Phase 2 Final

Question 1

68. A 68-year-old woman presents with an acute onset of dyspnea and sharp chest pain. Her medical history is significant for a hip replacement 2 weeks ago. The patient is conscious and alert, with a blood pressure of 112/58 mm Hg, pulse rate of 90 beats/min and irregular, and respirations of 22 breaths/min and labored. Which of the following treatment interventions is MOST appropriate for this patient?
    A) Pharmacologically assisted intubation and IV therapy
    B) Oxygenation and ventilation support and rapid transport
    C) 324 mg of aspirin and ventilation support with a bag-mask
    D) Supplemental oxygen and elevation of the lower extremities

Answer 1

B

Question 2

57. Compartment syndrome occurs when:
    A) metabolic waste products accumulate within a large hematoma that develops near a fracture site.
    B) yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling.
    C) blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue.
    D) pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.

Answer 2

D

Question 3

61. You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should:
    A) immediately stabilize both lower extremities.
    B) remove his helmet and apply a cervical collar.
    C) manually stabilize his head and assess his airway.
    D) carefully straighten his legs and assess distal pulses.

Answer 3

C

Question 4

66. You have applied board splints to a suspected lower leg fracture in a young woman and have given her fentanyl for pain. En route to the hospital, the patient states that the pain is excruciating. Further narcotics fail to relieve the pain. Reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak. You should:
    A) start a second IV line and administer 1 mEq/kg of sodium bicarbonate.
    B) remove the splint to prevent excessive swelling of the extremity.
    C) loosen the splint, elevate the leg, apply ice, and notify the hospital.
    D) remove the board splints, apply an air splint, and then reassess her.

Answer 4

C

Question 5

65. A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should:
    A) splint the elbow in the position found and reassess distal circulation.
    B) carefully straighten the arm to facilitate placement of a vacuum splint.
    C) apply a sling and swathe to immobilize the injury and then apply heat.
    D) administer fentanyl for pain relief and then carefully straighten the arm.

Answer 5

A

Question 6

63. A 60-year-old woman slipped and fell on an icy sidewalk and landed on her outstretched hand. Your assessment reveals that she has an obvious Colles fracture. The patient denies any other injuries and is conscious and alert. Her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10. Given this patient’s current status, the MOST appropriate way to treat her injury involves:
    A) gently straightening the fracture site and then applying a splint.
    B) administering analgesia and then properly splinting her injury.
    C) giving her a sedative for pain relief and then applying an air splint.
    D) manually stabilizing her wrist as your partner applies a vacuum splint.

Answer 6

B

Question 7

122. A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:
     A) applying a cervical collar and assisting his ventilations with a bag-mask device.
     B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds.
     C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions.
     D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

Answer 7

D

Question 8

40. An epidural hematoma typically causes rapid deterioration in the head-injured patient’s condition because:
    A) numerous axons are severely damaged.
    B) the meningeal veins are often disrupted.
    C) it is associated with brisk arterial bleeding.
    D) concomitant spinal cord injury is often present.

Answer 8

C

Question 9

41. Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:
    A) rapidly increasing intracranial pressure.
    B) an underlying skull fracture.
    C) a fluctuating level of consciousness.
    D) unilateral hemiparesis or slurred speech.

Answer 9

A

Question 10

42. A subdural hematoma is classified as acute if clinical signs and symptoms develop:
    A) immediately following the injury.
    B) within 24 hours following the injury.
    C) within 36 hours following the injury.
    D) within 48 hours following the injury.

Answer 10

B

Question 11

101. The FIRST step in any neurologic assessment involves:
     A) obtaining an initial Glasgow Coma Scale score.
     B) asking the patient if he or she can feel or move.
     C) determining the patient’s level of consciousness.
     D) assessing the pupils for size, equality, and reactivity.

Answer 11

C

Question 12

107. Spinal cord injuries that cause neurogenic shock generally produce:
     A) cool, clammy skin distal to the site of the spinal cord injury.
     B) reflex tachycardia due to sympathetic nervous system stimulation.
     C) flaccid paralysis and complete loss of sensation distal to the injury.
     D) signs and symptoms that are identical to those of hypovolemic shock.

Answer 12

C

Question 13

112. In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle?
     A) Conscious with bilateral femur fractures
     B) Unconscious with obvious spinal deformity
     C) Confused with lower back pain and tachycardia
     D) Conscious with neck pain and stable vital signs

Answer 13

D

Question 14

31. The MOST disastrous consequence of a severe traumatic brain injury is:
    A) an increase in intracranial pressure.
    B) an increase in mean arterial pressure.
    C) severe hypertension and bradycardia.
    D) a decrease in cerebral perfusion pressure.

Answer 14

D

Question 15

33. Prehospital treatment of the patient with a traumatic brain injury must focus primarily on:
    A) maintaining cerebral perfusion pressure.
    B) hyperventilating the patient at 20 breaths/min.
    C) maintaining a systolic blood pressure of at least 120 mm Hg.
    D) taking measures to decrease intracranial pressure.

Answer 15

A

Question 16

48. Hyperventilation of the brain-injured patient:
    A) shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.
    B) has clearly demonstrated decreased mortality and morbidity in patients with a severe head injury.
    C) causes cerebral vasodilation with increased intracranial pressure and should be avoided.
    D) is only appropriate if the patient is unresponsive and has bilaterally dilated and sluggishly reactive pupils.

Answer 16

A

Question 17

48. Unlike adults, children who are struck by a motor vehicle are MORE likely to:
    A) be run over by the vehicle as they are propelled to the ground.
    B) experience injuries to the lower extremities from the initial impact.
    C) be propelled onto the hood of the vehicle during the second impact.
    D) turn away from the oncoming vehicle, resulting in posterior trauma.

Answer 17

A

Question 18

30.  The initial point of bodily impact when an unrestrained passenger takes the “down and under” pathway during a frontal collision is the:
A)  knees.
B)  pelvis.
C)  femurs.
D)  abdomen.

Answer 18

A

Question 19

58.  Which of the following characteristics of an entry wound indicates that the weapon was fired at close range?
A)  Abrasions around the wound
B)  Indentation of cutaneous tissues
C)  Severe bleeding from the wound
D)  Tattoo marks from powder burns

Answer 19

D

Question 20

56.  Compared to a handgun, a rifle:
A)  is less accurate.
B)  fires a single projectile.
C)  fires at a higher velocity.
D)  has less powerful ammunition

Answer 20

C

Question 21

26.  The third phase of a motor vehicle accident involves:
A)  crush injuries to the body.
B)  impact by another vehicle.
C)  deceleration of internal organs.
D)  injuries caused by flying debris.

Answer 21

C

Question 22

63.  The shock wave velocity from an explosion is slower and its duration is longer if a person is:
A)  closer to the explosion.
B)  standing behind a solid object.
C)  farther from the explosion.
D)  standing beside a solid object.

Answer 22

C

Question 23

8. Perfusion is defined as:
   A) the effective exchange of oxygen and carbon dioxide within the lungs and at the cellular level.
   B) the circulation of blood through an organ or tissue in amounts adequate to meet the body’s demands.
   C) an ejection fraction that is adequate to maintain radial pulses or a systolic blood pressure of at least 90 mm Hg.
   D) the circulation of an adequate volume of blood to ensure uninterrupted cerebral and myocardial oxygenation.

Answer 23

B

Question 24

37.  Circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs is called:
A)  perfusion.
B)  respiration.
C)  oxygenation.
D)  metabolism.

Answer 24

A

Question 25

40. The paramedic’s MAIN goal in treating a patient with shock is to:
    A) administer oxygen in a concentration sufficient to maintain an oxygen saturation greater than 95%.
    B) start two large-bore IV lines and infuse enough isotonic crystalloid solution to maintain adequate tissue perfusion.
    C) recognize the signs and symptoms of shock in its earliest phase and begin immediate treatment before permanent damage occurs.
    D) maintain body temperature and elevate the patient’s legs 6 to 12 inches in order to improve blood flow to the core of the body.

Answer 25

C

Question 26

34. The physiologic process of hemostasis is achieved through:
    A) an increased production of red blood cells.
    B) the destruction of fibrin and platelets.
    C) the use of anticoagulants such as Coumadin.
    D) vasoconstriction and platelet aggregation.

Answer 26

D

Question 27

25. When applying a tourniquet to control major external hemorrhage from an extremity injury, you should:
    A) apply the tourniquet over a joint, as this will further help compress blood vessels.
    B) maintain direct pressure to the wound until the tourniquet has been fully applied.
    C) secure the tourniquet in place until the pulses distal to the injury have weakened.
    D) apply a pressure dressing over the tourniquet to further help control the bleeding.

Answer 27

B

Question 28

43. 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.

Answer 28

C

Question 29

45. 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.

Answer 29

B

Question 30

35.  In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with:
A)  polyuria and weak pulses.
B)  bounding radial pulses.
C)  mottled skin and dilated pupils.
D)  restlessness and pale cool skin.

Answer 30

C

Question 31

41.  Decompensated shock in the adult is characterized by:
A)  increased tidal volume.
B)  bounding radial pulses.
C)  15% blood loss or more.
D)  a falling blood pressure.

Answer 31

D

Question 32

42.  Which of the following signs would you MOST likely observe in a patient with compensated shock?
A)  Anxiety or agitation
B)  Dilation of the pupils
C)  Absent peripheral pulses
D)  Response to painful stimuli

Answer 32

A

Question 33

67.  Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they:
A)  expand rapidly.
B)  contain oxygen.
C)  are compressible.
D)  do not compress.

Answer 33

C

Question 34

94.  The venom from a pit viper causes all of the following effects, EXCEPT:
A)  local tissue necrosis.
B)  increased blood clotting.
C)  neuromuscular dysfunction.
D)  increased vascular permeability.

Answer 34

B

Question 35

95. The MOST common and reliable sign of pit viper envenomation is:
    A) tachycardia within 30 seconds of the bite.
    B) patient anxiety and a slow, bounding pulse.
    C) swelling of the tongue and marked hypertension.
    D) rapidly developing edema around the bite area.

Answer 35

D

Question 36

52.  Which of the following is NOT a form of passive rewarming?
A)  Removing wet clothing
B)  Applying warm blankets
C)  Applying chemical heat packs
D)  Encouraging ambulation

Answer 36

C

Question 37

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

Answer 37

A

Question 38

96.  A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should be MOST suspicious that this patient has a(n):
A)  poorly healed diabetic ulcer.
B)  local reaction to an ant bite.
C)  infection caused by a tick.
D)  brown recluse spider bite

Answer 38

D

Question 39

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

Answer 39

C

Question 40

83. You are caring for a young woman with a local cold injury to her hands. Your assessment reveals that her hands are hard to the touch, mottled, cold, and without sensation. Her body temperature is 96.3°F per tympanic thermometer. Your estimated transport time to the hospital is 45 minutes. The MOST appropriate treatment for this patient includes:
    A) preventing further loss of body heat; protecting her hands from injury with dry, bulky dressings; and transporting without delay.
    B) applying chemical heat packs to her axilla and groin, rapidly rewarming her hands with hot water, bandaging her hands, and transporting.
    C) starting an IV and infusing warm normal saline, having her place her hands in her armpits to keep them warm, and transporting as soon as possible.
    D) immersing her hands in water that is between 95°F and 104°F, starting an IV and administering fentanyl, bandaging her thawed hands, and transporting.

Answer 40

A

Question 41

88.  Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for:
A)  nitrogen narcosis.
B)  a tension pneumothorax.
C)  decompression sickness.
D)  an arterial gas embolism.

Answer 41

D

Question 42

25.  Which of the following clinical findings would you NOT expect to encounter in a patient with heat exhaustion?
A)  Abdominal cramping
B)  Mental disorientation
C)  Hypertension upon standing
D)  Body temperature of 103°F

Answer 42

C

Question 43

26.  The diagnosis of heatstroke is usually made when a patient has a high core body temperature and:
A)  an altered mental status.
B)  an absence of sweating.
C)  a history of heat exposure.
D)  a heart rate above 140 beats/min.

Answer 43

A

Question 44

27. Classic heatstroke:
    A) is also called active heatstroke and is usually seen in diabetics.
    B) presents with a high core body temperature and profuse sweating.
    C) affects young people and is often accompanied by hypoglycemia.
    D) typically affects older people and is not associated with exertion.

Answer 44

D

Question 45

28.  In contrast to classic heatstroke, exertional heatstroke:
A)  causes hyperglycemia.
B)  presents with hot, dry skin.
C)  affects young, healthy people.
D)  is associated with diuretic use.

Answer 45

C

Question 46

29. Patients with heatstroke:
    A) present initially with hot, dry skin.
    B) are typically bradypneic and hypotensive.
    C) have a core temperature greater than 104°F.
    D) should routinely be given 50% dextrose.

Answer 46

C

Question 47

68. Nitrogen causes decompression sickness:
    A) on descent because of the bubbles that form on reduction of pressure.
    B) on ascent because of the bubbles that form on reduction of pressure.
    C) on descent because of a progressive increase in atmospheric absolute.
    D) on ascent because of a progressive increase in atmospheric absolute.

Answer 47

B

Question 48

73. What is the pathophysiology of decompression sickness?
    A) Diffusion of nitrogen out of the tissues during too slow of an ascent
    B) An imbalance of nitrogen in the tissues and alveoli due to rapid ascent
    C) Increasing quantities of nitrogen and oxygen in the blood during descent
    D) Excess carbon dioxide accumulation in the muscles due to a rapid ascent

Answer 48

B

Question 49

74.  The MOST common clinical finding observed in patients with type I decompression sickness is:
A)  joint pain.
B)  unsteadiness.
C)  pruritus and rashes.
D)  a cough and dyspnea.

Answer 49

A

Question 50

33. 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.

Answer 50

C

Question 51

39. A 39-year-old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should:
    A) administer oxygen via nonrebreathing mask; cover the exposed bowel with dry, sterile dressings; start an IV and give a 500-mL fluid bolus; and transport to a trauma center.
    B) assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.
    C) insert an oral airway, provide ventilatory assistance, cover the exposed bowel with aluminum foil, begin transport, and start two large-bore IV lines with normal saline en route.
    D) consider intubation to protect his airway; cover the exposed bowel with moist, sterile dressings; start an IV and give analgesia; and transport to a trauma center with fluid boluses en route.

Answer 51

B

Question 52

9. Which of the following statements regarding the liver is correct?
   A) The liver is the largest hollow organ in the abdomen and is responsible for producing and storing bile.
   B) The liver is a relatively avascular organ that is uncommonly injured during blunt abdominal trauma.
   C) The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood.
   D) The liver is partially protected by the left lower rib cage and serves the function of filtering bacteria from the blood.

Answer 52

C

Question 53

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

Answer 53

A

Question 54

34.  Following blunt force trauma to the lower right rib cage, a 40-year-old man presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that he has a:
A)  pyloric injury.
B)  liver injury.
C)  splenic rupture.
D)  pneumothorax.

Answer 54

B

Question 55

62.  Signs and symptoms of HIV infection may include all of the following, EXCEPT:
A)  acute febrile illness.
B)  swollen lymph glands.
C)  malaise and a headache.
D)  right upper quadrant pain.

Answer 55

D

Question 56

37. A paramedic would MOST likely be infected with TB if he or she:
    A) was close to a coughing patient who had a positive TB skin test.
    B) performed mouth-to-mouth on a patient with active untreated TB.
    C) was exposed to blood-stained vomitus of a patient with active TB.
    D) received a needlestick from a person suspected of having active TB.

Answer 56

B

Question 57

60.  The primary target of infection with the human immunodeficiency virus is the:
A)  immune system.
B)  lymphatic system.
C)  pulmonary system.
D)  central nervous system.

Answer 57

A

Question 58

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

Answer 58

D

Question 59

33. Common signs and symptoms of meningitis include:
    A) irritability, back pain, headache, and hypertension.
    B) slow-onset fever, tinnitus, and an occipital headache.
    C) mental status changes, fever, stiff neck, and headache.
    D) a dark red rash, combativeness, and a low-grade fever.

Answer 59

C

Question 60

25.  Administering a drug that possesses a positive chronotropic effect will have a direct effect on:
A)  stroke volume.
B)  blood pressure.
C)  cardiac output.
D)  the heart rate.

Answer 60

D

Question 61

26.  Changes in cardiac contractility may be induced by medications that have a positive or negative \_\_\_\_\_\_\_\_\_\_\_ effect.
A)  vasoactive
B)  dromotropic
C)  inotropic
D)  chronotropic

Answer 61

C

Question 62

32.  The effect on the velocity of electrical conduction is referred to as the \_\_\_\_\_\_\_\_\_ effect.
A)  inotropic
B)  dromotropic
C)  chronotropic
D)  conductivity

Answer 62

B

Question 63

32.  The effect on the velocity of electrical conduction is referred to as the \_\_\_\_\_\_\_\_\_ effect.
A)  inotropic
B)  dromotropic
C)  chronotropic
D)  conductivity

Answer 63

B

Question 64

205.  Premature ventricular complexes (PVCs) that originate from different sites in the ventricle:
A)  are called unifocal PVCs.
B)  produce a palpable pulse.
C)  are also called fusion PVCs.
D)  will appear differently on the ECG.

Answer 64

D

Question 65

206.  A “run” of ventricular tachycardia occurs if at least \_\_\_\_ PVCs occur in a row.
A)  two
B)  three
C)  four
D)  five

Answer 65

B

Question 66

207. Ventricular bigeminy occurs when:
     A) two premature ventricular complexes (PVCs) occur in a row.
     B) every second complex is a PVC.
     C) at least two differently shaped PVCs occur.
     D) a 6-second strip contains at least two PVCs.

Answer 66

B

Question 67

19.  The amount of blood that is pumped out by either ventricle per minute is called:
A)  ejection fraction.
B)  cardiac output.
C)  stroke volume.
D)  minute volume.

Answer 67

B

Question 68

21.  Cardiac output is influenced by:
A)  heart rate.
B)  stroke volume.
C)  heart rate and/or stroke volume.
D)  ejection fraction and heart rate.

Answer 68

C

Question 69

100.  The presence of dizziness in a patient with a suspected myocardial infarction is MOST likely the result of:
A)  fear and anxiety.
B)  the effects of nitroglycerin.
C)  acute left-sided heart failure.
D)  a reduction in cardiac output.

Answer 69

D

Question 70

110. When monitoring a patient’s cardiac rhythm, it is MOST important to remember that:
     A) a heart rate below 60 beats per minute must be treated immediately.
     B) many patients with acute myocardial infarction experience asystole.
     C) the ECG does not provide data regarding the patient’s cardiac output.
     D) the presence of a QRS complex correlates with the patient’s pulse.

Answer 70

C

Question 71

143. A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:
     A) myocardial stretching due to increased preload.
     B) decreases in stroke volume and ventricular filling.
     C) increased automaticity of the cardiac pacemaker.
     D) ectopic pacemaker sites in the atria or ventricles.

Answer 71

B

Question 72

257.  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.

Answer 72

C

Question 73

146. An electrical wave moving in the direction of a positive electrode will:
     A) cause a positive deflection on the ECG.
     B) produce a significant amount of artifact.
     C) cause a negative deflection on the ECG.
     D) manifest with narrow QRS complexes.

Answer 73

A

Question 74

213. The firing of an artificial ventricular pacemaker causes:
     A) a change in the shape of the preceding P waves.
     B) a vertical spike followed by a wide QRS complex.
     C) a small spike followed by a narrow QRS complex.
     D) a wide QRS complex followed by a vertical spike.

Answer 74

B

Question 75

207. Ventricular bigeminy occurs when:
     A) two premature ventricular complexes (PVCs) occur in a row.
     B) every second complex is a PVC.
     C) at least two differently shaped PVCs occur.
     D) a 6-second strip contains at least two PVCs.

Answer 75

B

Question 76

181.  Patients with a heart rate greater than 150 beats/min usually become unstable because of:
A)  reduced ventricular filling.
B)  an increase in the atrial kick.
C)  increased right atrial preload.
D)  a significantly reduced afterload.

Answer 76

A

Question 77

51. Unlike the parasympathetic nervous system, the sympathetic nervous system:
    A) is not under the direct control of the autonomic nervous system.
    B) provides a mechanism for the body to adapt to changing demands.
    C) is blocked when drugs such as atropine are administered.
    D) constricts the pupils and increases gastrointestinal function when stimulated.

Answer 77

B

Question 78

55.  Stimulation of alpha and beta receptors affects the:
A)  heart only.
B)  heart and blood vessels.
C)  blood vessels and lungs.
D)  heart, lungs, and blood vessels.

Answer 78

D

Question 79

56.  Vasoconstriction occurs following stimulation of:
A)  beta-1 receptors.
B)  beta-2 receptors.
C)  alpha receptors.
D)  alpha and beta receptors.

Answer 79

C

Question 80

58. To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:
    A) stimulates beta-1 and beta-2 receptors.
    B) stimulates beta-2 and alpha receptors.
    C) blocks beta-1 and beta-2 receptors.
    D) blocks beta receptors and stimulates alpha receptors.

Answer 80

A

Question 81

233. Ischemia to the anterior wall of the myocardium would present with:
     A) T-wave inversion in leads V3 and V4.
     B) ST-segment depression in leads I and aVL.
     C) T-wave inversion in leads II, III, and aVF.
     D) ST-segment elevation in leads V3 and V4.

Answer 81

A

Question 82

61. 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

Answer 82

D

Question 83

56. An elderly man presents with slurred speech, confusion, and unilateral facial asymmetry. When asked to squeeze your hands, the strength in his left hand is markedly less than the strength in his right hand. The patient’s wife tells you that her husband has type 2 diabetes and hypertension. On the basis of your clinical findings, you should:
    A) consider him a candidate for fibrinolytic therapy if his symptoms began less than 12 hours ago.
    B) rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.
    C) start an IV and administer crystalloid fluid boluses if his systolic blood pressure is less than 110 mm Hg.
    D) suspect that he is experiencing a hemorrhagic stroke, begin immediate transport, and start an IV en route.

Answer 83

B

Question 84

78.  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

Answer 84

C

Question 85

46.  Tremors that increase as the patient's hand gets closer to an object that he or she is trying to grab are called \_\_\_\_\_\_\_\_\_ tremors and are MOST common in patients with \_\_\_\_\_\_\_\_\_.
A)  rest, Parkinson disease
B)  postural, Alzheimer disease
C)  clonic, cerebral palsy
D)  intention, multiple sclerosis

Answer 85

D

Question 86

47.  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

Answer 86

B

Question 87

78.  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

Answer 87

C

Question 88

63. You are dispatched to a residence for a 44-year-old woman with a severe headache. You arrive to find the patient lying on her sofa with a wet washcloth on her forehead. She tells you that she has a history of migraine headaches and that this is one of her “typical” headaches. She also complains of nausea and photophobia. Her blood pressure is 170/94 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes:
    A) carefully assessing her pupils, administering oxygen, starting an IV and giving her morphine, and transporting.
    B) placing her in a Fowler position, administering oxygen, and transporting her to the hospital for definitive care.
    C) oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or siren.
    D) administering high-flow oxygen, establishing vascular access, and administering nitroglycerin to lower her blood pressure.

Answer 88

C

Question 89

55. A 59-year-old woman presents with acute onset of confusion, left-sided hemiparesis, and a right-sided facial droop. Her airway is patent and she is breathing adequately. Her blood pressure is 150/100 mm Hg and her pulse is 70 beats/min. The cardiac monitor displays atrial fibrillation with a variable rate of 60 to 90 beats/min. When obtaining the patient’s medical history from her husband, the MOST important question to ask him is:
    A) “Does your wife have a history of diabetes?”
    B) “Is your wife allergic to aspirin or contrast dye?”
    C) “When did your wife last see her physician?”
    D) “When did you first notice your wife’s symptoms?”

Answer 89

D

Question 90

66.  A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include:
A)  diazepam, 5 mg.
B)  promethazine, 25 mg.
C)  diphenhydramine, 25 mg.
D)  ondansetron, 4 mg.

Answer 90

C

Question 91

74. 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.

Answer 91

A

Question 92

58. Which of the following statements regarding prehospital vascular access and fluid therapy in the severely burned patient is correct?
    A) Most burn patients will require at least 4 L of IV fluid immediately.
    B) At least one large-bore IV should be started while en route to the hospital.
    C) Intraosseous cannulation is absolutely contraindicated in severely burned patients.
    D) An IV line in a lower extremity is preferable to one in a burned upper extremity.

Answer 92

B

Question 93

55.  The MOST acute complication associated with large body surface area burns is:
A)  infection.
B)  hypovolemia.
C)  hypothermia.
D)  myoglobinemia.

Answer 93

C

Question 94

68. During your primary assessment of a 21-year-old man with a suspected inhalation injury, you note that he is combative and his respirations are profoundly labored and stridorous. The closest appropriate medical facility is approximately 25 miles by ground, and the local air transport service is unavailable. You should:
    A) provide supplemental oxygen via nonrebreathing mask, insert an intraosseous catheter, and administer a sedative medication.
    B) assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate his trachea.
    C) administer humidified oxygen, start at least one large-bore IV, and visualize his upper airway to assess the severity of soft-tissue swelling.
    D) insert an oropharyngeal airway, ventilate him with a bag-mask device at 20 breaths/min, and prepare to nasotracheally intubate him.

Answer 94

B

Question 95

7.  What type of thermal burn is MOST commonly associated with inhalation injury?
A)  Steam burns
B)  Flame burns
C)  Scald burns
D)  Arc burns

Answer 95

A

Question 96

11. Supraglottic damage following a burn is MOST often caused by:
    A) the inhalation of superheated gases.
    B) exposure to carbon monoxide or cyanide.
    C) the inhalation of hot particulate steam.
    D) direct flame exposure to the oropharynx.

Answer 96

A

Question 97

41.  If a burn patient presents with a hoarse voice and states, “I'm cold,” your MOST immediate concern should be:
A)  hypothermia.
B)  burn shock.
C)  inhalation injury.
D)  cyanide toxicity.

Answer 97

C

Question 98

47.  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

Answer 98

A

Question 99

31.  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

Answer 99

A

Question 100

33.  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

Answer 100

C

Question 101

44. 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

Answer 101

B

Question 102

16. Histamine release causes all of the following effects, EXCEPT:
    A) vasodilation, which results in flushed skin and hypotension.
    B) contraction of the smooth muscles of the respiratory system.
    C) increased cardiac contractility, which results in hypertension.
    D) increased vascular permeability, which results in tissue edema.

Answer 102

C

Question 103

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

Answer 103

B

Question 104

61. 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.

Answer 104

B

Question 105

67.  In adult patients, oral ingestion of a caustic substance:
A)  is usually intentional.
B)  causes immediate death.
C)  contraindicates intubation.
D)  requires activated charcoal.

Answer 105

A

Question 106

101. A 45-year-old man is found unresponsive in an alley. During your assessment, you note that he is tachycardic and breathing rapidly. He has an obvious odor of alcohol on his breath. Your MOST immediate concern should be to:
     A) obtain a blood glucose reading.
     B) take actions to prevent aspiration.
     C) determine the etiology of his tachycardia.
     D) start an IV line and administer naloxone

Answer 106

B

Question 107

44. Priority care for an unresponsive patient who has overdosed on phenobarbital includes:
    A) administering oxygen and giving naloxone.
    B) administering diazepam to prevent seizures.
    C) securing the airway and preventing aspiration.
    D) observing the ECG closely for lethal dysrhythmias.

Answer 107

C

Question 108

102. 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.

Answer 108

A

Question 109

116. 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

Answer 109

B

Question 110

114. A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should:
     A) cover the burn and transport at once.
     B) begin immediate irrigation with water.
     C) apply a light coat of baking soda to the burn.
     D) administer oxygen via nonrebreathing mask.

Answer 110

B

Question 111

57. The toxicity of carbon monoxide arises primarily from:
    A) its destructive properties on ferric ions.
    B) its affinity for hemoglobin in red blood cells.
    C) the fact that carbon monoxide destroys hemoglobin molecules.
    D) its ability to markedly decrease the metabolic rate.

Answer 111

B

Question 112

60. Pulse oximetry will not provide a true assessment of arterial oxygenation in patients with carbon monoxide toxicity because:
    A) the device falsely interprets oxyhemoglobin as carboxyhemoglobin.
    B) carbon monoxide damages the computer chip inside the pulse oximeter.
    C) the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin.
    D) carbon monoxide turns the blood dark red, which indicates low oxygen content.

Answer 112

C

Question 113

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

Answer 113

C

Question 114

56.  Signs and symptoms of organophosphate poisoning include:
A)  vomiting.
B)  tachycardia.
C)  constipation.
D)  pupillary dilation.

Answer 114

A

Question 115

104.  You arrive at the scene of an unknown drug-related emergency. Law enforcement is present and has ensured scene security. The patient, a young male, is found sitting at the kitchen table. He is laughing uncontrollably and tells you, “Life sure is good!” Your partner finds a basin of water and an empty box of baking soda on the counter. You should be MOST suspicious that this patient:
A)  is speedballing.
B)  has injected heroin.
C)  was snorting cocaine.
D)  has smoked crack cocaine.

Answer 115

D

Question 116

63. 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.

Answer 116

D

Question 117

49. The preferred site for performing a needle thoracentesis is:
    A) superior to the third rib into the intercostal space at the midclavicular line.
    B) just below the second rib into the intercostal space at the midaxillary line.
    C) just above to the fifth rib into the intercostal space at the midaxillary line.
    D) inferior to the third rib into the intercostal space at the midclavicular line.

Answer 117

A

Question 118

66. Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should:
    A) ventilate the patient with a bag-mask device and transport immediately.
    B) perform an immediate needle thoracentesis to the right side of the chest.
    C) give 100% oxygen and start a large-bore IV line en route to the hospital.
    D) transport at once and decompress the chest if tracheal deviation is observed.

Answer 118

B

Question 119

1. Which of the following statements regarding the thorax is correct?
   A) The thoracic cavity extends to the ninth or tenth rib posteriorly.
   B) The diaphragm inserts into the anterior thoracic cage below the fifth rib.
   C) The dimensions of the thorax are defined inferiorly by the thoracic inlet.
   D) The dimensions of the thorax are defined anteriorly by the thoracic vertebrae.

Answer 119

B

Question 120

15. The diaphragm:
    A) is an accessory muscle used during respiratory distress.
    B) works in conjunction with the sternum during inspiration.
    C) forms a barrier between the thoracic and abdominal cavities.
    D) creates positive intrathoracic pressure when it increases in size.

Answer 120

C

Question 121

33. Which of the following statements regarding diaphragmatic injury is correct?
    A) During the latent phase of a diaphragmatic injury, abdominal contents herniate through the defect, cutting off their blood supply.
    B) The spleen provides significant protection to the diaphragm on the left side, resulting in a higher incidence of right-sided diaphragmatic injuries.
    C) Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side.
    D) Once the diaphragm has been injured, the healing process is facilitated by the natural pressure differences between the abdominal and thoracic cavities.

Answer 121

C

Question 122

56. Management of a diaphragmatic injury focuses on:
    A) maintaining adequate oxygenation and ventilation, and rapid transport.
    B) inserting a nasogastric tube to decompress the gastrointestinal organs.
    C) applying the pneumatic antishock garment to stabilize the diaphragm.
    D) intubation and hyperventilation with 100% supplemental oxygen.

Answer 122

A

Question 123

65. A robbery suspect was shot once in the left anterior chest by law enforcement personnel when he pulled a gun on them. The patient is exhibiting obvious signs of shock, is in significant respiratory distress, and is coughing up blood. Further assessment reveals collapsed jugular veins and absent breath sounds over the left hemithorax. After covering the gunshot wound with the appropriate dressing, you should:
    A) perform a needle thoracentesis to the left side of the chest, initiate rapid transport, and administer 20-mL/kg fluid boluses en route.
    B) administer 100% oxygen, administer 1 to 2 L of normal saline, and transport to a trauma center for an emergency pericardiocentesis.
    C) provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.
    D) ventilate the patient with a demand valve, transport to a trauma center, and run two large-bore IV lines wide open while en route to the hospital.

Answer 123

C

Question 124

28. Which of the following statements regarding a pericardial tamponade is correct?
    A) Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
    B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
    C) Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
    D) The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.

Answer 124

B

Question 125

53.  You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and:
A)  loud heart tones.
B)  respiratory distress.
C)  a bounding pulse.
D)  normal lung sounds.

Answer 125

D

Question 126

16.  Anemia would result from all of the following conditions, EXCEPT:
A)  acute blood loss.
B)  an increase in iron.
C)  chronic hemorrhage.
D)  erythrocyte hemolysis.

Answer 126

B

Question 127

17. Anemia resulting from an autoimmune disorder occurs when:
    A) the body’s red blood cells destroy certain white blood cells.
    B) a patient receives blood of a type different than his or her own.
    C) hemoglobin becomes desaturated due to a massive infection.
    D) red blood cells are destroyed by the body’s own antibodies.

Answer 127

D

Question 128

28. 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.

Answer 128

C

Question 129

35. 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.

Answer 129

B

Question 130

34. You receive a call to a residence for a patient who is “sick.” Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should:
    A) notify her husband, explain the situation to him, and advise him that you will be transporting his wife to the hospital.
    B) advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.
    C) tell her that her condition is critical and that you are legally required to transport her to the closest appropriate medical facility.
    D) ask her to sign a refusal of EMS transport form, have a neighbor sit with her until her husband gets home, and then return to service.

Answer 130

B

Question 131

27.  Patients with type A hemophilia:
A)  have a low platelet count.
B)  require infusions of factor IX.
C)  bleed due to thrombocytopenia.
D)  have a deficiency of factor VIII.

Answer 131

D

Question 132

35. Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by:
    A) prolonged compensatory hyperventilation.
    B) decreased fluid intake secondary to hyperglycemia.
    C) hyperglycemia-induced osmotic diuresis and vomiting.
    D) the loss of key electrolytes such as sodium and potassium.

Answer 132

C

Question 133

37.  A patient with diabetic ketoacidosis experiences polydipsia as a result of:
A)  hyperglycemia.
B)  dehydration.
C)  metabolic acidosis.
D)  inefficient nutrient utilization.

Answer 133

B

Question 134

39. Patients with hyperosmolar hyperglycemic nonketotic coma:
    A) present with severe dehydration and neurologic deficits.
    B) experience more severe acidosis than patients with diabetic ketoacidosis.
    C) typically require prehospital sodium bicarbonate therapy.
    D) most commonly have a history of type 1 diabetes mellitus.

Answer 134

A

Question 135

56. A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man’s wife, he has had a fever and flu-like symptoms for the past few days. She further tells you that he has “stuck to his diet” as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads “high.” This patient is MOST likely:
    A) producing ketones due to fat metabolism.
    B) experiencing hyperosmolar nonketotic coma.
    C) significantly acidotic and requires bicarbonate.
    D) hyperglycemic secondary to being dehydrated.

Answer 135

B

Question 136

6.  The primary anatomic link between the endocrine system and the nervous system is/are the:
A)  pancreas.
B)  adrenal glands.
C)  hypothalamus.
D)  adrenal cortex.

Answer 136

C

Question 137

29.  The clinical presentation of a hypoglycemic patient would MOST likely resemble that of a patient with:
A)  classic heatstroke.
B)  an opiate overdose.
C)  alcohol intoxication.
D)  a hemorrhagic stroke.

Answer 137

C

Question 138

13.  The adrenal medulla secretes norepinephrine following stimulation from the:
A)  brainstem.
B)  diencephalon.
C)  hypothalamus.
D)  pituitary gland.

Answer 138

C

Question 139

33.  Which of the following assessment findings or techniques would prove MOST useful when determining the extent of internal volume loss?
A)  Resting blood pressure
B)  Temperature of the skin
C)  Duration of the illness
D)  Orthostatic vital signs

Answer 139

D

Question 140

52. A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should:
    A) assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus.
    B) perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer’s boluses to maintain a systolic blood pressure of at least 90 mm Hg.
    C) turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion.
    D) suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted.

Answer 140

C

Question 141

44.  Blood that has been digested by stomach acids manifests as:
A)  hematochezia.
B)  bright red vomitus.
C)  gray-colored stool.
D)  coffee-ground emesis.

Answer 141

D

Question 142

61. 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.

Answer 142

B

Question 143

36. When a patient’s leg is entrapped under a crushing object for a prolonged period of time, toxic metabolic waste products are released into the systemic circulation:
    A) and result in low serum potassium levels.
    B) after the patient’s leg is freed from entrapment.
    C) after the leg has been entrapped for 2 hours.
    D) only if the renal system is functioning properly.

Answer 143

B

Question 144

45. The use of wet dressings in the field is limited because:
    A) their use may result in severe hypothermia.
    B) they are of no value in providing pain relief.
    C) their sterility cannot be maintained in the field.
    D) they provide a medium for pathogens to grow.

Answer 144

D

Question 145

63. You have dressed and bandaged a laceration to the arm of a 16-year-old woman and are transporting her to the hospital. En route, the patient complains that her fingers are tingling. You touch her hand and note that it is cool. You should:
    A) readjust the bandage if needed and reassess distal neurovascular function.
    B) conclude that the laceration has probably severed a major nerve in her arm.
    C) elevate her arm, apply an icepack over the bandage, and reassess her hand.
    D) contact the receiving facility and have them place a neurosurgeon on standby.

Answer 145

A

Question 146

49. You should splint an open soft-tissue injury to an extremity because:
    A) most patients do not keep the extremity still when asked to do so.
    B) most open soft-tissue injuries are associated with a fracture.
    C) splinting is an excellent means of providing relief from pain.
    D) motion of the extremity may disrupt the blood-clotting process.

Answer 146

D