Phase 3 Final Review

Question 1

127. The administration of dopamine or any other vasopressor drug requires:
     A) online medical control approval.
     B) careful titration and blood pressure monitoring.
     C) an electromechanical infusion pump.
     D) concomitant crystalloid fluid boluses.

Answer 1

B

Question 2

269. A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should:
     A) start an IV line, administer 5 mg of midazolam, intubate the patient’s trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital.
     B) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.
     C) place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure.
     D) elevate the patient’s legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

Answer 2

B

Question 3

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 3

C

Question 4

29. Which of the following statements regarding the SA node is correct?
    A) The SA node is the dominant cardiac pacemaker in healthy patients.
    B) SA nodal ischemia occurs when the left coronary artery is occluded.
    C) The SA node is located in the superior aspect of the right ventricle.
    D) Impulses generated by the SA node travel through the right atrium only.

Answer 4

A

Question 5

28.  The area of conduction tissue in which electrical activity arises at any given time is called the:
A)  myocyte.
B)  pacemaker.
C)  sinus node.
D)  bundle of His.

Answer 5

B

Question 6

31.  An electrical impulse is slightly delayed at the AV node so that the:
A)  bundle of His can depolarize fully.
B)  ventricles can contract completely.
C)  primary cardiac pacemaker can reset.
D)  atria can empty into the ventricles.

Answer 6

D

Question 7

169.  In sinus bradycardia, the:
A)  heart rate is less than 70 beats/min.
B)  pacemaker site is the SA node.
C)  QRS complexes are often wide.
D)  P waves are consistently upright.

Answer 7

B

Question 8

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 8

B

Question 9

211. Which of the following statements regarding asystole is correct?
     A) A disconnected ECG lead often mimics asystole.
     B) Defibrillation is indicated in some cases of asystole.
     C) Most cases of asystole present with P waves only.
     D) Asystole is the result of prolonged myocardial hypoxia

Answer 9

D

Question 10

219.  The presence of a J wave (Osborn wave) on the ECG is an indicator of:
A)  a delta wave.
B)  hyponatremia.
C)  hypercalcemia.
D)  hypothermia.

Answer 10

D

Question 11

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

Answer 11

B

Question 12

59. A pure alpha agent:
    A) causes marked vasoconstriction.
    B) has a direct effect on the heart rate.
    C) causes moderate bronchoconstriction.
    D) decreases the blood pressure by dilating the vessels.

Answer 12

A

Question 13

68.  Common complaints in patients experiencing an acute coronary syndrome include all of the following, EXCEPT:
A)  fatigue.
B)  headache.
C)  chest pain.
D)  palpitations.

Answer 13

B

Question 14

70. Paroxysmal nocturnal dyspnea is defined as:
    A) dyspnea that is brought on by excessive movement during sleep.
    B) sitting upright in a chair in order to facilitate effective breathing.
    C) the inability to function at night due to severe difficulty breathing.
    D) acute shortness of breath that suddenly awakens a person from sleep.

Answer 14

D

Question 15

93. In contrast to stable angina, unstable angina:
    A) occurs following periods of strenuous exertion.
    B) often awakens the patient from his or her sleep.
    C) indicates that myocardial necrosis has occurred.
    D) is less frequent but is associated with more pain.

Answer 15

B

Question 16

92. Stable angina:
    A) typically subsides within 10 to 15 minutes.
    B) occurs after a predictable amount of exertion.
    C) usually requires both rest and nitroglycerin to subside.
    D) is characterized by sharp chest pain rather than pressure.

Answer 16

B

Question 17

96. Cardiac arrhythmias following an acute myocardial infarction:
    A) tend to originate from ischemic areas around the infarction.
    B) typically manifest as atrial fibrillation or atrial tachycardia.
    C) generally originate from the center of the infarcted tissues.
    D) are uncommon within the first 24 hours after the infarction.

Answer 17

A

Question 18

272. You are assessing the 12-lead tracing of a 40-year-old man with chest pain and note ST-segment elevation in leads II, III, and aVF. Lead V4R shows 2-mm ST-segment elevation. The patient’s blood pressure is 88/58 mm Hg, and his heart rate is 72 beats/min and regular. He denies any significant past medical history but is allergic to salicylates. After placing the patient on oxygen and starting an IV line of normal saline, you should:
     A) administer up to 325 mg of baby aspirin.
     B) give 2-mg increments of morphine sulfate.
     C) start a dopamine infusion at 2 µg/kg/min.
     D) give crystalloid boluses to increase preload.

Answer 18

D

Question 19

103. What is the MOST appropriate sequence of treatment for a patient with a suspected acute myocardial infarction?
     A) Oxygen, aspirin, nitroglycerin, morphine
     B) Oxygen, nitroglycerin, aspirin, morphine
     C) Aspirin, nitroglycerin, oxygen, morphine
     D) Morphine, oxygen, aspirin, nitroglycerin

Answer 19

A

Question 20

105. When administering aspirin to a patient with an acute coronary syndrome, you should:
     A) first check to make sure the patient is not severely hypertensive.
     B) administer half the usual dose if the patient has a history of stroke.
     C) have him or her chew and swallow 160 to 325 mg of baby aspirin.
     D) give up to 325 mg of enteric-coated aspirin for the patient to swallow.

Answer 20

C

Question 21

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 21

C

Question 22

116. In a patient with left heart failure and pulmonary edema:
     A) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood.
     B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart.
     C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.
     D) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.

Answer 22

C

Question 23

135. Which of the following mechanisms causes hypertension?
     A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity.
     B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion.
     C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
     D) Heart rate that is persistently above 80 beats/min causes an increase in cardiac output and a resultant increase in blood pressure.

Answer 23

C

Question 24

138. A hypertensive emergency is MOST accurately defined as:
     A) an increase in the blood pressure due to medication noncompliance.
     B) an elevated blood pressure that is accompanied by a frontal headache.
     C) a blood pressure greater than 170/90 mm Hg with a severe nosebleed.
     D) an acute elevation in blood pressure with signs of end-organ damage

Answer 24

D

Question 25

141.  It is MOST important to evaluate a cardiac arrhythmia in the context of the:
A)  patient's heart rate.
B)  patient's medical history.
C)  patient's overall condition.
D)  width of the QRS complex.

Answer 25

C

Question 26

148. According to the Einthoven triangle, lead II is assessed by placing the:
     A) negative lead on the left arm and the positive lead on the left leg.
     B) positive lead on the left leg and the negative lead on the right arm.
     C) positive lead on the left arm and the negative lead on the right arm.
     D) negative lead on the right arm and the positive lead on the left leg.

Answer 26

D

Question 27

171. Which of the following statements regarding sinus bradycardia is correct?
     A) Treatment focuses on the patient’s tolerance to the bradycardia.
     B) Symptomatic bradycardia is often caused by a decreased atrial rate.
     C) Sinus bradycardia often requires multiple doses of atropine to correct it.
     D) Sinus bradycardia is caused by decreased vagal tone in most patients.

Answer 27

A

Question 28

287. You are called to a local gym for a patient with nausea. Your patient, a 29-year-old man, tells you that he thinks he has a “stomach bug.” He is conscious and alert, denies chest pain or shortness of breath, and tells you that he has been nauseated for the last 4 hours but has not vomited. His blood pressure is 124/66 mm Hg, pulse is 46 beats/min and strong, respirations are 20 breaths/min and regular, and room air oxygen saturation is 99%. The cardiac monitor reveals a sinus bradycardia. You should:
     A) give 100% oxygen, start two large-bore IV lines, administer 20 mL/kg normal saline boluses, and transport.
     B) administer oxygen via nasal cannula, start an IV of normal saline, consider administering an antiemetic, and transport.
     C) advise him that he can probably drive himself to the emergency department or schedule an appointment with his physician.
     D) apply high-flow oxygen via nonrebreathing mask, start an IV line, administer 0.5 mg of atropine, and transport to the closest facility.

Answer 28

B

Question 29

173.  The treatment for sinus tachycardia should focus on:
A)  decreasing the heart rate.
B)  correcting the underlying cause.
C)  administering IV fluid boluses.
D)  relieving pain and anxiety.

Answer 29

B

Question 30

269. A woman found her 48-year-old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II, and a 12-lead ECG reveals evidence of myocardial injury. You should:
     A) start an IV line, administer 5 mg of midazolam, intubate the patient’s trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 µg/kg/min en route to the hospital.
     B) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100- to 200-mL saline bolus, and start an infusion of dopamine.
     C) place the patient in a semi-Fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 mL/kg fluid boluses to improve his blood pressure.
     D) elevate the patient’s legs, ventilate him with a bag-mask device, begin transport, establish vascular access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

Answer 30

B

Question 31

176.  Which of the following differentiates an atrial rhythm from a sinus rhythm?
A)  Tachycardia
B)  Profound bradycardia
C)  Dissociated P waves
D)  Varying shapes in P waves

Answer 31

D

Question 32

106. Which of the following situations would contraindicate the administration of nitroglycerin?
     A) Hypersensitivity to salicylates
     B) Systolic BP less than 110 mm Hg
     C) Tadalafil use within the last 24 hours
     D) Use of Plavix within the last 12 hours

Answer 32

C

Question 33

265. Shortly after administering a second dose of 4 mg of morphine to a 49-year-old woman who is experiencing chest pain, the patient’s level of consciousness markedly decreases. Further assessment reveals that she is hypotensive, bradycardic, and hypoventilating. You should:
     A) administer 0.5 mg of atropine and reassess her.
     B) assist her ventilations and administer naloxone.
     C) elevate her legs and give a 500-mL saline bolus.
     D) immediately intubate her to protect her airway.

Answer 33

B

Question 34

267. A 67-year-old man presents with severe dyspnea, coarse crackles to all lung fields, and anxiety. He has a history of several myocardial infarctions and hypertension. Which of the following interventions will have the MOST immediate and positive effect?
     A) Positive end-expiratory pressure ventilation
     B) IV or IO access and 20 to 40 mg of furosemide
     C) 0.4 mg sublingual nitroglycerin, up to three doses
     D) Supplemental oxygen via nonrebreathing mask

Answer 34

A

Question 35

241. 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.

Answer 35

D

Question 36

242.  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.

Answer 36

C

Question 37

246.  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.

Answer 37

A

Question 38

254.  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

Answer 38

B

Question 39

273. You and your partner arrive at the scene of an unresponsive male patient. Your assessment reveals that he is pulseless and apneic. The patient’s wife tells you that he collapsed about 10 minutes ago. You should:
     A) ask the patient’s wife if her husband has a living will.
     B) apply the defibrillator pads and assess his cardiac rhythm.
     C) initiate CPR as your partner applies the defibrillator pads.
     D) begin CPR with a compression to ventilation ratio of 15:2.

Answer 39

C

Question 40

274.  You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:
A)  attempt cardiac pacing.
B)  check the carotid pulse.
C)  assess breathing effort.
D)  resume CPR at once.

Answer 40

D

Question 41

275. Following 2 minutes of CPR, you reassess an unresponsive man’s pulse and cardiac rhythm. He remains pulseless and the monitor displays coarse ventricular fibrillation. You should:
     A) continue CPR and intubate his trachea.
     B) resume CPR as the defibrillator is charging.
     C) perform 2 minutes of CPR and then reassess.
     D) continue CPR and establish IV or IO access.

Answer 41

B

Question 42

280. You have applied the cardiac monitor to your 66-year-old male cardiac arrest patient and see what appears to be asystole. You should:
     A) check for a pulse for a maximum of 10 seconds.
     B) resume CPR and place an advanced airway device.
     C) continue CPR and reassess the rhythm in 2 minutes.
     D) assess another lead or increase the gain sensitivity.

Answer 42

D

Question 43

107.  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.

Answer 43

C

Question 44

119. In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes:
     A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate.
     B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication.
     C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents.
     D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.

Answer 44

D

Question 45

290. You receive a call to a residence for a 44-year-old man who is “ill.” The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient’s vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is:
     A) hypocalcemic.
     B) hypernatremic.
     C) hyperkalemic.
     D) having an acute myocardial infarction.

Answer 45

C

Question 46

167.  The MOST common cause of cardiac arrest in adult patients is:
A)  acute myocardial infarction.
B)  electrocution.
C)  a dysrhythmia.
D)  respiratory failure.

Answer 46

C

Question 47

170.  Common causes of bradycardia include:
A)  exercise.
B)  hyperthermia.
C)  amphetamines.
D)  beta blocker use.

Answer 47

D

Question 48

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 48

B

Question 49

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 49

B

Question 50

99.  Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction?
A)  49-year-old obese man
B)  58-year-old diabetic woman
C)  60-year-old man with anxiety
D)  71-year-old woman with hypertension

Answer 50

B

Question 51

104. Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct?
     A) Evidence has shown that high (greater than 90%) concentrations of oxygen reduce mortality.
     B) In order to prevent hypoxic injury, do not give any patient with an acute myocardial infarction more than 2 L/min of oxygen.
     C) Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%.
     D) Any patient experiencing an acute myocardial infarction should receive high-flow oxygen

Answer 51

C

Question 52

94. Which of the following MOST accurately describes an acute myocardial infarction?
    A) Death of the myocardium secondary to spasm of a major coronary artery
    B) Injury to a portion of the heart muscle secondary to atherosclerotic disease
    C) Damage to the left ventricle following occlusion of the left coronary artery
    D) Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

Answer 52

D

Question 53

94. Which of the following MOST accurately describes an acute myocardial infarction?
    A) Death of the myocardium secondary to spasm of a major coronary artery
    B) Injury to a portion of the heart muscle secondary to atherosclerotic disease
    C) Damage to the left ventricle following occlusion of the left coronary artery
    D) Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

Answer 53

D

Question 54

71. A patient with orthopnea:
    A) experiences dyspnea during periods of exertion.
    B) prefers a semisitting position to facilitate breathing.
    C) experiences worsened dyspnea while lying down.
    D) sleeps in a recliner due to severe right heart failure.

Answer 54

C

Question 55

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 55

B

Question 56

119. In addition to supplemental oxygen, treatment of a patient with left-sided heart failure includes:
     A) a saline lock, a selective beta-2 adrenergic medication, and bicarbonate.
     B) an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication.
     C) a saline lock, fentanyl, and intubation facilitated by pharmacologic agents.
     D) an IV of normal saline to keep the vein open, nitroglycerin, and morphine.

Answer 56

D

Question 57

123.  Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of:
A)  jugular venous distention.
B)  a narrowing pulse pressure.
C)  clear and equal breath sounds.
D)  alterations in the QRS amplitude.

Answer 57

C

Question 58

90. Acute coronary syndrome is a term used to describe:
    A) acute chest pressure or discomfort that subsides with rest or nitroglycerin.
    B) a clinical condition in which patients experience chest pain during exertion.
    C) any group of clinical symptoms consistent with acute myocardial ischemia.
    D) a sudden cardiac rhythm disturbance that causes a decrease in cardiac output

Answer 58

C

Question 59

134. Hypertension is present when the blood pressure:
     A) increases by 20 mm Hg above a person’s normal blood pressure.
     B) is consistently greater than 140/90 mm Hg while at rest.
     C) is above 160 mm Hg systolic during strenuous exertion.
     D) rises acutely during an emotionally stressful situation.

Answer 59

B

Question 60

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

Answer 60

D

Question 61

124. Cardiogenic shock occurs when:
     A) blood backs up into the pulmonary circulation.
     B) more than 40% of the left ventricle has infarcted.
     C) left ventricular ejection fraction is less than 50%.
     D) any condition causes an increase in atrial preload.

Answer 61

B

Question 62

129.  In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm:
A)  often waxes and wanes.
B)  gradually becomes severe.
C)  is maximal from the onset.
D)  is preceded by other symptoms.

Answer 62

C

Question 63

15. Which of the following statements regarding the right side of the heart is correct?
    A) It receives blood exclusively from the venae cavae.
    B) The right side of the heart is a low-pressure pump.
    C) It pumps against the high resistance of the pulmonary circulation.
    D) The right side of the heart pumps blood through the pulmonary veins.

Answer 63

B

Question 64

16. In contrast to the right side of the heart, the left side of the heart:
    A) drives blood out of the heart against the relatively high resistance of the systemic circulation.
    B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs.
    C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.
    D) drives blood out of the heart against the relatively low resistance of the pulmonary circulation.

Answer 64

A

Question 65

5. The capillary “washout” phase occurs when:
   A) anaerobic metabolism causes the postcapillary sphincters to remain constricted, causing capillary fluid engorgement.
   B) postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells.
   C) cellular ischemia causes the postcapillary sphincters to remain constricted, causing the capillaries to become engorged with fluid.
   D) precapillary sphincters constrict in response to the buildup of lactic acid, vasomotor failure, and increased carbon dioxide.

Answer 65

B

Question 66

21. Which of the following statements regarding gas exchange in the lungs is correct?
    A) There are more carbon dioxide molecules in the blood than in inhaled air.
    B) Oxygen molecules move from the alveoli into the blood by diffusion.
    C) There are more oxygen molecules in the blood than in the alveoli.
    D) Carbon dioxide molecules move from the alveoli into the blood by diffusion.

Answer 66

B

Question 67

13.  Tissue perfusion is primarily a function of the:
A)  endocrine system.
B)  cardiovascular system.
C)  respiratory system.
D)  peripheral nervous system.

Answer 67

B

Question 68

93.  Treatment for pediatric asystole includes:
A)  atropine.
B)  epinephrine.
C)  cardiac pacing.
D)  hyperventilation.

Answer 68

B

Question 69

70. You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is MOST correct?
    A) You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg.
    B) Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure.
    C) This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
    D) This patient’s vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.

Answer 69

C

Question 70

46. In contrast to a 30-year-old man, if a 70-year-old were to consume an excessive amount of alcohol:
    A) he would experience a lower blood alcohol concentration secondary to a decrease in total body water.
    B) the alcohol would be eliminated from his body much faster unless he is taking an antihypertensive drug.
    C) it would take longer for him to develop alcohol toxicity secondary to decreased metabolism in the liver.
    D) he would experience a higher blood alcohol concentration due to decreases in body mass and total body water.

Answer 70

D

Question 71

40.  Resting tremor of an extremity and bradykinesia are associated with:
A)  Vascular dementia.
B)  Focal motor seizures.
C)  Parkinson disease.
D)  Alzheimer disease.

Answer 71

C

Question 72

65. After obtaining an elderly patient’s chief complaint, gathering additional information about the history of present illness would MOST likely be complicated because:
    A) the patient may ask you to repeat your questions.
    B) chronic problems may affect the acute problem.
    C) most elderly patients take numerous medications.
    D) the aging process causes difficulty in understanding.

Answer 72

B

Question 73

18.  When assessing an older person, you should remember that it is common for him or her to:
A)  slur his or her words.
B)  present with hemiparesis.
C)  respond slowly to questions.
D)  not understand your questions.

Answer 73

C

Question 74

13.  The leading cause of death from infection in Americans older than 65 years of age is:
A)  nephritis.
B)  pneumonia.
C)  encephalitis.
D)  meningitis.

Answer 74

B

Question 75

58.  Considering the physiologic changes that occur with age, which of the following interventions would pose the GREATEST potential for further harm when caring for an elderly patient with a severe burn that is complicated by a spinal injury?
A)  Intubation
B)  Fluid replacement
C)  Thermal management
D)  Spinal immobilization

Answer 75

B

Question 76

16.  Aging brings a widespread decrease in bone mass, especially:
A)  in postmenopausal women.
B)  in men over 50 years of age.
C)  if the person falls frequently.
D)  in the presence of hypertension.

Answer 76

A

Question 77

36.  Type II osteoporosis tends to progress more rapidly in:
A)  postmenopausal women.
B)  the lower extremity bones.
C)  males over 60 years of age.
D)  patients with excess calcium.

Answer 77

A

Question 78

64. When interviewing an elderly patient with a medical complaint, you should avoid:
    A) detailed explanations of what you are doing to him or her.
    B) looking directly at the patient as this may upset him or her.
    C) speaking to the family member first rather than the patient.
    D) talking about the patient in the absence of family members.

Answer 78

C

Question 79

63. The medical assessment of an elderly patient can be complex because:
    A) he or she often makes up symptoms that do not exist.
    B) caregivers typically prefer that you speak with them.
    C) he or she often has more than one medical condition.
    D) most elderly patients are hearing or visually impaired.

Answer 79

C

Question 80

54. Elderly people are more susceptible to intracranial bleeding because of:
    A) a marked increase in brain size.
    B) depletion of cerebrospinal fluid.
    C) enlargement of the subdural space.
    D) constriction of the cerebral vessels.

Answer 80

C

Question 81

52.  Which of the following is an extrinsic cause of falls in the elderly?
A)  Postural hypotension
B)  Dizziness or syncope
C)  A pathologic fracture
D)  An uneven sidewalk

Answer 81

D

Question 82

50.  Which of the following is NOT a predisposing risk factor for trauma in the elderly?
A)  Slower reflexes
B)  Decreased body water
C)  Equilibrium disorders
D)  Overall decrease in agility

Answer 82

B

Question 83

47. Untreated depression in people over 65 years of age:
    A) causes homicidal behavior in as much as 50% of this age group.
    B) is often recognized by the patient, who subsequently asks for help.
    C) is associated with a higher suicide rate than in any other age group.
    D) usually goes unrecognized because it is often mistaken for delirium.

Answer 83

C

Question 84

48.  Elderly \_\_\_\_\_\_\_\_\_ are at highest risk for suicide, and most often use \_\_\_\_\_\_\_\_\_\_\_ as their suicide method of choice.
A)  women, pills
B)  men, firearms
C)  women, knives
D)  men, hanging

Answer 84

B

Question 85

42. Polypharmacy is MOST accurately defined as:
    A) a harmful interaction when several drugs are taken together.
    B) the prescribing of multiple drugs to treat multiple conditions.
    C) unnecessarily prescribing numerous drugs to prevent a disease.
    D) the unintentional ingestion of multiple doses of the same drug.

Answer 85

B

Question 86

41. Adverse drug reactions in elderly people are the result of:
    A) partial digestion secondary to delayed gastric emptying.
    B) changes in body composition and an increase in body water.
    C) changes in drug metabolism due to diminished hepatic function.
    D) increased drug elimination due to decreased antidiuretic hormone.

Answer 86

C

Question 87

38. In contrast to delirium, dementia is:
    A) often caused by conditions such as poisonings and infection.
    B) an acute state of confusion that may last for up to 1 week.
    C) often reversible if the underlying cause is identified rapidly.
    D) a progressive disease that produces irreversible brain failure.

Answer 87

D

Question 88

28.  Which of the following conditions would MOST likely impair pulmonary function by limiting lung volume and maximal inspiratory pressure?
A)  Asthma
B)  Kyphosis
C)  Spondylosis
D)  Osteoporosis

Answer 88

B

Question 89

35.  Kyphosis is characterized by:
A)  cartilage degeneration.
B)  vertebral disc compression.
C)  a hunchback appearance.
D)  lateral curvature of the spine.

Answer 89

C

Question 90

27.  Which of the following cardiac dysrhythmias is associated with the highest risk of stroke?
A)  AV heart block
B)  Sinus tachycardia
C)  Junctional rhythm
D)  Atrial fibrillation

Answer 90

D

Question 91

19.  MOST age-related visual disturbances are the result of:
A)  diabetic retinopathy.
B)  cataracts or glaucoma.
C)  macular degeneration.
D)  retinal artery occlusion.

Answer 91

B

Question 92

15.  Therapeutic doses of certain drugs may reach toxic levels in older people due to deterioration of the:
A)  liver.
B)  spleen.
C)  gallbladder.
D)  intestinal tract.

Answer 92

A

Question 93

2. Following retirement, many older people:
   A) experience a rapid decline in their underlying health and become incapacitated within 12 months.
   B) often experience an improvement in their overall health because the stress of working has been eliminated.
   C) return to work within 6 months because their retirement pension does not support them adequately.
   D) commonly experience decreased self-esteem because they no longer feel useful or productive in society.

Answer 93

D

Question 94

12. When elderly patients are prescribed medications, the risk for drug toxicity increases because of:
    A) an increase in the glomerular filtration rate.
    B) age-related changes in hepatic enzyme systems.
    C) the presence of chronic conditions, such as diabetes.
    D) an increase in the production of antidiuretic hormone.

Answer 94

B

Question 95

4. Which of the following statements regarding aging is correct?
   A) Although aging causes various anatomic changes, physiologic functions generally remain intact.
   B) Health care providers may attribute genuine disease symptoms to age, resulting in inadequate care.
   C) All of the tissues and organs in the human body undergo the effects of aging at the same rate.
   D) Health care providers typically recognize the normal changes of aging and tend not to render unnecessary care.

Answer 95

B

Question 96

8.  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

Answer 96

B

Question 97

88. 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.

Answer 97

B

Question 98

42. 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.

Answer 98

C

Question 99

45. The purpose of the wafer that is included in an ostomy kit is to:
    A) protect the skin from irritation.
    B) seal the ostomy bag to the skin.
    C) maintain sterility of the ostomy bag.
    D) cover the stoma until the bag is attached.

Answer 99

A

Question 100

86. Multiple sclerosis is:
    A) a chronic central nervous system disease caused by destruction of the myelin and nerve axons within the brain and spinal cord.
    B) most often secondary to a diffuse axonal brain injury and causes neuromuscular disability due to stretching or tearing of the axons.
    C) a progressive disease in 90% of patients who have it, and is characterized by unrelenting pain, weakness, and visual impairment.
    D) chronic in most cases, and is the result of degenerative changes in the muscle that results in muscle atrophy and decreased bone density.

Answer 100

A

Question 101

10. Which of the following statements regarding Mongolian spots is correct?
    A) They resemble bruises and are found most commonly on the back and buttocks.
    B) They are abnormal bruising patterns on the back and are an indicator of abuse.
    C) They indicate abnormal bleeding and are associated with a high mortality rate.
    D) They are bruiselike patterns that most often appear in severely premature infants.

Answer 101

A

Question 102

60.  The outflow catheter of a cerebrospinal fluid shunt is MOST commonly placed into the patient's:
A)  right atrium.
B)  pulmonary cavity.
C)  peritoneal cavity.
D)  left ventricle.

Answer 102

C

Question 103

82. 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.

Answer 103

B

Question 104

72. Sensorineural hearing loss is caused by:
    A) decreased sound uptake through tiny hairs within the cochlea.
    B) an inability of sound to travel from the outer ear to the inner ear.
    C) destruction of the acoustic nerve from the use of certain drugs.
    D) failure of the brainstem to transmit messages via the acoustic nerve.

Answer 104

A

Question 105

61. Which of the following clinical presentations is MOST consistent with a malfunctioning cerebrospinal fluid shunt?
    A) Tachycardia, tinnitus, and a narrowing pulse pressure
    B) Visual disturbances, headache, and altered mental status
    C) Hypotension, sudden loss of hearing, and severe nausea
    D) Tachypnea, fluid drainage from the ears, and restlessness

Answer 105

B

Question 106

53.  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.

Answer 106

B

Question 107

50. Unlike the insertion of an indwelling urinary catheter, insertion of an intermittent (straight) urinary catheter:
    A) is necessary when the patient is bedridden for prolonged periods.
    B) does not involve inflation of a balloon to hold the catheter in place.
    C) is associated with a greater risk for damage to the urinary sphincter.
    D) generally does not require catheter lubrication with a water-soluble gel.

Answer 107

B

Question 108

43. An unresponsive woman with diabetes is wearing an insulin pump. Her blood glucose level is 24 mg/dL. You should:
    A) give a 20-mL/kg crystalloid bolus.
    B) administer 0.1 mg of glucagon IM.
    C) give her half the usual dose of dextrose.
    D) ensure that the insulin pump is turned off.

Answer 108

D

Question 109

36. You respond to a residence where an infant’s apnea monitor has alarmed several times within the last 30 minutes. When you assess the infant, you note that she is alert, she has strong peripheral pulses, and her skin is pink, warm, and dry. You should:
    A) expect that her oxygen saturation will be below 90%.
    B) transport the infant and monitor her breathing en route.
    C) administer blow-by oxygen to the infant and reassess her.
    D) advise the parents to contact the apnea monitor manufacturer.

Answer 109

B

Question 110

29.  Which of the following interventions is especially important when caring for a patient with a tracheostomy tube?
A)  Suctioning
B)  Mask ventilation
C)  Hyperventilation
D)  Head positioning

Answer 110

A

Question 111

32. Several attempts to clear a plugged tracheostomy tube with suction have failed. The patient, who is on a mechanical ventilator, has a pulse rate of 150 beats/min and is making exaggerated attempts to breathe. You should:
    A) remove the tracheostomy tube, place a mask over the stoma, and ventilate with a bag-mask device.
    B) deflate the cuff of the tracheostomy tube and ventilate the patient in the usual fashion with a bag-mask device.
    C) administer high-flow oxygen via nonrebreathing mask as you prepare to replace the tracheostomy tube.
    D) provide free-flow oxygen as you remove the tracheostomy tube and replace it with a similarly sized endotracheal tube.

Answer 111

B

Question 112

24.  Bag-mask ventilation of the obese patient would MOST likely be ineffective when the patient is:
A)  supine.
B)  apneic.
C)  semisitting.
D)  in reverse Trendelenburg.

Answer 112

A

Question 113

23.  Which of the following factors complicates airway management in an obese patient?
A)  Larger upper airway
B)  Limited neck mobility
C)  Smaller patient head size
D)  Proportionately small tongue

Answer 113

B

Question 114

20. The purpose of hospice care is to:
    A) render quality care to patients with a debilitating but temporary disease.
    B) provide quality end-of-life care through pain and symptom management.
    C) restore a person to his or her maximum physical and emotional potential.
    D) render around-the-clock intensive care to prevent cardiopulmonary arrest.

Answer 114

B

Question 115

6.  A man leaves his 4-year-old child home alone while he plays golf with his friends. This is an example of:
A)  assault.
B)  neglect.
C)  abandonment.
D)  emotional abuse.

Answer 115

C

Question 116

87. Muscular dystrophy can be defined as a(n):
    A) autoimmune disease in which the skeletal muscles are rapidly destroyed.
    B) nonprogressive neuromuscular disorder caused by fetal brain hypoxia.
    C) birth defect caused by improper development of the fetal neural tube.
    D) genetic disease that causes a slow, progressive degeneration of muscle fibers.

Answer 116

D

Question 117

1. When determining the optimal method to communicate with, assess, treat, and transport a patient with a special health care challenge, the paramedic should:
   A) routinely call medical control before talking to a caregiver.
   B) demonstrate confidence and enlist the expertise of the patient.
   C) recall that caregivers are often upset and therefore unreliable.
   D) remain professional and obtain initial information from a caregiver.

Answer 117

B

Question 118

18. When a patient is receiving palliative care, medical care:
    A) ceases, and the disease process is allowed to continue until the point of death.
    B) ceases, and efforts focus on relieving pain until the point at which the patient dies.
    C) continues, although aggressive, invasive, and uncomfortable interventions cease.
    D) continues, and only minimally invasive procedures are performed to prolong life.

Answer 118

C

Question 119

13. When caring for a patient with suspected abuse or neglect, your FIRST priority should be to:
    A) summon law enforcement personnel to the scene.
    B) provide an immediate assessment of the patient.
    C) remove the patient from the abusive environment.
    D) take deliberate action to ensure your own safety.

Answer 119

D

Question 120

2.  Approximately 70% of all child abuse or neglect cases involve:
A)  females over 8 years of age.
B)  an otherwise healthy child.
C)  males under 6 years of age.
D)  substance abuse by the perpetrator.

Answer 120

D

Question 121

17. When triaging patients at the scene of an explosion, you should be especially aware of the fact that:
    A) the terrorist may still be present at the scene.
    B) a secondary explosive device may be present.
    C) wind direction and speed may change quickly.
    D) many explosions involve radioactive material.

Answer 121

B

Question 122

4.  All of the following are examples of domestic terrorism, EXCEPT the:
A)  Oklahoma City bombing.
B)  Centennial Park bombing.
C)  World Trade Center attack.
D)  Atlanta abortion clinic attacks.

Answer 122

C