severe allergic reaction following multiple ant bites. He tells you that he has a prescribed EpiPen, which is expired, and that he takes a beta blocker for hypertension. Which of the following medications would MOST likely improve his condition, given his medical history? A) Proventil and Benadryl B) Epinephrine and albuterol C) A norepinephrine infusion D) Glucagon and ipratropium ```

``` Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT: A) aggressive airway control. B) epinephrine administration. C) assessment of lung sounds. D) a secondary assessment. ```

``` In the absence of IV or IO access, the ____ route is the preferred route for the administration of epinephrine to a patient in anaphylactic shock. A) IM B) ET C) SQ D) intradermal ```

``` Adults in anaphylactic shock should receive the ________ concentration of epinephrine via the ____ route in a dose of ____ mg. A) 1:1,000, IM, 1 B) 1:1,000, IV, 0.5 C) 1:10,000, IV, 0.1 D) 1:10,000, IM, 0.5 ```

You are caring for a 40-year-old man in obvious anaphylactic shock after being stung by a scorpion. The patient is responsive to pain only, has poor respiratory effort, and is hypotensive and tachycardic. Which of the following represents the MOST appropriate treatment sequence for this patient? A) Immediate intubation, 0.5 mg epinephrine 1:1,000 SQ, two large-bore IV lines with normal saline, a 250-mL normal saline bolus, and 25 mg of Benadryl IM B) Assisted ventilation, intubation if necessary, at least one large-bore IV with normal saline, 1 mg epinephrine 1:10,000 IV, and up to 50 mg of Benadryl IV or IM C) High-flow oxygen via nonrebreathing mask, 0.1 to 0.5 mg epinephrine 1:1,000 IM, two large-bore IV lines with normal saline, and 20-mL/kg boluses of normal saline D) Assisted ventilation, Combitube insertion, 25 to 50 mg of Benadryl IM followed immediately by 0.3 mg of epinephrine 1:1,000 SQ, and a large-bore IV with normal saline

The recommended dose and method for administering naloxone to a patient who overdosed on a narcotic and is unresponsive and hypoventilating is: A) 0.1 mg/kg rapidly until the patient's respirations improve. B) 0.4 to 2 mg rapidly until the patient regains consciousness. C) 5 to 10 mg via the endotracheal tube until the pupils dilate. D) 2 mg injected slowly until the patient's respirations improve.

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: 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.

If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose: A) avoid administering flumazenil and transport the patient immediately. B) you should consider concomitant overdose with another CNS depressant. C) it is likely that the patient is also under the influence of methamphetamine. D) you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.

You are caring for an alcoholic patient who has been abstinent for about 2 days. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52 mm Hg, pulse rate is 140 beats/min and weak, and respirations are 24 breaths/min with adequate depth. In addition to administering oxygen, you should: A) treat his hypotension with crystalloid fluid boluses. B) administer 6 mg of adenosine to slow his heart rate. C) sedate him with 5 mg of Valium and transport at once. D) provide emotional support only and transport immediately.

``` Which of the following is atypical of an alcoholic? A) Drinking early in the day B) Green tongue syndrome C) Memory loss or blackouts D) Chronically pale face and palms ```

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: 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.

You are treating a 20-year-old man with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should: A) administer high-flow oxygen, establish vascular access at the scene, transport, and apply a proximal tourniquet en route. B) administer high-flow oxygen, transport, and apply a proximal tourniquet and establish vascular access en route. C) apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route. D) control the bleeding by applying pressure to a proximal pressure point, administer high-flow oxygen, and transport.

You have successfully controlled a large arterial hemorrhage from a 42-year-old man's leg with direct pressure and a pressure dressing. He is conscious, but restless. His blood pressure is 84/58 mm Hg, pulse is 120 beats/min, and respirations are 24 breaths/min. You should: A) keep him warm, administer high-flow oxygen, establish one large-bore IV line at the scene, and transport. B) administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route. C) administer high-flow oxygen, start two large-bore IV lines at the scene and give a 2- to 3-L fluid bolus, and transport. D) Keep him warm, assist his ventilations, place a hemostatic agent in the wound, transport, and start a large-bore IV en route.

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should: A) apply direct pressure to his facial wounds and promptly intubate him. B) suction the blood from his mouth and assist ventilations with a bag-mask device. C) insert a nasal airway, apply oxygen via nonrebreathing mask, and transport. D) suction his oropharynx for 30 seconds and then perform endotracheal intubation.

You respond to an industrial plant for a 42-year-old man with a chemical burn. Upon arrival at the scene, you find the patient to be ambulatory. He tells you that he was moving some bags of dry lime when one of the bags broke and spilled lime all over him. After donning the appropriate personal protective equipment, you should: A) remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water. B) avoid brushing any of the lime from his skin, as doing so may cause additional injury, and flush his entire body with water for 30 minutes. C) remove his clothing, carefully brush the lime away from his skin, but avoid flushing with water, as doing so will likely increase burn severity. D) remove all of his clothing, apply baking powder to neutralize the lime, and begin flushing his body with copious amounts of sterile saline.

``` According to the rule of nines, an adult man with partial- and full-thickness burns to his head, face, and anterior chest has burns to ____% of his total body surface area. A) 18 B) 27 C) 36 D) 45 ```

Burn shock is caused by: A) a massive infection that occurs when microorganisms breach burned skin. B) renal failure secondary to excess myoglobin production from burned muscle. C) fluid loss across damaged skin and volume shifts within the rest of the body. D) acute dehydration, and it commonly manifests within 30 minutes after the burn.

A 4-year-old boy pulled a pot of boiling water off of the stove and experienced partial-thickness splash burns to his neck, anterior trunk, and both anterior arms. During your assessment, you note that the child is conscious but is not crying. He is tachypneic and tachycardic, and his skin is cool and moist. Other than the burns, there are no other gross injuries. Which of the following statements regarding this scenario is correct? A) You should assist the child's ventilations and prepare to intubate his trachea. B) An IV should be established and you should administer a 20-mL/kg bolus of D5W. C) The child may be hypoglycemic and requires assessment of his blood glucose level. D) It is likely that this child's burn was intentionally inflicted and you should report it.

Which of the following statements regarding partial-thickness burns is correct? A) Partial-thickness burns are usually extremely painful for the patient. B) Partial-thickness burns are difficult to distinguish from superficial burns in the field. C) The majority of partial-thickness burns are caused by an open flame. D) Partial-thickness burns typically heal spontaneously without scarring.

A partial-thickness burn is considered to be critical if it: A) occurs in any patient over the age of 45 years. B) is located to the proximal aspect of an extremity. C) is rated as at least a 5 on a pain scale of 0 to 10. D) involves more than 30% of the body surface area.

``` Immediate care for a burn patient involves: A) applying sterile burn sheets. B) establishing a patent airway. C) stopping the burning process. D) maintaining body temperature. ```

The appropriate treatment for MOST chemical burns is: A) application of a dry, sterile dressing. B) flushing with copious amounts of water. C) neutralization with an alkaline substance. D) application of a moist, sterile dressing.

When assessing a burn patient, it is MOST important to: A) accurately calculate the extent of body surface area burned. B) be alert for occult trauma that could affect patient outcome. C) apprise medical control of the situation as soon as possible. D) rapidly determine if the patient will require an escharotomy.

Upon initial contact with a severely burned patient, you must: A) assess airway and breathing adequacy. B) cover the patient to prevent hypothermia. C) ensure that the patient is not still burning. D) quickly establish the extent of the burns.

``` You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes? A) 340 mL B) 355 mL C) 370 mL D) 395 mL ```

A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 99% on room air. He denies any other injuries. Initial management for this patient involves: A) applying ice to the burn to provide immediate pain relief. B) applying cool, wet dressings to the burn and elevating his arm. C) starting an IV of normal saline and administering 2 mg of morphine. D) administering oxygen and applying an anesthetic cream to the burn.

A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient's son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to: A) avoid narcotic analgesics because of his medical history. B) auscultate his breath sounds before administering IV fluids. C) obtain a 12-lead ECG to assess for signs of cardiac ischemia. D) apply cold, moist dressings to his burns to provide pain relief.

General care for an eye injury involves: A) applying direct pressure to the globe. B) irrigating the eye with sterile saline solution. C) covering both eyes to minimize further injury. D) applying a cold compress to the eyeball.

``` The primary risk associated with oral and dental injuries is: A) malocclusion. B) intraoral infection. C) permanent tooth loss. D) airway compromise. ```

A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semiconscious, has shallow breathing, and has blood draining from the corner of his mouth. Initial management for this patient involves: A) inserting an oropharyngeal airway, preoxygenating him with a bag-mask device for 2 minutes, and then intubating his trachea. B) applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a bag-mask device. C) fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him with a bag-mask device at a rate of 20 breaths/min. D) manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

A conscious but combative patient with severe facial trauma is fully immobilized on a backboard. During your assessment, the patient begins coughing up large amounts of blood. You suction his oropharynx, but his mouth quickly refills with blood. You should: A) preoxygenate the patient with a bag-mask for 2 minutes and then perform nasotracheal intubation. B) roll the backboard on its side, suction his oropharynx, and prepare to perform pharmacologically assisted intubation. C) alternate suctioning of his oropharynx for 15 seconds and assisting ventilations for 2 minutes until his airway is clear of blood. D) continually suction his oropharynx until it is clear of blood, apply oxygen via nonrebreathing mask, and administer a sedative drug.

Decerebrate posturing is characterized by: A) flexion of the arms and extension of the legs. B) inward flexion of the wrists and flexed knees. C) extension of the arms and extension of the legs. D) pulling in of the arms toward the core of the body.

Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should: A) start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion. B) conclude that she is in neurogenic shock, start an IV line of normal saline, and initiate a dopamine infusion. C) start at least one large-bore IV of normal saline and administer a narcotic analgesic to treat her severe pain. D) perform a focused history and physical exam, start an IV of normal saline, and administer a corticosteroid.

A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are distended and his breath sounds are bilaterally diminished but equal. The MOST appropriate treatment for this patient involves: A) performing bilateral needle thoracenteses, intubating the patient and ventilating at 10 to 12 breaths/min, and transporting him to a trauma center. B) administering oxygen via nonrebreathing mask, transporting at once, and placing an occlusive dressing over the stab wound if his oxygen saturation is low. C) assisting his ventilations, initiating transport, starting a large-bore IV line en route, and administering fluids to maintain a systolic blood pressure of 100 mm Hg. D) covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route.

A flail chest is characterized by: A) a free-floating segment of fractured ribs. B) bulging of fractured ribs during inspiration. C) excessive negative intrathoracic pressure. D) drawing in of fractured ribs during expiration.

``` You would NOT expect a patient with a flail chest to present with: A) cyanosis. B) hyperpnea. C) shallow breathing. D) decreased breath sounds. ```

A 59-year-old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should: A) trim the steel rod to 6 inches, stabilize it in place with bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center. B) carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large-bore IV line and give 2 L of normal saline, and transport. C) remove the rod so you can perform effective CPR, control any external bleeding, start two large-bore IV lines, and assess his cardiac rhythm en route to the hospital. D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

When assessing a patient with abdominal trauma for distention, you must recall that: A) a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma. B) abdominal distention is usually caused by muscle tensing rather than intraabdominal bleeding. C) a significant amount of blood volume in the abdominal cavity is required to produce distention. D) because distention is a late sign of intraabdominal bleeding, it should not be assessed for in the field.

Periumbilical ecchymosis is: A) commonly observed in the prehospital setting following blunt force trauma to the abdomen. B) referred to as Cullen 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 sign and manifests almost immediately following blunt abdominal trauma.

A young man has an isolated injury to his left lower leg. Your assessment reveals obvious deformity and ecchymosis. Distal circulation as well as motor and sensory functions are grossly intact, and the patient is hemodynamically stable. In addition to stabilizing the suspected fracture site, you should: A) carefully palpate to elicit crepitus. B) immobilize the knee and the ankle. C) apply a traction splint for pain relief. D) place a chemical heat pack over the injury.

Which of the following is the MOST accurate definition of multiple-organ dysfunction syndrome? A) Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness B) Sequential failure of two or more organs or organ systems caused by an acute injury or illness affecting any part of the patient's central nervous system C) Acute and predictable failure of the kidneys, liver, lungs, and heart that resulted from any disorder or injury that directly affected these organs D) Progressive failure of two or more organs or organ systems that were directly affected by the acute disorder or injury that caused the patient's initial illness

``` Signs and symptoms of multiple-organ dysfunction syndrome may include: A) severe polyuria. B) marked hyperglycemia. C) uncontrollable bleeding. D) warm, flushed skin. ```

You are delivering a baby who was in a breech presentation. The baby's body has delivered, and you are attempting to deliver its head by lifting its body upward. After about 3 minutes, the baby's head has not delivered. You should: A) elevate the mother's hips with pillows, administer high-flow oxygen, and transport immediately. B) support the baby's body, carefully turn the mother on her left side, and transport expeditiously. C) place your gloved hand in the vagina and gently lift the baby's face away from the vaginal wall. D) elevate the mother's hips and apply gentle traction to the baby's body until the head has delivered.

``` You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and a patent IV line is in place. During transport, you reassess her and note that she has become diaphoretic, tachycardic, and tachypneic. You should: A) reassess her blood pressure. B) administer a rapid fluid bolus. C) cover her with warm blankets. D) tilt the backboard to the left side. ```

46. In contrast to an abruptio placenta, a placenta previa: A) typically presents with tearing abdominal pain. B) is usually caused by maternal abdominal trauma. C) is associated with an absence of fetal heart tones. D) usually presents with painless vaginal bleeding.

Abruptio placenta is MOST accurately defined as: A) separation of the placenta secondary to blunt maternal abdominal trauma. B) premature separation of a normally implanted placenta from the uterine wall. C) a condition in which the placenta progressively detaches from the uterine wall. D) a placenta that implants low in the uterus and partially or fully covers the cervix.

``` A 30-year-old woman presents with bright red vaginal bleeding and severe abdominal pain. She tells you that she is 35 weeks pregnant and that this episode began suddenly about 30 minutes ago. She further tells you that she has not felt the baby move in over an hour. As your partner is treating the patient for shock, you obtain her medical history. The patient tells you that she has high blood pressure and admits to using cocaine throughout her pregnancy. This patient is MOST likely experiencing: A) placenta previa. B) a ruptured uterus. C) abruptio placenta. D) a threatened abortion. ```

When suctioning the newborn's oropharynx to clear secretions prior to intubation, it is MOST important to: A) limit suctioning to 15 seconds. B) use a flexible suction catheter. C) monitor the newborn's heart rate. D) assess pulse oximetry and capnography.

``` You are assisting in the delivery of a baby. After the baby's head emerges from the vagina, you should quickly assess for the presence of a nuchal cord and then: A) assess for facial cyanosis. B) administer free-flow oxygen. C) suction its mouth and nose. D) dry its face to stimulate breathing. ```

Following significant blunt trauma to the abdomen, a 9-year-old boy presents with diaphoresis and pallor. He is conscious and alert, with a blood pressure of 90/58 mm Hg, a heart rate of 130 beats/min, and a respiratory rate of 28 breaths/min with adequate depth. With an estimated ground transport time of 30 minutes, you should: A) assist his ventilations to increase tidal volume, cover him with a blanket, establish at least one large-bore IV line, administer a 20-mL/kg normal saline bolus, and transport to a trauma center. B) administer high-flow oxygen, apply spinal precautions if indicated, provide warmth, begin transport, establish vascular access en route, and administer enough crystalloid solution to maintain adequate perfusion. C) apply supplemental oxygen, start two large-bore IV lines with normal saline, administer several crystalloid boluses of 20 mL/kg, apply spinal precautions if indicated, and transport to an appropriate medical facility. D) apply warm blankets, elevate his lower extremities 12 inches, administer high-flow oxygen, insert an IO catheter, administer a 250-mL normal saline bolus, and transport expeditiously to an appropriate trauma center.

A sick or injured child's general appearance is MOST reflective of: A) the etiology of the problem. B) his or her cardiovascular status. C) his or her central nervous system function. D) his or her ability to be consoled.

When caring for an infant or child who is in compensated shock, you should: A) intubate at the earliest sign of altered mentation. B) administer a 10-mL/kg normal saline fluid bolus. C) assist ventilations to improve tissue oxygenation. D) establish IV or IO access en route to the hospital.

A child in decompensated shock with hypotension should: A) be intubated to protect his or her airway. B) receive initial fluid resuscitation at the scene. C) be given 25% dextrose to prevent hypoglycemia. D) receive volume expansion with 5% dextrose in water.

``` You respond to a residence for an unknown emergency involving an 83-year-old man. When you arrive, you find the patient, who is conscious and alert, sitting on his couch with his head held over a bowl. He tells you that his nose started bleeding about 20 minutes ago and he cannot get it to stop. As your partner assists the patient in controlling the bleeding, you inquire about his medical history. He tells you that he has chronic atrial fibrillation, has high blood pressure, and is occasionally depressed. When you ask him about compliance with his medications, he tells you, “I take my medicine every day, but the writing on the bottles is so small.” The patient's blood pressure is 112/58 mm Hg, pulse rate is 88 beats/min and irregular, and respirations are 18 and unlabored. This patient has MOST likely inadvertently: A) overdosed on his Xanax. B) underdosed on his Toprol. C) underdosed on his digoxin. D) overdosed on his warfarin. ```

``` Which of the following medications has a direct blood-thinning effect? A) Plavix B) Aspirin C) Accupril D) Warfarin ```

Spina bifida occurs when: A) hydrocephalus causes a significant increase in pressure within the spinal canal, resulting in chronic compression of the spinal cord. B) the fetus's spinal column does not close properly or completely and vertebrae do not develop, leaving a portion of the spinal cord exposed. C) trauma during birth causes distracting injuries to the cervical and thoracic vertebrae, resulting in partial or complete paralysis below the injury. D) growth of the fetus's spinal column stops at the thoracic vertebrae, which leaves the lumbar portion of the spinal cord completely unprotected.

While transporting a cancer patient who is receiving chemotherapy, you should recall that: A) it is likely that the patient's condition is terminal. B) chemotherapy weakens a patient's immune system. C) prophylactic antiemetic medications are often needed. D) chemotherapy is only used to treat metastatic cancer.

``` You are assessing a patient and discover that he has a ventricular assist device because of severe left heart failure. In this case, the device is MOST likely connected to the: A) left atrium. B) right atrium. C) right ventricle. D) left ventricle. ```

A 66-year-old man with severe left heart failure is receiving an inotropic medication via an infusion pump. He presents with an altered mental status, increased breathing difficulty, and hypotension. You should: A) administer oxygen and discontinue the medication infusion by turning the pump off. B) assist his breathing, slowly increase the dose of his inotropic medication, and transport. C) support his breathing, continue his medication infusion, and contact medical control. D) administer oxygen, discontinue the medication infusion, and establish a peripheral IV.

``` The fistula used for hemodialysis is a surgical connection between: A) two large veins. B) an artery and a vein. C) two large arteries. D) a vein and the peritoneum. ```

``` Which of the following injury patterns is MOST suggestive of child abuse? A) Burns with splash marks B) Bruises on the abdomen C) Bruises on the lower leg D) Laceration to the chin ```

A helicopter landing zone should be: A) marked with a strobe light at the front and rear of the proposed site. B) 100 feet by 100 feet in size and on a surface that is firm, level, and free of debris. C) 50 feet by 50 feet in size and in an area that is at least 50 feet from the ambulance. D) at least a quarter of a mile from the ambulance to avoid injury from flying debris.

When assisting with a helicopter landing at night, you should: A) leave your headlights on to signify your location. B) avoid shining a spotlight up at the descending aircraft. C) place a single strobe light in the center of the landing zone. D) refrain from parking the ambulance under overhead wires.

The FIRST step in the START triage system involves: A) directing all the walking wounded to an easily identifiable landmark. B) quickly removing the obviously dead victims to a predesignated area. C) identifying the nonambulatory patients and assessing their breathing. D) obtaining an estimate of the total number of critically injured victims.

According to the START triage system, a nonbreathing patient should be triaged as immediate if: A) he or she is in need of immediate intubation. B) the airway is completely blocked by swelling. C) a manual airway maneuver restores breathing. D) he or she does not respond to two rescue breaths.

According to the START triage system, if a patient has a strong radial pulse, you should: A) place him or her in the delayed category. B) control bleeding and assess mental status. C) assess his or her ability to follow commands. D) determine whether the pulse rate is slow or fast.

Upon arriving at the scene of a major incident, you can clearly see that there are numerous patients, some of whom are receiving care and others of whom are walking around unattended. Your MOST appropriate action should be to: A) immediately triage the unattended patients. B) move the walking patients to a separate area. C) notify dispatch and request air medical transport. D) report to the staging area for further instructions.

Where would you MOST likely find a material safety data sheet that provides information about a hazardous material? A) At a tanker truck's destination location B) At a permanent manufacturing or storage facility C) Affixed to the roof of a commercial tanker truck D) In a steel box in the conductor's cabin of a train

During a small-scale incident, the incident commander: A) will likely not respond to the scene. B) may perform all the command functions. C) primarily assumes the role of safety officer. D) delegates all authority to the senior paramedic.

At a very large incident, the operations section is responsible for: A) locating food, shelter, and health care for you and the other responders present at the incident. B) managing the tactical operations job usually handled by the incident commander on routine EMS calls. C) ensuring that there is ample lighting and functional communications equipment during the incident. D) obtaining data regarding problems that may arise at the incident and revising the plan to solve the problem.

During an incident involving a building collapse, a paramedic is assigned eight rescuers to function under his authority. However, as the incident progresses, the paramedic finds that he is unable to effectively manage the personnel assigned to him. He should: A) send two of the rescuers to the triage section since this is where they will most likely be needed. B) transfer authority to one of the rescuers assigned to him and then follow that person's directions. C) divide tasks and delegate supervision of some tasks to one or more of the rescuers assigned to him. D) release half of the rescuers assigned to him and instruct them to report directly to the incident commander.

``` The number one killer of fire fighters at the scene of a fire is/are: A) heatstroke. B) thermal burns. C) inhalation injury. D) cardiac events. ```

You receive a call to a residence in a rural area of your jurisdiction for a patient with an acute COPD exacerbation. Upon arriving at the scene, you knock on the door and identify yourself. The patient, an elderly-sounding man, tells you that you took too long to get to him and that he has a shotgun. You should: A) look inside a nearby window to see if he really does have a gun. B) immediately retreat to the ambulance and notify law enforcement. C) advise the patient that you got to the scene as quickly as possible. D) stay at a safe distance from the door and ask the man to walk outside.

Paramedic School FINAL final Flashcards

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