unit exam 4

Question 1

The chief clinical manifestation of addisonian crisis is:
Select one:
a. shock. 
b. dehydration.
c. lower back pain.
d. an elevated temperature.

Answer 1

a. shock.

Question 2

The MOST common cause of addisonian crisis is:
Select one:
a. overwhelming stress.
b. a severe acute infectious process.
c. abrupt termination of corticosteroid use.
d. acute failure of one or both of the adrenal glands.

Answer 2

c. abrupt termination of corticosteroid use.

Question 3

A 30-year-old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm Hg, her pulse is 110 beats/min and full, and her respirations are rapid and deep. On the basis of this patient's clinical presentation, she will MOST likely require:
Select one:
a. 25 g of 50% dextrose.
b. in-hospital antibiotics.
c. 0.5 to 1 mg of glucagon.
d. crystalloid fluid hydration.

Answer 3

d. crystalloid fluid hydration.

Question 4

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:
Select one:
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 4

b. advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.

Question 5

A 50-year-old male with a history of long-term alcohol abuse presents with dull epigastric pain that is worse when he is lying flat. What should you suspect?
Select one:
a. Pancreatitis 
b. Cushing syndrome
c. Addison disease
d. Addisonian crisis

Answer 5

a. Pancreatitis

Question 6

Unlike hypothyroidism, hyperthyroidism:
Select one:
a. results in a decreased cardiac output.
b. causes a decrease in the metabolic rate.
c. causes an increase in oxygen demand.
d. often results in acute myxedema coma.

Answer 6

c. causes an increase in oxygen demand.

Question 7

You are assessing a 70-year-old man with a blood glucose reading of 400 mg/dL and note the presence of sharply peaked T waves on the cardiac monitor. Which of the following medications would this patient MOST likely receive in the prehospital setting?
Select one:
a. Insulin
b. Glucagon
c. Potassium
d. Bicarbonate

Answer 7

d. Bicarbonate

Question 8

You are transferring a 60-year-old man with COPD from a community hospital to a metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied. When reading his chart, you note that he has polycythemia, a history of a prior stroke, and hypertension. The patient tells you that he feels a fluttering sensation in his chest. You glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190 beats/min. The patient’s blood pressure is 116/70 mm Hg and he remains conscious and alert. You should:
Select one:
a. carefully auscultate his lung sounds and then administer a 500-mL bolus of normal saline solution.
b. administer 5 mg of midazolam, perform synchronized cardioversion with 50 joules, and reassess his cardiac rhythm.
c. ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.
d. place the patient supine, elevate his legs 6 to 12 inches, and administer 150 mg of amiodarone over 10 minutes.

Answer 8

c. ensure adequate oxygenation and ventilation, administer 6 mg of adenosine, and reassess his cardiac rhythm.