unit 1 exam

Question 1

The treatment for cardiogenic shock is generally focused on:
Select one:
a. infusing enough IV fluid to maintain a systolic BP of 110 mm Hg.
b. strengthening cardiac contractility without increasing the heart rate.
c. increasing the heart rate to improve cardiac output and cerebral perfusion.
d. administering nitroglycerin to improve perfusion to the myocardium.

Answer 1

b. strengthening cardiac contractility without increasing the heart rate.

Question 2

A morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?
Select one:
a. Begin assisting his ventilations.
b. Assess his oxygen saturation level.
c. Administer a beta-2 agonist drug.
d. Sit him up or place him on his side.

Answer 2

d. Sit him up or place him on his side.

Question 3

Pickwickian syndrome is a condition in which respiratory compromise results from:
Select one:
a. extreme obesity.
b. pulmonary edema. 
c. cervical spine injury.
d. diaphragmatic rupture.

Answer 3

a. extreme obesity.

Question 4

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:
Select one:
a. diazepam, 5 mg.
b. promethazine, 25 mg.
c. diphenhydramine, 25 mg. 
d. ondansetron, 4 mg.

Answer 4

c. diphenhydramine, 25 mg.

Question 5

Which of the following statements regarding the right side of the heart is correct?
Select one:
a. It receives blood exclusively from the venae cavae.
b. The right side of the heart is a low-pressure system.
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 5

b. The right side of the heart is a low-pressure system.

Question 6

A person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has:
Select one:
a. pleurisy.
b. a pleural effusion.
c. a pneumothorax. 
d. acute pneumonia.

Answer 6

c. pneumothorax.

Question 7

An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a “water pill” and Vasotec for high blood pressure. You should:
Select one:
a. expect to hear crackles when you auscultate her lungs.
b. suspect acute right-sided heart failure and administer oxygen.
c. start an IV of normal saline and give her a 250-mL bolus.
d. conclude that she has been noncompliant with her diuretic.

Answer 7

b. suspect acute right-sided heart failure and administer oxygen.

Question 8

atients with a continuous-flow ventricular assist device:
Select one:
a. cannot receive epinephrine if they are bradycardic.
b. may not have a palpable pulse, despite adequate perfusion.
c. have a BP that is 20 to 30 mm Hg higher than it actually is.
d. should be defibrillated with a higher-than-normal energy setting.

Answer 8

b. may not have a palpable pulse, despite adequate perfusion.

Question 9

A 55-year-old female complains of severe vertigo, tinnitus, nausea, and a sense of fullness in her right ear. You should:
Select one:
a. administer an antiemetic and monitor her airway in case she vomits.
b. carefully inspect her ear with an otoscope and administer furosemide.
c. administer diphenhydramine to reduce any swelling in her inner ear.
d. keep her supine, administer crystalloid fluid boluses, and inspect her ear.

Answer 9

a. administer an antiemetic and monitor her airway in case she vomits.

Question 10

Residual corticosteroid in the pharynx following a metered-dose inhaler treatment can predispose the patient to:
Select one:
a. thrush. 
b. bleeding.
c. laryngospasm.
d. bronchospasm.

Answer 10

a. thrush.

Question 11

Cardiac tamponade can be differentiated from a tension pneumothorax by the presence of:
Select one:
a. equal breath sounds.
b. jugular venous distention. 
c. a narrowing pulse pressure.
d. alterations in the QRS amplitude.

Answer 11

a. equal breath sounds.

Question 12

You respond to the residence of a known heroin abuser. The patient, a 30-year-old man, is unconscious and unresponsive. He is hypoventilating, bradycardic, and hypotensive. Administration of 10 mg of naloxone has had no effect, and your transport time to the hospital is approximately 30 minutes. You should:
Select one:
a. check his blood glucose level as your partner prepares to intubate.
b. transport at once and administer additional naloxone while en route.
c. administer 25 g of 50% dextrose and reassess his level of consciousness.
d. hyperventilate him with high-flow oxygen to minimize tissue hypoxia.

Answer 12

a. check his blood glucose level as your partner prepares to intubate.

Question 13

Cor pulmonale is MOST often the result of:
Select one:
a. COPD.
b. acute MI.
c. stable angina.
d. hypertension.

Answer 13

a. COPD.

Question 14

A 34-year-old female states that she feels like she has a grain of sand in her eye. Assessment reveals that her eye and the surrounding area are red. Treatment for her should include:
Select one:
a. carefully assessing her eye for an object embedded in the globe and removing it if one is present.
b. instructing her to continue rapid eye blinking and administering analgesia as indicated.
c. gently rubbing the surface of the eye with a cotton-tipped applicator to remove the foreign body.
d. gently irrigating her eye and taping the affected eye closed to prevent it from drying out.

Answer 14

d. gently irrigating her eye and taping the affected eye closed to prevent it from dying out.

Question 15

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

Answer 15

b. Recent antitussive use

Question 16

CPAP is used to treat patients with sleep apnea by:
Select one:
a. improving patency of the lower airway through the use of positive-end expiratory pressure.
b. maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.
c. increasing the rate and depth of ventilation, thus improving minute volume and mitigating hypoxia.
d. delivering one pressure during the inspiratory phase and a different pressure during the expiratory phase.

Answer 16

b. maintaining stability of the posterior pharynx, thereby preventing upper airway obstruction.

Question 17

Abnormal neurologic signs that accompany hypertensive encephalopathy occur when:
Select one:
a. pressure in the brain causes transient dysfunction of the parietal lobe and cerebral vasodilation.
b. the mean arterial pressure exceeds 100 mm Hg and blood is forced from the brain and into the spinal cord.
c. neurons sustain permanent damage secondary to a single increase in blood pressure above 200/130 mm Hg.
d. pressure causes a breach in the blood-brain barrier and fluid leaks out, causing an increase in intracranial pressure.

Answer 17

d. pressure causes a breach in the blood-brain barrier and fluid leaks out, causing an increase in intracranial pressure.

Question 18

A 33-year-old woman had an apparent syncopal episode. According to her husband, she complained of dizziness shortly before the episode. He further states that he caught her before she fell to the ground. Upon your arrival, the patient is conscious but confused and is sitting in a chair. Her blood pressure is 90/60 mm Hg, pulse rate is 110 beats/min and weak, and respirations are 22 breaths/min and regular. Her blood glucose level is 74 mg/dL. The MOST likely cause of her syncopal episode is:
Select one:
a. a seizure.
b. dehydration. 
c. a vasovagal response.
d. acute hypoglycemia.

Answer 18

b. dehydration.

Question 19

A 56-year-old diabetic woman presents with numbness and tingling to both of her hands that have gradually intensified over the past few weeks. Your assessment reveals stable vital signs, adequate breathing, and a blood glucose level of 190 mg/dL. The cardiac monitor reveals a normal sinus rhythm. The patient tells you that she has eaten but has not taken her insulin yet. You should:
Select one:
a. provide supportive care and safely transport her to the hospital.
b. assist her with her prescribed insulin to lower her blood glucose.
c. advise her to take ibuprofen and to follow up with her physician.
d. conclude that she has postpolio syndrome and give her fentanyl.

Answer 19

a. provide supportive care and safely transport her to the hospital.

Question 20

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

Answer 20

a. assist his ventilations and establish vascular access.

Question 21

Use of a spacer device in conjunction with a metered-dose inhaler:
Select one:
a. is only indicated in children under 6 years of age, who are generally not able to use the inhaler effectively.
b. may be required when assisting a patient who is breathing inadequately, but generally results in less medication delivery to the lungs.
c. collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.
d. requires the patient to time his or her inhalation to coincide with the discharge of the metered-dose inhaler.

Answer 21

c. collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.

Question 22

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

Answer 22

d. recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.

Question 23

During a generalized tonic-clonic seizure, the patient is rigid and his back is arched. This represents the \_\_\_\_\_\_\_\_\_ phase of the seizure.
Select one:
a. tonic
b. clonic
c. hypertonic 
d. postictal

Answer 23

c. hypertonic

Question 24

Your partner is evaluating a patient’s 12-lead ECG and states that she sees a right bundle branch block. What did your partner observe?
Select one:
a. A QS pattern in lead V1
b. QRS complexes of 112 milliseconds
c. A QRS pattern in lead V1
d. QRS complexes of 128 milliseconds

Answer 24

d. QRS complexes of 128 milliseconds

Question 25

A loss of balance and equilibrium suggests injury to the:
Select one:
a. midbrain.
b. cerebrum.
c. thalamus.
d. cerebellum.

Answer 25

d. cerebellum.

Question 26

You are dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing:
Select one:
a. bronchitis.
b. pneumonia. 
c. end-stage COPD.
d. COPD exacerbation.

Answer 26

b. pneumonia.

Question 27

Symptoms of temporomandibular joint (TMJ) disorder include:
Select one:
a. sinus drainage.
b. an uneven bite.
c. tongue pain.
d. high fever.

Answer 27

b. an uneven bite.

Question 28

Hypertensive disease is characterized by:
Select one:
a. persistent elevation of the diastolic pressure.
b. a diastolic blood pressure above 90 mm Hg.
c. constant fluctuation in the systolic blood pressure.
d. a systolic blood pressure greater than 140 mm Hg.

Answer 28

a. persistent elevation of the diastolic pressure.

Question 29

A 69-year-old female presents with a sudden onset of shortness of breath that woke her from her sleep. She is conscious, but anxious, and is coughing up pink sputum. She can only speak in two-word sentences and has cyanosis to her face. Her BP is 170/90 mm Hg, pulse rate is 130 beats/min, and respirations are 28 breaths/min. What should you do?
Select one:
a. Provide noninvasive positive-pressure ventilation.
b. Administer a sedative and paralytic and intubate.
c. Establish vascular access and transport immediately.
d. Administer nitroglycerin and obtain a 12-lead ECG.

Answer 29

a. Provide noninvasive positive-pressure ventilation.

Question 30

A 70-year-old male presents with pain in his legs while walking. Within a few minutes of sitting down, however, his symptoms resolve. What should you suspect?
Select one:
a. Abdominal aortic aneurysm
b. Peripheral arterial disease 
c. Right ventricular failure
d. Deep vein thrombosis

Answer 30

b. Peripheral artery disease

Question 31

You are evaluating a 60-year-old woman’s 12-lead ECG and note that the R wave height in lead V1 exceeds the S wave depth. What condition would MOST likely cause this?
Select one:
a. Left ventricular failure 
b. Pulmonary hypertension
c. A tricuspid valve murmur
d. Severe systemic hypertension

Answer 31

b. Pulmonary hypertension

Question 32

If a patient’s aortic aneurysm is not compressing on any adjacent structures:
Select one:
a. the pain is often confined to the back.
b. he or she will likely be asymptomatic.
c. a pulsatile mass will usually be absent.
d. his or her pain will likely be less severe.

Answer 32

b. he or she will likely be asymptomatic.

Question 33

Which of the following signs or symptoms is consistent with postpolio syndrome?
Select one:
a. Persistent high fever
b. Difficulty swallowing
c. Unilateral vision loss
d. Acute unilateral paralysis

Answer 33

b. Difficulty swallowing

Question 34

A STEMI should be suspected in a 45-year-old female if the ST segments in leads V2 and V3 are elevated by \_\_\_\_ or more.
Select one:
a. 0.5
b. 1.0
c. 1.5 
d. 0.25

Answer 34

c. 1.5

Question 35

Which of the following is the MOST immediate and significant complication associated with posterior epistaxis?
Select one:
a. Hemorrhagic shock
b. Nasal inflammation
c. Nausea and vomiting 
d. Severe sinus infection

Answer 35

c. Nausea and vomiting

Question 36

In contrast to the pain associated with an acute myocardial infarction, pain from a dissecting aortic aneurysm:
Select one:
a. often waxes and wanes.
b. gradually becomes severe.
c. is maximal from the onset. 
d. is preceded by other symptoms.

Answer 36

c. is maximal from the onset.

Question 37

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

Answer 37

a. apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.

Question 38

Common signs of left ventricular failure include all of the following, EXCEPT:
Select one:
a. confusion. 
b. tachycardia.
c. hypotension.
d. hypertension.

Answer 38

c. hypotension.

Question 39

A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:
Select one:
a. increase her oxygen flow rate to 6 L/min.
b. administer a beta-2 agonist via nebulizer.
c. place her in a position that facilitates breathing.
d. auscultate her lungs for adventitious breath sounds.

Answer 39

c. place her in a position that facilitates breathing.

Question 40

A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from:
Select one:
a. supplemental oxygen.
b. a high-dose vasopressor infusion.
c. a 250-mL bolus of a crystalloid solution.
d. rapid transport to an appropriate hospital.

Answer 40

d. rapid transport to an appropriate hospital.

Question 41

You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She states that her left leg has been painful, red, and swollen. Based on this patient's clinical presentation, you should suspect:
Select one:
a. a pleural effusion.
b. spontaneous pneumothorax.
c. acute pulmonary embolism.
d. hyperventilation syndrome.

Answer 41

c. acute pulmonary embolism.

Question 42

What 12-lead ECG finding should make you suspect a posterior STEMI?
Select one:
a. ST elevation in leads V3 and V4
b. ST depression in leads V1 and V2
c. ST elevation in leads III and aVF 
d. ST depression in leads I and aVL

Answer 42

b. ST depression in leads V1 and V2

Question 43

When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear:
Select one:
a. inspiratory rhonchi to the bilateral apices of the lungs.
b. crackles in the bases of the lungs at the end of inspiration.
c. faint rhonchi to all lung fields on inspiration and expiration.
d. coarse crackles to the bases of the lungs during inspiration.

Answer 43

b. crackles in the bases of the lungs at the end of inspiration.

Question 44

A right-sided ECG is indicated for patients who present with:
Select one:
a. a systolic BP greater than 150 mm Hg.
b. ECG evidence of an inferior infarction.
c. chest pain that occurs only during exertion.
d. chest pain that is unresolved with nitroglycerin.

Answer 44

b. ECG evidence of an inferior infarction.

Question 45

Percutaneous coronary interventions involve:
Select one:
a. recanalizing a blocked coronary artery by passing a balloon or stent through a catheter via a peripheral artery.
b. passing a 2-mm catheter through the femoral artery and administering a fibrinolytic agent through the catheter.
c. using a large vein from one of the lower extremities to reroute blood flow past an occluded coronary artery.
d. passing a guide wire through one of the external jugular veins to directly visualize an occluded coronary artery.

Answer 45

a. recanalizing a blocked coronary artery by passing a balloon or stent through a catheter via a peripheral artery.

Question 46

Which of the following clinical signs would specifically indicate ethmoid sinusitis?
Select one:
a. Headache 
b. Toothache
c. Muscle aches
d. Nasal congestion

Answer 46

a. Headache

Question 47

Vasoactive medications for cardiogenic shock should be titrated to achieve a minimum systolic blood pressure of:
Select one:
a. 80 mm Hg.
b. 90 mm Hg. 
c. 100 mm Hg.
d. 120 mm Hg.

Answer 47

b. 90 mm Hg.

Question 48

Left ventricular hypertrophy should be considered in a 50-year-old patient if the sum of the depth of the S wave in lead V1 and the height of the R wave in either lead V5 or V6 exceeds:
Select one:
a. 22 mm.
b. 28 mm.
c. 32 mm.
d. 35 mm.

Answer 48

d. 35 mm.

Question 49

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:
Select one:
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 49

d. “When did you first notice your wife’s symptoms?”

Question 50

A high level of oxygen to the brain of a patient with a hemorrhagic stroke and increased intracranial pressure:
Select one:
a. dilates the blood vessels and can cause brain herniation.
b. lowers intracranial pressure and oxygenates the brain.
c. increases intracranial pressure, but oxygenates the brain.
d. causes vasoconstriction and can impair brain perfusion.

Answer 50

d. causes vasoconstriction and can impair brain perfusion.

Question 51

Use of an automated transport ventilator is NOT appropriate for patients who are:
Select one:
a. in cardiac arrest. Incorrect
b. apneic with a pulse.
c. chemically paralyzed.
d. breathing spontaneously.

Answer 51

d. breathing spontaneously.

Question 52

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

Answer 52

b. remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.

Question 53

You are assessing an elderly man who has asthma and uses an inhaled corticosteroid on a regular basis. He has white patches on his tongue and the inside of his mouth. He is conscious and alert and his airway is patent. You should:
Select one:
a. suspect that he has leukoplakia.
b. irrigate his mouth with sterile water.
c. provide supportive care and transport.
d. carefully scrape the lesions from his tongue.

Answer 53

c. provide supportive care and transport.

Question 54

A 51-year-old man complains of chronic headaches that have worsened progressively over the past 3 months. Today, he called 9-1-1 because his headache is severe and he is nauseated. His vital signs are stable and he is breathing adequately. The patient denies any medical problems and states that he has been taking acetaminophen for the headaches. You should be MOST suspicious for:
Select one:
a. acute sinusitis. 
b. an intracranial neoplasm.
c. acute hemorrhagic stroke.
d. a ruptured cerebral artery.

Answer 54

b. an intracranial neoplasm.

Question 55

A 21-year-old woman experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. She is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves:
Select one:
a. performing a needle decompression to the right side of her chest.
b. assisting his ventilations in order to increase her oxygen saturation.
c. administering high-flow supplemental oxygen and transporting at once.
d. applying a CPAP unit and starting an IV line en route to the hospital.

Answer 55

c. administering high-flow supplemental oxygen and transporting at once.

Question 56

It is MOST important to evaluate a cardiac dysrhythmia in the context of the:
Select one:
a. patient’s heart rate.
b. patient’s medical history.
c. patient’s overall clinical condition.
d. width of the QRS complex.

Answer 56

c. patient’s overall clinical condition.

Question 57

Which of the following conditions can be caused by gastroesophageal reflux disease (GERD)?
Select one:
a. Laryngitis 
b. Ludwig angina
c. Labyrinthitis
d. Peritonsilar abscess

Answer 57

a. LAryngitis

Question 58

A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V1 through V4. What should you suspect?
Select one:
a. Right ventricular infarction
b. Right coronary artery occlusion
c. Left circumflex occlusion
d. Left anterior descending artery occlusion

Answer 58

d. Left anterior descending artery occlusion

Question 59

One of the hallmarks of a pulmonary embolism is:
Select one:
a. the disappearance of radial pulses during inhalation.
b. pleuritic chest pain that occurs after a strong cough.
c. cyanosis that does not resolve with oxygen therapy.
d. jugular venous distention while in a supine position.

Answer 59

c. cyanosis that does not resolve with oxygen therapy.

Question 60

Disruption of blood flow through the innominate artery due to dissection is likely to produce:
Select one:
a. pulse or blood pressure deficits.
b. a rapid, irregular pulse.
c. collapsed jugular veins.
d. a widened pulse pressure.

Answer 60

a. pulse or blood pressure deficits.

Question 61

Atrial kick is defined as:
Select one:
a. the blood that flows passively into the ventricles.
b. pressure on the AV valves during ventricular contraction.
c. an attempt of the atria to contract against closed valves.
d. the volume of blood that the atria contract to the ventricles.

Answer 61

d. the volume of blood that the atria contract to the ventricles.

Question 62

Bedridden patients with excessive pulmonary secretions are MOST prone to developing:
Select one:
a. pneumonia. 
b. bronchospasm.
c. a pneumothorax.
d. a pulmonary embolism.

Answer 62

a. pneumonia.

Question 63

A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:
Select one:
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 63

b. decreases in stroke volume and ventricular filling.

Question 64

Patients with obvious respiratory failure require immediate:
Select one:
a. intubation.
b. ventilation support. 
c. passive oxygenation.
d. bronchodilator therapy.

Answer 64

b. ventilation support.

Question 65

On the 12-lead ECG, right atrial abnormality is characterized by:
Select one:
a. a P wave amplitude greater than 1.5 mm in lead V1.
b. a P wave duration greater than 110 milliseconds in lead II.
c. negatively deflected P waves in leads II and V1.
d. a PR interval that is greater than 200 milliseconds.

Answer 65

a. a P wave amplitude greater than 1.5 mm in lead V1.

Question 66

A chemistry student accidentally splashed a strong acid chemical into his eyes. He wears rigid gas-permeable contact lenses and is experiencing intense pain. You should:
Select one:
a. leave his contact lenses in place and irrigate his eyes throughout transport.
b. carefully remove his contact lenses and cover both eyes with dry dressings.
c. carefully remove his contact lenses and flush his eyes for at least 20 minutes.
d. leave his contact lenses in place and neutralize the acid with a strong alkali.

Answer 66

c. carefully remove his contact lenses and flush his eyes for a least 20 minutes.

Question 67

A hypertensive emergency is MOST accurately defined as:
Select one:
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 67

d. an acute elevation in blood pressure with signs of end-organ damage.

Question 68

A patient presents with fever, a headache, and a unilaterally sore throat. What should you suspect?
Select one:
a. Epiglottitis
b. Oral candidiasis
c. Bacterial pharyngitis 
d. peritonsilar abscess

Answer 68

d. peritonsilar abscess

Question 69

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

Answer 69

a. ensuring an adequate mask seal with minimal leakage.

Question 70

A 59-year-old female presents with severe substernal chest pain. She is anxious and diaphoretic. What should you do?
Select one:
a. Administer aspirin.
b. Establish IV access.
c. Administer nitroglycerin.
d. Obtain a 12-lead ECG.

Answer 70

a. administer aspirin.

Question 71

Disruption of blood flow into the left common carotid artery would MOST likely produce signs and symptoms of aNo:
Select one:
a. ischemic stroke.
b. pericardial tamponade.
c. hemorrhagic stroke.
d. myocardial infarction.

Answer 71

a. ischemic stroke.

Question 72

The process of aortic dissection begins when:
Select one:
a. the intimal layer of the aortic wall is torn.
b. hypertension causes acute rupture of the aorta.
c. the aorta is weakened due to excessive pressure.
d. blood accumulates between the layers of the aorta.

Answer 72

a. the intimal layer of the aortic wall is torn.

Question 73

You are dispatched to a residence for a middle-aged woman with generalized weakness of approximately 18 hours duration. Your primary assessment reveals right-sided hemiparesis, a left-sided facial droop, and bilaterally equal and reactive pupils. Further assessment reveals that her blood glucose level is 70 mg/dL. En route to the hospital, you note increased movement of her right arm. She is receiving oxygen via nasal cannula and has a patent IV line in place. Which of the following statements regarding this scenario is correct?
Select one:
a. You should administer nitroglycerin or labetalol if her systolic blood pressure is greater than 150 mm Hg.
b. The patient will likely receive fibrinolytic therapy in the emergency department if no contraindications exist.
c. Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.
d. The patient’s signs and symptoms are likely the result of her blood sugar and will resolve with dextrose.

Answer 73

c. Although the patient is likely experiencing a TIA, you should treat her as though she is experiencing a stroke.

Question 74

If the paramedic must initiate drug therapy in the field for hypertensive encephalopathy, he or she should:
Select one:
a. maintain the patient in a supine position.
b. administer a 500-mL normal saline bolus first.
c. measure the BP at least every 5 to 10 minutes.
d. first ensure that the heart rate is less than 100/min.

Answer 74

a. maintain the patient in a supine position.

Question 75

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

Answer 75

b. is often a last resort because asthmatics are difficult to ventilate and are prone to pneumothoraces.

Question 76

You are transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:
Select one:
a. remove the nonrebreathing mask and apply a nasal cannula.
b. administer a sedative and a paralytic and then intubate his trachea.
c. begin assisting his ventilations with a bag-mask device and 100% oxygen.
d. insert a nasal airway, apply a CPAP unit, and notify medical control.

Answer 76

c. begin assisting his ventilations with a bag-mask device and 100% oxygen.

Question 77

In a patient with left ventricular failure and pulmonary edema:
Select one:
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 77

c. increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the aveoli.

Question 78

A 68-year-old male who has COPD presents with edema to his feet and ankles, jugular venous distention, and an enlarged abdomen. What should you suspect?
Select one:
a. Acute hepatic failure
b. Left ventricular failure 
c. Acute renal failure
d. Right ventricular failure

Answer 78

d. Right ventricular failure

Question 79

A known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:
Select one:
a. suction his oropharynx, perform intubation, and then administer naloxone via slow IV push.
b. preoxygenate him with a bag-mask device for 2 to 3 minutes and then intubate his trachea.
c. apply oxygen via nonrebreathing mask, administer naloxone, and be prepared to assist ventilations.
d. assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Answer 79

d. assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.

Question 80

Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with:
Select one:
a. emphysema.
b. lung cancer. 
c. pleural effusion.
d. acute bronchitis.

Answer 80

b. lung cancer.

Question 81

A 70-year-old female complains of ringing and itching in both of her ears, as well as loss of hearing. What should you suspect?
Select one:
a. Labyrinthitis
b. Cerumen impaction
c. Bilateral otitis media
d. Meniere disease

Answer 81

b. Cerumen impaction

Question 82

A 33-year-old male presents with chest pain that is alleviated when he sits forward. The 12-lead ECG shows ST elevation of 2 to 3 mm in multiple leads. What should you suspect?
Select one:
a. Pericarditis 
b. Unstable angina
c. Aortic aneurysm
d. Acute myocardial infarction

Answer 82

a. Pericarditis

Question 83

A 19-year-old man presents with a decreased level of consciousness. According to his girlfriend, he has no known medical problems and takes no medications. Initial treatment for this patient involves:
Select one:
a. administering oxygen via nonrebreathing mask.
b. ensuring airway patency and adequate breathing.
c. evaluating his cardiac rhythm with the ECG monitor.
d. performing a rapid check of his blood glucose level.

Answer 83

b. ensuring airway patency and adequate breathing.

Question 84

A 60-year-old woman presents with fever, chills, and shortness of breath. She has a history of mitral valve prolapse. Assessment reveals flat, painless red lesions on the palms of her hands. What should you suspect?
Select one:
a. Pericarditis
b. Myocarditis
c. Endocarditis
d. Cardiac tamponade

Answer 84

c. Endocarditis

Question 85

Which of the following medications is an anticholinergic bronchodilator?
Select one:
a. Alupent
b. Albuterol
c. Bronkosol
d. Ipratropium

Answer 85

d. Ipratropium

Question 86

Your patient has a BP of 220/110. What is this patient’s mean arterial pressure (MAP)?
Select one:
a. 129 mm Hg
b. 147 mm Hg
c. 158 mm Hg 
d. 166 mm Hg

Answer 86

b. 147 mm Hg

Question 87

A patient with right ventricular failure would most likely present with:
Select one:
a. an enlarged liver.
b. collapsed jugular veins.
c. rhonchi in the lungs. 
d. pulmonary edema.

Answer 87

a. an enlarged liver.

Question 88

In addition to prompt transport, the goal of prehospital management for a patient with a suspected aortic dissection includes:
Select one:
a. lowering the blood pressure. 
b. IV fluid boluses.
c. high-flow oxygen.
d. adequate pain relief.

Answer 88

d. adequate pain relief.

Question 89

Which of the following mechanisms causes hypertension?
Select one:
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 89

c. Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.

Question 90

You would MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on:
Select one:
a. LSD.
b. ibuprofen.
c. Prozac.
d. heroin.

Answer 90

d. heroin.

Question 91

A hyperventilating patient:
Select one:
a. may be acidotic and trying to decrease her or his pH level.
b. is most effectively treated by administering a sedative drug.
c. should rebreathe her or his carbon dioxide to effect resolution.
d. presents with tachypnea and marked use of accessory muscles.

Answer 91

a. may be acidotic and trying to decrease her or his pH level.

Question 92

Hypertension is present when the blood pressure:
Select one:
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 92

b. is consistently greater than 140/90 mm Hg while at rest.

Question 93

In addition to supplemental oxygen, treatment of a patient with left ventricular failure includes:
Select one:
a. a saline lock and a selective beta-2 adrenergic medication.
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 and nitroglycerin.

Answer 93

b. an IV of normal saline, a 20-mL/kg fluid bolus, and a diuretic medication.

Question 94

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:
Select one:
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 94

b. resume CPR as the defibrillator is charging.

Question 95

A patient with cardiogenic shock and pulmonary edema should be positioned:
Select one:
a. in the Trendelenburg position.
b. in a semi-Fowler position.
c. supine with the legs elevated. 
d. in a lateral recumbent position.

Answer 95

b. in a semi-Fowler position.

Question 96

According to the Los Angeles Prehospital Stroke Screen, the possibility of a stroke is increased if:
Select one:
a. the patient is younger than 45 years of age.
b. the blood glucose is between 60 and 400 mg/dL.
c. at baseline, the patient is normally bedridden.
d. a bilateral facial droop is present during the exam.

Answer 96

b. the blood glucose is between 60 and 400 mg/dL.

Question 97

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:
Select one:
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 97

b. rule out hypoglycemia by assessing his blood sugar, but suspect a right-sided ischemic stroke.

Question 98

Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
Select one:
a. movement loosens pulmonary secretions and stimulates coughing.
b. most cases of pneumonia occur in conjunction with bronchospasm.
c. the secretions in their lungs suddenly disperse and impair breathing.
d. pneumonia often occurs in the lung bases, typically on only one side.

Answer 98

d. pneumonia often occurs in the lung bases, typically on only one side.

Question 99

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:
Select one:
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 99

c. oxygen as tolerated, starting an IV line and administering ondansetron, and transporting without lights or sirens.

Question 100

A 48-year-old man with a history of hypertension presents with a severe headache, tinnitus, and blurred vision. He is conscious and alert and denies any other symptoms. His BP is 204/120 mm Hg, his pulse rate is 100 beats/min, and his oxygen saturation is 96%. The closest appropriate facility is 20 minutes away. You should:
Select one:
a. monitor his cardiac rhythm and transport.
b. start an IV line and administer labetalol.
c. administer high-flow oxygen and transport.
d. keep him in a supine position and transport.

Answer 100

a. monitor his cardiac rhythm and transport.