FILE_9455.docx

1\. A patient has requested to be transported to a specific hospital; however, the hospital does not have the proper resources to meet the patient\'s needs. You should: A\) determine if there is a more appropriate medical facility within a reasonable distance. B\) advise the patient that his or he...

1\. A patient has requested to be transported to a specific hospital; however, the hospital does not have the proper resources to meet the patient\'s needs. You should: A\) determine if there is a more appropriate medical facility within a reasonable distance. B\) advise the patient that his or her hospital of choice is a poorly equipped medical facility. C\) remember that the hospital can always transfer the patient to a more appropriate facility. D\) contact medical control and request permission to transport the patient to his or her choice hospital. Ans: A 2\. If the receiving facility does not have adequate resources to take care of your patient, you should next determine whether: A\) there is an appropriate facility within a reasonable distance. B\) an emergency physician should be dispatched to the scene. C\) transport of the patient by ambulance is absolutely necessary. D\) a BLS ambulance can transport the patient to a distant hospital. Ans: A 3\. Which of the following is NOT a typical function of the EMS medical director? A\) Interfacing between EMS systems and other agencies B\) Responding to an emergency scene with the paramedics C\) Participating in the hiring process of new EMS personnel D\) Developing protocols in cooperation with other EMS experts Ans: B 4\. A critical incident is MOST accurately defined as: A\) a delayed stress reaction to an incident that is similar to what has been experienced in the past. B\) a situation that completely incapacitates a person\'s ability to cope with the acute stress reaction at the scene. C\) any incident that completely overwhelms a paramedic\'s ability to manage the short-term stress caused by the incident. D\) an incident that overwhelms the ability of an EMS worker or system to cope with the experience, either at the scene or later. Ans: D 5\. Common signs of PTSD include all of the following, EXCEPT: A\) recurring mental flashbacks of the incident. B\) a change in appetite following a serious incident. C\) feelings of guilt that you performed inadequately. D\) difficulty getting an incident out of your thoughts. Ans: C 6\. Prolonged or excessive stress has been proven to be a strong contributor to: A\) depression. B\) hypotension. C\) schizophrenia. D\) bipolar disorder. Ans: A 7\. Children are at higher risk for serious injury than adults because of: A\) a shorter body stature. B\) inadequate parental guidance. C\) a proportionately larger head. D\) a lack of personal responsibility. Ans: C 8\. In 2016, the leading cause of death in the United States is: A\) choking. B\) poisoning. C\) falls. D\) drowning. Ans: B 9\. A DNR order is MOST accurately defined as a: A\) written order designed to tell health care providers when resuscitation is or is not appropriate. B\) legal document that is executed by the patient while he or she still has decision-making capacity. C\) written or oral directive that stipulates the care that a patient should receive at the end of his or her life. D\) legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients. Ans: A 10\. Abandonment occurs when: A\) a patient is released and did not require further medical care. B\) an emergency nurse takes a verbal report from a paramedic. C\) care of a patient was terminated without his or her consent. D\) a patient refuses care and subsequently dies of his condition. Ans: C 11\. If a paramedic is attacked by a violent patient: A\) the paramedic is legally permitted to defend himself or herself with the use of deadly force. B\) the law allows the paramedic to use a knife or firearm as a means of self-defense against the attacker. C\) the paramedic will not be held legally accountable if the attack was the result of patient provocation. D\) the paramedic may respond with force that is equal to or slightly greater than the force offered by the patient. Ans: D 12\. When functioning at a crime scene, it is important for the paramedic to: A\) collect and safeguard any and all evidence. B\) carefully question witnesses as to what they saw. C\) use caution and not disturb the scene unnecessarily. D\) avoid performing patient care until cleared by the police. Ans: C 13\. An elderly man states that he is sad and depressed because his wife recently died of cancer. Which of the following statements from the paramedic demonstrates empathy? A\) "I understand why you are sad, and I am sad for you. Is there anything I can do to make you feel better?" B\) "I\'m sorry to hear about your wife, but you should take comfort in the fact that she is in a better place." C\) "I\'m sorry, sir. I don\'t know how I would feel in your situation, but I am sure it would be similar." D\) "Your wife\'s death is very tragic, but perhaps going to the hospital will provide you with some relief." Ans: C 14\. If the wife of a critically ill man asks you if her husband is going to die, the MOST appropriate response should be: A\) "The situation appears grim, but you should not lose all hope." B\) "It is possible, and you should prepare yourself for the worst." C\) "That question is best answered by the physician at the hospital." D\) "He is very sick, but we are doing everything we can to help him." Ans: D 15\. For purposes of refusing medical care, a patient\'s mental status may be considered impaired if he or she: A\) is notably frightened. B\) makes a derogatory comment. C\) is not sure of the exact time. D\) makes nonsensical statements. Ans: D 16\. Which of the following statements is LEAST descriptive when documenting the events of a cardiac arrest call on your patient care report? A\) "Followed ACLS protocols." B\) "Intubated with a 7.5-mm ET tube." C\) "Gave 1 mg of epinephrine at 1002." D\) "Inserted 18-gauge IV in right forearm." Ans: A 17\. Any vertical plane that is parallel to the median plane and divides the body into unequal left and right parts is called the: A\) sagittal plane. B\) median plane. C\) caudal plane. D\) transverse plane. Ans: A 18\. Relative to the wrist, the elbow is: A\) flexion. B\) extension. C\) pronation. D\) supination. Ans: A 19\. Relative to the wrist, the elbow is: A\) anterior. B\) posterior. C\) proximal. D\) distal. Ans: C 20\. A pH of 7.30 indicates: A\) a neutral pH. B\) a basic pH. C\) alkalosis. D\) acidosis. Ans: D 21\. Afterload is defined as the: A\) volume of blood returned to the left and right atrium. B\) amount of blood pumped from the heart per contraction. C\) degree of pressure against which the left ventricle pumps. D\) volume of blood pumped ejected from the heart per minute. Ans: C 22\. All of the following are functions of the parasympathetic nervous system, EXCEPT: A\) constriction of the pupils. B\) lowering of the blood pressure. C\) decreased gastrointestinal function. D\) mediating arousal in males and females. Ans: C 23\. All of the following are voluntary muscles, EXCEPT: A\) skeletal muscle. B\) smooth muscle. C\) striated muscle. D\) somatic muscle. Ans: B 24\. Blood enters the right atrium of the heart from the: A\) vena cava and aorta. B\) aorta and coronary sinus. C\) pulmonary vein and aorta. D\) vena cavae and coronary sinus. Ans: D 25\. During an acidotic state, the kidneys attempt to maintain a normal pH by: A\) excreting bicarbonate. B\) retaining bicarbonate. C\) retaining hydrogen ions. D\) secreting hydrogen ions. Ans: B 26\. Freshly oxygenated blood is returned to the left atrium through the: A\) pulmonary veins. B\) pulmonary arteries. C\) superior vena cava. D\) inferior vena cava. Ans: A 27\. The heart\'s primary pacemaker, which is located in the right atrium, is the: A\) AV node. B\) SA node. C\) AV junction. D\) bundle of His. Ans: B 28\. A diabetic patient who failed to take his or her insulin and presents with peaked T waves on the cardiac monitor and muscle weakness is MOST likely: A\) hypocalcemic. B\) hyperkalemic. C\) hypokalemic. D\) hypoglycemic. Ans: B 29\. A loss of normal sympathetic nervous system tone causes: A\) neurogenic shock. B\) obstructive shock. C\) profound vasoconstriction. D\) a reduced absolute blood volume. Ans: A 30\. Distributive shock occurs when: A\) central vasoconstriction forces blood from the core of the body. B\) blood pools in expanded vascular beds and tissue perfusion decreases. C\) microorganisms attack the blood vessels, resulting in vasodilation. D\) a significant decrease in cardiac contractility causes decreased perfusion. Ans: B 31\. Hyperkalemia is defined as: A\) excess potassium in the cells. B\) a relative deficit of sodium. C\) an elevated serum potassium level. D\) a critically low magnesium level. Ans: C 32\. An infant\'s fontanelles are typically fused together by the age of: A\) 12 months. B\) 18 months. C\) 24 months. D\) 36 months. Ans: B 33\. Barotrauma secondary to bag-mask ventilations in an infant means that your ventilations: A\) were too forceful. B\) caused gastric distention. C\) were too slow for the infant\'s age. D\) did not produce visible chest rise. Ans: A 34\. A deformed steering wheel in conjunction with a deployed air bag indicates that the: A\) driver wore a lap belt only. B\) driver was not wearing a seat belt. C\) driver has intrathoracic hemorrhage. D\) driver\'s legs struck the steering wheel. Ans: B 35\. A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is: A\) irregular. B\) bounding. C\) thready. D\) rapid. Ans: B 36\. Distention of the jugular veins indicates: A\) a state of hypovolemia. B\) left-sided heart failure. C\) decreased venous pressure. D\) increased venous capacitance. Ans: D 37\. Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): A\) basilar skull fracture. B\) orbital blowout fracture. C\) fracture of the cribriform plate. D\) ruptured tympanic membrane. Ans: A 38\. The mnemonic "OPQRST" is a tool that: A\) is only effective when assessing a patient who is experiencing severe pain. B\) allows the paramedic to reach a field diagnosis quickly and initiate treatment. C\) is used commonly to rule out conditions that are immediately life threatening. D\) offers an easy-to-remember approach to analyzing a patient\'s chief complaint. Ans: D 39\. The residual pressure in the circulatory system while the left ventricle is relaxing is called the: A\) pulse pressure. B\) diastolic pressure. C\) systolic pressure. D\) mean arterial pressure. Ans: B 40\. What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? A\) 10 B\) 11 C\) 12 D\) 13 Ans: C 41\. Which of the following is an example of a pertinent negative? A\) A family member states that the patient has hypertension. B\) A patient tells you that he has developed a plan for suicide. C\) A patient with chest discomfort denies shortness of breath. D\) An agitated patient tells you that he did not request your help. Ans: C 42\. The MOST effective way for the paramedic to avoid tunnel vision is to: A\) perform a secondary assessment on every patient he or she encounters. B\) keep an open mind to all of the possible causes of the patient\'s problem. C\) reassess all patients at least every 15 minutes until patient care is transferred. D\) possess a detailed knowledge of anatomy, physiology, and pathophysiology. Ans: B 43\. Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? A\) A rigid abdomen and signs of shock B\) An elderly patient with prolonged asystole C\) A driver who passed out and then struck a tree D\) Isolated tibia/fibula fracture from minor trauma Ans: C 44\. A medication that possesses a negative chronotropic effect will: A\) cause a decrease in the heart rate. B\) cause an increase in blood pressure. C\) decrease myocardial contractile force. D\) increase cardiac electrical conduction velocity. Ans: A 45\. A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of: A\) synergism. B\) summation. C\) potentiation. D\) antagonism. Ans: A 46\. Fentanyl (Sublimaze) is the preferred opioid analgesic for patients in critical or unstable condition because: A\) its effects last much longer than any other opioid. B\) it is not as prone to causing hypotension as morphine. C\) it only requires one small dose to achieve analgesia. D\) it hyperstimulates mu (μ) opioid receptor sites. Ans: B 47\. In general, alpha-adrenergic receptor antagonists: A\) decrease the heart rate. B\) lower the blood pressure. C\) are used for hypotension. D\) increase vascular resistance. Ans: B 48\. Stimulation of alpha-2 receptors: A\) constricts the vascular smooth muscle. B\) suppresses the release of norepinephrine. C\) causes profound systemic hypertension. D\) increases the release of norepinephrine. Ans: B 49\. Which of the following medications has the ability to increase cardiac contractility while simultaneously causing dilation of systemic arteries and veins? A\) Nitroglycerin (Nitrostat) B\) Dopamine (Intropin) C\) Milrinone (Primacor) D\) Norepinephrine (Levophed) Ans: C 50\. Which of the following statements regarding sympathomimetic chemicals is correct? A\) They are not synthetically manufactured. B\) They block the release of acetylcholine. C\) They only stimulate alpha-1 receptors. D\) They are not found naturally in the body. Ans: D 51\. "Track marks" along the course of a patient\'s vein are usually a sign of: A\) sclerosis caused by frequent cannulation. B\) numerous one-way valves inside the vein. C\) small vein rupture caused by hypertension. D\) multiple thromboses deep within the vein. Ans: A 52\. A 60-year-old woman with acute chest discomfort requires 0.4 mg of sublingual nitroglycerin. Prior to administering the medication, you should: A\) assess her mucous membranes to ensure they are dry. B\) ask her if she wears a transdermal nitroglycerin patch. C\) ensure that her systolic BP is greater than 120 mm Hg. D\) determine to which hospital she wishes to be transported. Ans: B 53\. A microdrip administration set: A\) allows 10 or 15 drops per milliliter. B\) delivers 1 mL for every 60 drops. C\) should be used when patients need fluid replacement. D\) does not contain a needlelike orifice in its drip chamber. Ans: B 54\. A prefilled syringe of lidocaine contains 100 mg/5 mL of volume. How many milligrams per milliliter (mg/mL) are present in the syringe? A\) 5 B\) 10 C\) 20 D\) 25 Ans: C 55\. You reassess your patient after administering a medication via the IV bolus route and note that his clinical condition is unchanged. What is the LEAST likely cause of the patient\'s unchanged condition? A\) The patient may require another dose of the same drug. B\) The dose was too low for the patient\'s clinical condition. C\) The IV tubing was occluded proximal to the injection port. D\) You diluted the bolus by following it with a 20-mL saline flush. Ans: C 56\. Your protocols call for you to administer 5 mg of diazepam (Valium) to a patient who is seizing. You have a 10-mL vial of Valium that contains 10 mg. How many milliliters will you give? A\) 0.5 mL B\) 5 mL C\) 0.25 mL D\) 10 mL Ans: B 57\. A 40-year-old man fell 20 ft from a tree while trimming branches. Your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should: A\) insert a nasopharyngeal airway and assess his respirations. B\) carefully open his airway with the head tilt-chin lift maneuver. C\) assist his ventilations and prepare to intubate him immediately. D\) suction his oropharynx and reattempt the jaw-thrust maneuver. Ans: B 58\. A young woman experienced massive facial trauma after being ejected from her car when it struck a tree. She is semiconscious, has blood draining from her mouth, and has poor respiratory effort. The MOST appropriate initial airway management for this patient involves: A\) vigorously suctioning her oropharynx for no longer than 15 seconds and then inserting a multilumen airway device. B\) alternating suctioning her oropharynx for 15 seconds and assisting her ventilations for 2 minutes until you can definitively secure her airway. C\) suctioning her oropharynx and performing direct laryngoscopy to assess the amount of upper airway damage or swelling that is present. D\) providing positive-pressure ventilatory support with a bag-mask device and making preparations to perform an open cricothyrotomy. Ans: B 59\. CPAP is NOT appropriate for patients with: A\) acute or chronic bronchospasm. B\) slow, shallow respiratory effort. C\) an oxygen saturation less than 90%. D\) evidence of congestive heart failure. Ans: B 60\. You are intubating a 60-year-old man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient\'s mouth, manually stabilizing the tube, and removing the stylet, you should: A\) inflate the distal cuff with 5 to 10 mL of air. B\) attach an ETCO~2~ detector to the tube. C\) secure the ET tube with a commercial device. D\) begin ventilations and auscultate breath sounds. Ans: A 61\. A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient\'s wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient\'s respiratory distress? A\) Oxygen noncompliance B\) Recent antitussive use C\) An underlying infection D\) Acute right heart failure Ans: B 62\. 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: 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. Ans: C 63\. A pulse oximetry reading would be LEAST accurate in a patient: A\) with chronic hypoxia. B\) whose extremities are cool. C\) with persistent tachycardia. D\) with poor peripheral perfusion. Ans: D 64\. Wheezing is resolved with medications that: A\) dry up secretions in the lower airway. B\) reduce soft tissue swelling in the larynx. C\) relax the smooth muscle of the bronchioles. D\) cause bronchoconstriction and improved airflow. Ans: C 65\. You are transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should: A\) continue the CPAP treatment and administer a diuretic to remove fluids from his lungs quickly. B\) remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him. C\) suspect that he has developed a pneumothorax and prepare to perform a needle chest decompression. D\) decrease the amount of positive-end expiratory pressure that you are delivering and reassess. Ans: B 66\. 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: 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 and 100% oxygen. D\) insert a nasal airway, apply a CPAP unit, and notify medical control. Ans: C 67\. The classic presentation of chronic bronchitis is: A\) excessive mucus production and a chronic or recurrent productive cough. B\) a thin male with pursed-lip breathing and a history of heavy cigarette smoking. C\) a dry, hacking cough and a barrel chest due to chronic pulmonary air trapping. D\) expiratory wheezing and jugular venous distention due to pulmonary hypertension. Ans: A 68\. A "run" of ventricular tachycardia occurs if at least \_\_\_\_ PVCs occur in a row. A\) two B\) three C\) four D\) five Ans: B 69\. A 55-year-old man complains of severe pain between his shoulder blades, which he describes as "ripping" in nature. He tells you that the pain began suddenly and has been intense and unrelenting since its onset. His medical history includes hypertension, and he admits to being noncompliant with his antihypertensive medication. Which of the following assessment findings would MOST likely reinforce your suspicion regarding the cause of his pain? A\) Disappearance of radial pulses during inspiration B\) Difference in blood pressure between the two arms C\) ST-segment depression on the 12-lead ECG tracing D\) Bruits to both carotid arteries during auscultation Ans: B 70\. A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V1, through V4. What should you suspect. A\) Right coronary artery occlusion B\) Left anterior descending artery occlusion C\) Left circumflex occlusion D\) Right ventricular infarction Ans: B 71\. A classic sign of atrial flutter is: A\) a constant 2:1 conduction ratio. B\) the presence of sawtooth F waves. C\) a ventricular rate less than 100 beats/min. D\) an irregular but consistent R-R interval. Ans: B 72\. A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by: A\) myocardial stretching due to increased preload. B\) decreases in stroke volume and ventricular filling. C\) increased automaticity of the cardiac pacemaker. D\) ectopic pacemaker sites in the atria or ventricles. Ans: B 73\. A delta wave is identified on a cardiac rhythm strip as a(n): A\) apparent P wave that occurs at the end of the QRS complex. B\) acute widening of the QRS complex immediately after the R wave. C\) slurring of the upstroke of the first part of the QRS complex. D\) delay between the end of the P wave and the beginning of the R wave. Ans: C 74\. A major complication associated with atrial fibrillation is: A\) clot formation in the fibrillating atria. B\) a significant reduction in atrial filling. C\) pulmonary congestion and hypoxemia. D\) a profound increase in the atrial kick. Ans: A 75\. A pathologic Q wave: A\) generally indicates that an acute myocardial infarction has occurred within the past hour. B\) is deeper than one quarter of the height of the R wave and indicates injury. C\) is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. D\) can only be substantiated by viewing at least two previous 12-lead ECGs. Ans: C 76\. A prolonged PR interval: A\) is greater than 120 milliseconds. B\) indicates that the AV node was bypassed. C\) indicates an abnormal delay at the AV node. D\) is a sign of rapid atrial depolarization. Ans: C 77\. A regular cardiac rhythm with a rate of 104 beats/min, upright P waves, a PR interval of 0.14 seconds, and QRS complexes that measure 0.10 seconds should be interpreted as: A\) supraventricular tachycardia. B\) normal sinus rhythm. C\) sinus tachycardia. D\) junctional tachycardia. Ans: C 78\. A regular rhythm with inverted P waves before each QRS complex, a ventricular rate of 70 beats/min, narrow QRS complexes, and a PR interval of 0.16 seconds should be interpreted as a(n): A\) ectopic atrial rhythm. B\) junctional escape rhythm. C\) supraventricular tachycardia. D\) accelerated junctional rhythm. Ans: D 79\. A right-sided ECG is indicated for patients who present with: A\) chest pain that occurs only during exertion. B\) ECG evidence of an inferior infarction. C\) a systolic BP greater than 150 mm Hg. D\) chest pain that is unresolved with nitroglycerin. Ans: B 80\. 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. Ans: C 81\. An unresponsive, pulseless, apneic patient presents with ventricular tachycardia on the cardiac monitor, After defibrillating the patient, you should: A\) reassess the cardiac rhythm to see if it has changed. B\) take no more than 10 seconds to assess for a pulse. C\) resume CPR and reassess the patient after 2 minutes. D\) deliver another shock if his cardiac rhythm is unchanged. Ans: C 82\. Atrial fibrillation can be interpreted by noting: A\) PR intervals that vary from complex to complex. B\) an irregularly irregular rhythm and absent P waves. C\) a regularly irregular rhythm with abnormal P waves. D\) the presence of wide QRS complexes and a rapid rate. Ans: B 83\. Cor pulmonale is most often the result of: A\) acute MI. B\) stable angina. C\) hypertension. D\) COPD. Ans: D 84\. In most patients, the SA node is supplied with blood from the: A\) right coronary artery B\) left main coronary artery C\) left circumflex coronary artery D\) left anterior descending coronary artery Ans: A 85\. Premature ventricular complexes (PVCs) that originate from different sites in the ventricle: A\) are called unifocal PVCs. B\) produce a palpable pulse. C\) are also called fusion PVCs. D\) will appear differently on the ECG. Ans: D 86\. Q waves are considered abnormal or pathologic if they are: A\) greater than 0.02 seconds wide and consistently precede the R wave. B\) more than one third the overall height of the QRS complex in lead II. C\) not visible in leads I or II when the QRS gain sensitivity is increased. D\) present in a patient who is experiencing chest pressure or discomfort. Ans: B 87\. The inferior wall of the left ventricle is supplied by the: A\) right coronary artery. B\) left coronary artery. C\) circumflex artery. D\) left anterior descending artery. Ans: A 88\. The treatment for cardiogenic shock is generally focused on: A\) increasing the heart rate to improve cardiac output and cerebral perfusion. B\) infusing enough IV fluid to maintain a systolic BP of 110 mm Hg. C\) administering nitroglycerin to improve perfusion to the myocardium. D\) strengthening cardiac contractility without increasing the heart rate. Ans: D 89\. What is the R-on-T phenomenon? A\) A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized B\) When the R wave occurs at the J point of the next cardiac cycle C\) A unifocal PVC that occurs during the upslope of any given T wave D\) A PVC that occurs during a time when the ventricles are depolarizing Ans: A 90\. 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? A\) Severe systemic hypertension B\) tricuspid valve murmur C\) Pulmonary hypertension D\) Left ventricular failure\ Ans: C 91\. A 29-year-old man, who was recently prescribed an antipsychotic medication, presents with an acute onset of bizarre contortions of the face. Treatment should include: A\) diazepam, 5 mg. B\) promethazine, 25 mg. C\) diphenhydramine, 25 mg. D\) ondansetron, 4 mg. Ans: C 92\. A rhythmic contraction and relaxation of muscle groups that is commonly observed during a seizure is called \_\_\_\_\_\_\_\_\_\_ activity. A\) tonic B\) clonic C\) hypertonic D\) myoclonic Ans: B 93\. A woman brings her 18-year-old son to your EMS station. The patient is actively seizing and, according to the mother, has been seizing for the past 10 minutes. She states that her son has a history of seizures and takes Depakote. The patient is cyanotic, is breathing erratically, and has generalized muscle twitching to all extremities. You should: A\) place a bite block between his molars to prevent oral trauma, administer high-flow oxygen, and give lorazepam IM. B\) protect him from further injury by restraining him, attempt orotracheal intubation, establish an IV, and give Valium. C\) hyperventilate him with a bag-mask to eliminate excess carbon dioxide, establish vascular access, and give lorazepam. D\) open his airway and begin assisting his ventilations, establish an IV or IO line, and administer 5 to 10 mg of diazepam. Ans: D 94\. Prehospital treatment for a patient with a suspected stroke may include all of the following, EXCEPT: A\) 30° elevation of the head. B\) diazepam or lorazepam. C\) up to 325 mg of aspirin. D\) crystalloid fluid boluses. Ans: C 95\. You are dispatched to a local pharmacy, where a 24-year-old woman experienced an apparent seizure. During your assessment, you note that the patient is conscious but combative. The patient\'s supervisor states that she has a history of seizures and takes Tegretol. The patient\'s blood pressure is 146/90 mm Hg, pulse rate is 110 beats/min and regular, and respirations are 24 breaths/min with adequate depth. The MOST appropriate treatment for this patient includes: A\) administering oxygen as tolerated, establishing an IV line, padding the rails of the ambulance cot, and transporting without lights and siren. B\) establishing vascular access, administering diazepam or lorazepam to reduce her combativeness, and transporting to the closest hospital. C\) giving her high-flow oxygen, inserting an IO catheter in her proximal tibia, transporting, and observing for further seizure activity. D\) administering oxygen, restraining her to protect her from further injury, placing a bite block in her mouth in case she seizes again, and transporting. Ans: A 96\. You arrive at the scene shortly after a 7-year-old girl experienced a seizure. According to the child\'s mother, she was sitting at the dinner table and then suddenly stopped speaking and started blinking her eyes very rapidly. The episode lasted less than 1 minute, after which the child\'s condition rapidly improved. This clinical presentation is consistent with a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_ seizure. A\) absence B\) tonic-clonic C\) simple partial D\) complex partial Ans: A 97\. A 4-year-old child presents with a deep "croup-like" cough, difficulty breathing, and a high fever. You should suspect: A\) epiglottitis. B\) pharyngitis. C\) laryngitis. D\) tracheitis. Ans: D 98\. Glaucoma is a condition caused by: A\) a loss of peripheral vision. B\) retinal artery occlusion. C\) increased intraocular pressure. D\) decreased vitreous humor. Ans: C 99\. Which of the following is the MOST immediate and significant complication associated with posterior epistaxis? A\) Hemorrhagic shock B\) Nausea and vomiting C\) Nasal inflammation D\) Severe sinus infection Ans: B 100\. Clinical signs of hypokalemia include: A\) convulsions and absent P waves. B\) muscle cramps and peaked T waves. C\) coma and severe peripheral edema. D\) weakness and flattened T waves. Ans: D 101\. Which of the following statements regarding Grey Turner sign is correct? A\) Grey Turner sign is characterized by bruising around the umbilicus. B\) The presence of Grey Turner sign should make you suspicious for hepatitis. C\) Grey Turner sign is the cessation of inspiration during abdominal palpation. D\) Grey Turner sign is characterized by flank bruising and indicates retroperitoneal hemorrhage. Ans: D 102\. A 62-year-old man presents with an acute onset of bright red vomiting. According to his wife, he ingests excessive amounts of alcohol each day. As you are assessing the patient, you note that his level of consciousness has decreased markedly. His mouth is full of blood, and his skin is pale and moist. You should: A\) assist his ventilations for 2 to 3 minutes, insert a Combitube, suction his airway for up to 15 seconds, start two large-bore IV lines with normal saline, and administer a 1-L fluid bolus. B\) perform immediate tracheal intubation, insert a nasogastric tube, establish IV or IO access, and administer 10- to 20-mL/kg normal saline or lactated Ringer\'s boluses to maintain a systolic blood pressure of at least 90 mm Hg. C\) turn him on his side and suction his oropharynx, intubate his trachea if the oral bleeding continues, establish at least one large-bore IV with normal saline, and administer enough fluids to maintain adequate perfusion. D\) suction his mouth for up to 20 seconds, insert a nasopharyngeal airway, ventilate him at a rate of 20 breaths/min, consider endotracheal intubation, start a large-bore IV line, and run the IV wide open until signs of improvement are noted. Ans: C 103\. What is the parietal peritoneum? A\) The lining that covers the abdominal organs B\) The lining or bag that contains abdominal organs C\) The space behind the anterior abdomen D\) The inner lining of the large intestine Ans: B 104\. Which of the following medications should be given with caution in patients who are taking blood thinners? A\) Torodal B\) Fentanyl C\) Nubain D\) Demerol Ans: A 105\. A 50-year-old man presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation? A\) Renal failure B\) Head trauma C\) Nitroglycerin use D\) Antidepressant use Ans: D 106\. A renal calculus that has become lodged in a lower ureter would likely produce all of the following signs and symptoms, EXCEPT: A\) fever. B\) hematuria. C\) urinary urgency. D\) painful urination. Ans: A 107\. Any time a patient with end-stage renal disease is found in cardiac arrest, the paramedic should strongly consider which of the following as the cause? A\) Hyperkalemia B\) Hypocalcemia C\) Hypokalemia D\) Hypercalcemia Ans: A 108\. A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should: A\) recognize that she probably received an overaggressive dialysis treatment. B\) start an IV line with normal saline and infuse 200 mL of normal saline per hour. C\) transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure. D\) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital. Ans: D 109\. Which of the following is a potentially life-threatening complication of missing one or more dialysis treatments? A\) Uremic frost B\) Hyperkalemia C\) Hypocalcemia D\) Peripheral edema Ans: B 110\. A young female with experienced trauma to her genitalia and has profuse vaginal bleeding. She is hypotensive, tachycardic, and tachypneic. You should: A\) transport immediately.\ B) perform a quick internal exam to locate the bleeding. C\) place a trauma dressing into her vagina. D\) administer an analgesic. Ans: A 111\. Pelvic inflammatory disease commonly affects all of the following organs, EXCEPT the: A\) ovaries. B\) urinary bladder. C\) uterus. D\) fallopian tubes. Ans: B 112\. While caring for an unresponsive young woman who was apparently sexually assaulted, you note that her respirations are slow and shallow, her pulse is slow and weak, and her blood pressure is low. There is a small amount of dried blood on her thigh, but no grossly active bleeding. Immediate care for this patient involves: A\) elevating her lower extremities to improve her blood pressure. B\) establishing an IV line and administering 0.5 mg of atropine. C\) visualizing her vaginal area to assess for external bleeding. D\) maintaining her airway and providing ventilatory assistance. Ans: D 113\. A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man\'s wife, he has had a fever and flu-like symptoms for the past few days. She further tells you that he has "stuck to his diet" as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads "high." This patient is MOST likely: A\) producing ketones due to fat metabolism. B\) experiencing hyperosmolar nonketotic coma. C\) significantly acidotic and requires bicarbonate. D\) hyperglycemic secondary to being dehydrated. Ans: B 114\. Diabetic ketoacidosis occurs when: A\) blood glucose levels rise above 250 mg/dL. B\) the renal system begins to excrete ketones. C\) the cells metabolize fat and produce ketones. D\) insulin production exceeds glucagon production. Ans: C 115\. The clinical presentation of a hypoglycemic patient would MOST likely resemble that of a patient with: A\) classic heatstroke. B\) an opiate overdose. C\) alcohol intoxication. D\) a hemorrhagic stroke. Ans: C 116\. You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being "drunk." Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient\'s ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should: A\) intubate his trachea to prevent aspiration and transport him immediately. B\) administer a second dose of dextrose and prepare for immediate transport. C\) give him 1 mg of glucagon IM and reassess his blood glucose. D\) conclude that he will require immediate definitive care and begin transport. Ans: B 117\. A patient with diabetic ketoacidosis experiences polydipsia as a result of: A\) hyperglycemia. B\) dehydration. C\) metabolic acidosis. D\) inefficient nutrient utilization. Ans: B 118\. Prior to administering 50% dextrose (D~50~) via IV push, it is MOST important to: A\) protect the airway with an endotracheal tube. B\) ensure that the IV line is patent and freely flowing. C\) confirm a blood glucose reading of less than 40 mg/dL. D\) draw blood for later analysis in the emergency department. Ans: B 119\. You are dispatched to the residence of a 60-year-old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several "small strokes." In addition to properly managing her airway, you should: A\) perform a field glucose test to rule out hypoglycemia. B\) start an IV line and give her 50 mL of 50% dextrose. C\) avoid giving her glucose because of her small strokes. D\) start an IV line and give her a 20-mL/kg fluid bolus. Ans: A 120\. A 22-year old male with sickle cell disease presents with severe abdominal pain. On assessment, his abdomen appears bloated and is rigid to the touch. What should you suspect? A\) Acute chest syndrome\ B) Acute vasoocclusive crisis C\) Acute hepatic failure D\) Splenic sequestration syndrome Ans: D 121\. Anemia would result from all of the following conditions, EXCEPT: A\) erythrocyte hemolysis. B\) an increase in iron. C\) acute blood loss. D\) chronic hemorrhage. Ans: B 122\. 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 160 beats/min. The patient\'s blood pressure is 116/70 mm Hg and he remains conscious and alert. You should: 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. Ans: C 123\. Histamine release causes all of the following effects, EXCEPT: A\) vasodilation, which results in flushed skin and hypotension. B\) contraction of the smooth muscles of the respiratory system. C\) increased cardiac contractility, which results in hypertension. D\) increased vascular permeability, which results in tissue edema. Ans: C 124\. Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT: A\) aggressive airway control. B\) epinephrine administration. C\) assessment of lung sounds. D\) a secondary assessment. Ans: D 125\. The MOST ominous respiratory sign in a patient with anaphylactic shock is: A\) diminished lung sounds. B\) loud expiratory wheezing. C\) diffuse coarse crackles. D\) labored tachypnea. Ans: A 126\. The primary treatment for hypotension secondary to anaphylaxis is: A\) epinephrine. B\) diphenhydramine. C\) isotonic crystalloid. D\) a dopamine infusion. Ans: A 127\. A 70-year-old homeless man presents with a rash to his hands, wrists, and ankles. He denies any known allergies and states that the rash itches severely at night. His vital signs are stable, and he is breathing without difficulty. You should: A\) transport him to the hospital and thoroughly wash your hands after patient care has been completed. B\) establish vascular access in case he begins to experience signs and symptoms of a severe allergic reaction. C\) be highly suspicious that he has body lice and use a high-level disinfectant when cleaning the ambulance. D\) administer 25 mg of diphenhydramine IM and transport him to an appropriate medical facility. Ans: A 128\. If the source patient\'s blood tests positive for HIV: A\) the exposed individual will receive a one-time injection of immune globulin and will be tested for HIV in 2 weeks. B\) the blood will be assessed for viral load and the exposed individual may be offered a 4-week trial of antiretroviral therapy. C\) the most rapid method for determining if the exposed individual was infected is by assessing his or her lymphocyte count. D\) federal law requires that the exposed individual be placed on antiretroviral therapy and not be allowed to work in a health care setting. Ans: B 129\. In older adults, shingles arises when the \_\_\_\_\_\_\_\_\_ virus resides in the ganglion of a nerve. A\) rubella B\) varicella C\) rubeola D\) herpes Ans: B 130\. You receive a call for an "unresponsive person." Law enforcement arrives at the scene before you and advises that the scene is secure. When you arrive, you find the patient, a young man, lying supine on the floor of his poorly kept apartment. He is unresponsive and is breathing with a marked reduction in tidal volume. One of the police officers recognizes the patient as a known intravenous drug abuser. During your care of this patient, you should: A\) apply a nonrebreathing mask and set the flow rate at 15 L/min. B\) avoid removing his wallet or any other possessions from his pockets. C\) defer vascular access until the patient is in the emergency department. D\) establish an IV line of normal saline and administer 2 mg of flumazenil. Ans: B 131\. A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should: A\) cover the burn and transport at once. B\) begin immediate irrigation with water. C\) apply a light coat of baking soda to the burn. D\) administer oxygen via nonrebreathing mask. Ans: B 132\. A 45-year-old man is found unresponsive in an alley. During your assessment, you note that he is tachycardic and breathing rapidly. He has an obvious odor of alcohol on his breath. Your MOST immediate concern should be to: A\) obtain a blood glucose reading. B\) take actions to prevent aspiration. C\) determine the etiology of his tachycardia. D\) start an IV line and administer naloxone. Ans: B 133\. Cardiac arrest following a narcotic overdose is usually the result of: A\) seizures. B\) renal failure. C\) respiratory arrest. D\) a cardiac dysrhythmia. Ans: C 134\. Unlike an opioid, an opiate: A\) is a natural product derived from opium. B\) produces a distinctly different toxidrome. C\) is not reversed by naloxone administration. D\) is a synthetic, non--opium-derived narcotic. Ans: A 135\. You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should: A\) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport. B\) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately. C\) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital. D\) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport. Ans: B 136\. A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement personnel are at the scene. You have controlled the bleeding with direct pressure and a pressure bandage. The patient\'s vital signs are stable and she is conscious and alert; however, she refuses to go to the hospital. Despite pleas from her family to go to the hospital, she still refuses. You should: A\) respect her wishes because she is coherent, but leave her with a trusted family member. B\) use reasonable force to physically restrain the patient, administer a sedative, and transport. C\) remain with the patient, contact medical control, and request law enforcement intervention. D\) contact medical control and advise him or her that you will be transporting the patient against her will. Ans: C 137\. A 50-year-old woman called 9-1-1 after she was suddenly awakened in the middle of the night with the feeling that she was being smothered. Your assessment reveals that she is clearly anxious, is trembling, and complains of chest pain and numbness and tingling to her face and hands. Her blood pressure is 168/96 mm Hg, pulse rate is 140 beats/min, and respirations are 30 breaths/min. Her medications include Xanax, Lipitor, and Vasotec. The MOST appropriate treatment for this patient includes: A\) applying a nonrebreathing mask with the flow rate set at 2 L/min, assessing her blood glucose level, administering diazepam for sedation, and transporting her without lights and siren. B\) attempting to regulate her breathing by asking her to hold her breath, assessing her end-tidal carbon dioxide level, administering 1 µg/kg of fentanyl IM for sedation, and transporting. C\) applying a cardiac monitor, establishing vascular access and administering adenosine, administering oxygen via nasal cannula, considering a beta adrenergic antagonist to lower her blood pressure, and transporting. D\) coaching her to slow her breathing, monitoring her oxygen saturation and end-tidal carbon dioxide levels, administering supplemental oxygen, assessing her cardiac rhythm, establishing vascular access, and transporting. Ans: D 138\. Common signs and symptoms of a panic attack include all of the following, EXCEPT: A\) trembling and parasthesias. B\) a sensation of being smothered. C\) a prolonged loss of consciousness. D\) nausea and abdominal discomfort. Ans: C 139\. The BEST example of an impulse control disorder is: A\) stealing. B\) pathologic gambling. C\) uncontrollable worrying. D\) obsessing over one\'s health. Ans: B 140\. Which of the following scenarios is MOST indicative of posttraumatic stress disorder? A\) An advanced EMT student who has a morbid fear of needles experiences a syncopal episode during IV skills practice during class B\) A paramedic whose son was struck and killed by a car becomes acutely anxious upon arriving at the scene of a motor-vehicle-versus-pedestrian incident C\) An elderly woman who is afraid of losing her independence becomes agitated when being told that she is being admitted to a skilled nursing care facility D\) An experienced paramedic who had a nightmare regarding a case of sudden infant death syndrome cries at the scene of a cardiac arrest involving an infant Ans: B 141\. You are dispatched to a skilled nursing care facility for a 74-year-old male resident who is ill. During your assessment, you note that the patient has his head cocked to the side and is unable to move it. The charge nurse tells you that the patient was placed on Seroquel 2 days ago. Based on this patient\'s clinical presentation and medication history, you should: A\) administer 25 to 50 mg of diphenhydramine. B\) suspect that the patient has catatonic schizophrenia. C\) establish vascular access and administer naloxone. D\) expect to find that his blood sugar level is elevated. Ans: A 142\. The MOST reliable indicator that significant energy was dissipated by braking before a motor vehicle collision is: A\) deformity to the driver\'s brake pedal. B\) severe damage to the front rims of the tires. C\) a trail of debris leading to the site of impact. D\) the presence of tire skid marks at the scene. Ans: D 143\. Which of the following characteristics of an entry wound indicates that the weapon was fired at close range? A\) Abrasions around the wound B\) Indentation of cutaneous tissues C\) Severe bleeding from the wound D\) Tattoo marks from powder burns Ans: D 144\. Which of the following is NOT a factor when considering transport of a trauma patient via helicopter? A\) The need for definitive airway management B\) Distance from the scene to the landing zone C\) Time it will take the aircraft to reach the scene D\) Type of terrain on which the helicopter will land Ans: A 145\. Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced? A\) Index of suspicion B\) Past medical history C\) Age of the patient D\) Mechanism of injury Ans: D 146\. After packing a severe groin injury with hemostatic gauze, you should: A\) hold direct pressure for 3 minutes. B\) cover the gauze with a trauma dressing. C\) administer an IV analgesic. D\) soak the dressing with sterile saline. Ans: A 147\. How can you tell if bleeding from the ears or nose contains cerebrospinal fluid (CSF)? A\) CSF clots within 10 seconds. B\) CSF has a high glucose content. C\) CSF is a bright yellow color.\ D) CSF has a dark brown color. Ans: B 148\. Which of the following organs or body systems requires a constant blood supply, regardless of external factors? A\) Skin B\) Muscles C\) Kidneys D\) Gastrointestinal tract Ans: C 149\. A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should be MOST suspicious that this patient has: A\) tetanus. B\) meningitis. C\) a viral infection. D\) a staph infection. Ans: A 150\. A patient taking \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ would MOST likely experience a delay in the healing of a wound. A\) antidepressants B\) acetaminophen C\) antihypertensives D\) corticosteroids Ans: D 151\. A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure and a pressure dressing, the wound continues to bleed heavily. You should: A\) apply supplemental oxygen and keep her warm. B\) elevate the extremity above the level of her heart. C\) apply a tourniquet between her elbow and wrist. D\) locate and apply digital pressure to the brachial artery. Ans: C 152\. All of the following are functions of the skin, EXCEPT: A\) providing the immune response for the body. B\) protecting the underlying tissue from injury. C\) sensing changes in the external environment. D\) assisting in the regulation of body temperature. Ans: A 153\. The skin helps regulate body temperature through: A\) peripheral vasodilation, which shunts cool blood to the core of the body. B\) the production of sweat, which is evaporated from the surface of the skin. C\) increased elastin production, which provides insulation to the epidermis. D\) cutaneous vasoconstriction, which brings warm blood to the skin\'s surface. Ans: B 154\. When applying a dressing and bandage to a scalp wound, you should: A\) carefully assess the skull for an underlying fracture. B\) remove any foreign particles from the wound first. C\) always use a loose dressing to soak up the blood. D\) apply a cervical collar in case the c-spine is injured. Ans: A 155\. When caring for a patient with an open chest wound, you should: A\) routinely transport the patient in a left lateral recumbent position. B\) place a porous dressing over the wound and secure it on three sides. C\) secure a dressing in place by circumferentially wrapping the chest. D\) frequently assess breath sounds for indications of a pneumothorax. Ans: D 156\. A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves: A\) instructing your partner to resume one-rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes. B\) continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20 to 24 breaths per minute. C\) performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes. D\) continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary. Ans: D 157\. A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 99% on room air. He denies any other injuries. Initial management for this patient involves: A\) applying ice to the burn to provide immediate pain relief. B\) applying cool, wet dressings to the burn and elevating his arm. C\) starting an IV of normal saline and administering 2 mg of morphine. D\) administering oxygen and applying an anesthetic cream to the burn. Ans: B 158\. A superficial burn is: A\) usually painless because the nerve endings are not exposed. B\) characterized by reddened skin with varying degrees of pain. C\) painful, but will heal spontaneously, often with scar formation. D\) a second-degree burn that is characterized by blister formation. Ans: B 159\. Which of the following statements regarding carbon monoxide (CO) poisoning is correct? A\) Never rule out CO poisoning because of the absence of cherry red skin. B\) The most common symptom of CO poisoning is chest pressure. C\) CO results in systemic hypoxia by disintegrating red blood cells. D\) Hyperbaric therapy is beneficial only if CO levels are above 40%. Ans: A 160\. Which of the following statements regarding the rule of palms is correct? A\) The patient\'s palm, excluding the fingers, represents 1% of his or her total body surface area. B\) The rule of palms is not an accurate estimator of total body surface area burned in pediatric patients. C\) The patient\'s palm, including the fingers, represents 1% of his or her total body surface area. D\) The rule of palms is most accurate when a patient has experienced burns to less than 20% of his or her total body surface area. Ans: A 161\. You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to: A\) remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. B\) administer at least 2 L of normal saline solution to prevent renal failure. C\) thoroughly assess and clean the entry and exit wounds to prevent an infection. D\) reassess his vital signs every 15 minutes and treat any fractures or dislocations. Ans: A 162\. A 51-year-old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to: A\) suction her oropharynx for up to 15 seconds. B\) manually stabilize her head in a neutral position. C\) control the intraoral bleeding with sterile gauze. D\) ensure that she is sitting up and leaning forward. Ans: D 163\. If you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform: A\) nasotracheal intubation. B\) a needle or surgical cricothyrotomy. C\) pharmacologically assisted intubation. D\) digital (tactile) intubation. Ans: B 164\. In addition to massive bleeding, injury to a carotid or vertebral artery would MOST likely cause: A\) hemiparalysis. B\) an air embolism. C\) severe bradycardia. D\) cerebral hypoxia. Ans: D 165\. When managing the airway of an unresponsive patient with serious anterior neck trauma and shallow breathing, you should: A\) apply a cervical collar and perform intubation immediately. B\) ventilate the patient with an oxygen-powered ventilation device. C\) give oxygen via nonrebreathing mask and apply a pulse oximeter. D\) assist ventilations with a bag-mask device and prepare to intubate. Ans: D 166\. You are dispatched to a high school where a 16-year-old male was stabbed in the eye with a pencil. The patient is conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient\'s injury includes: A\) irrigating the injured eye with sterile saline, covering both eyes with a protective eye shield, and transporting immediately. B\) applying an icepack to the affected eye, administering 1 µg/kg of fentanyl IM, elevating the patient\'s legs, and transporting. C\) covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly. D\) covering the affected eye with a moist, sterile dressing, applying gently pressure to reduce intraocular pressure, and transporting at once. Ans: C 167\. A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves: A\) hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center. B\) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. C\) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. D\) applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital. Ans: C 168\. A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient\'s clinical presentation is MOST consistent with: A\) neurogenic shock. B\) intracranial pressure. C\) autonomic dysreflexia. D\) symptomatic bradycardia. Ans: C 169\. A motorcycle or football helmet should be removed if: A\) the patient complains of severe neck pain and the helmet fits snugly. B\) you are going to transport the patient to a medical treatment facility. C\) the patient is breathing shallowly and access to the airway is difficult. D\) you are properly trained in the technique, even if you are by yourself. Ans: C 170\. General treatment for a 40-year-old patient with a significant head injury and signs of Cushing triad includes: A\) administering a corticosteroid. B\) ventilating at a rate of 30 breaths/min. C\) elevating the head 15 to 30 degrees. D\) a 20mL/kg bolus of normal saline. 171\. If the mechanism of injury indicates that your patient may have sustained a spinal cord injury: A\) contact medical control to determine if spinal immobilization is needed. B\) assume that a spine injury exists, regardless of the neurologic findings. C\) apply a cervical collar and transport the patient in a position of comfort. D\) fully immobilize the spine only if gross neurologic deficits are present. Ans: B 172\. You have intubated an unresponsive, apneic patient with a suspected spinal injury. After confirming proper ET tube placement and securing the tube, you should: A\) request medical control authorization to give Solu-Medrol. B\) ventilate at 10 to 12 breaths/min and monitor end-tidal CO2. C\) maintain an end-tidal CO2 reading of greater than 45 mm Hg. D\) provide mild hyperventilation in case a head injury is present. Ans: B 173\. A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to: A\) perform intubation to secure the patient\'s airway. B\) rapidly assess the chest for signs of a sternal fracture. C\) start an IV line and administer an antiarrhythmic drug. D\) attach the ECG leads and be prepared to defibrillate. Ans: D 174\. A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. After performing your primary assessment and administering high-flow oxygen, you assess her chest and note a segment of obviously fractured ribs that bulges outward during exhalation. You should: A\) increase intrathoracic pressure with a demand valve. B\) apply a bulky dressing to the segment of fractured ribs. C\) position her on her injured side and monitor her breathing. D\) apply pressure to the segment of ribs as the patient inhales. Ans: B 175\. Immediate treatment for an open pneumothorax involves: A\) assisting ventilations with a bag-mask device. B\) covering the open wound with a porous dressing. C\) converting the pneumothorax to a closed injury. D\) administering oxygen via nonrebreathing mask. Ans: C 176\. Which of the following is an appropriate site for performing a needle thoracentesis: A\) superior to the third rib into the intercostal space at the midclavicular line. B\) just below the second rib into the intercostal space at the midaxillary line. C\) just above to the fifth rib into the intercostal space at the midaxillary line. D\) inferior to the third rib into the intercostal space at the midclavicular line. Ans: A 177\. You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and: A\) loud heart tones. B\) respiratory distress. C\) a bounding pulse. D\) normal lung sounds. Ans: D 178\. Following blunt force trauma to the lower right rib cage, a 40-year-old man presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that he has a: A\) pyloric injury. B\) liver injury. C\) splenic rupture. D\) pneumothorax. Ans: B 179\. Grey Turner sign is defined as ecchymosis to the \_\_\_\_\_\_\_\_\_ and is indicative of \_\_\_\_\_\_\_\_\_. A\) umbilicus, peritoneal bleeding B\) epigastrium, stomach rupture C\) flank, retroperitoneal bleeding D\) back, traumatic aortic dissection Ans: C 180\. In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of: A\) 70 to 80 mm Hg B\) 100 to 110 mm Hg C\) 80 to 09 mm Hg D\) 90 to 100 mm Hg Ans: C 181\. What do the spleen and liver have in common? A\) They are both highly vascular and bleed profusely when injured. B\) The liver and spleen are well protected by the abdominal muscles. C\) They are less likely to be crushed by blunt trauma than other organs. D\) The liver and spleen are the only solid organs in the abdominal cavity. Ans: A 182\. You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient\'s chances of survival? A\) Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route B\) Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center C\) Application and inflation of the PASG, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center D\) Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route Ans: A 183\. A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should: A\) splint the elbow in the position found and reassess distal circulation. B\) carefully straighten the arm to facilitate placement of a vacuum splint. C\) apply a sling and swathe to immobilize the injury and then apply heat. D\) administer fentanyl for pain relief and then carefully straighten the arm. Ans: A 184\. Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT: A\) pulmonary edema. B\) pleuritic chest pain. C\) right-sided heart failure. D\) tachycardia and tachypnea. Ans: A 185\. During your assessment of a patient with a femur fracture, you discover a rapidly expanding hematoma on the medial aspect of his thigh. What should you suspect? A\) Venous thrombus B\) Fasciitis C\) Compartment syndrome D\) Arterial injury Ans: D 186\. In a closed femur fracture, blood loss may exceed \_\_\_\_\_\_\_ before enough pressure develops to tamponade the bleeding. A\) 250 mL B\) 500 mL C\) 750 mL D\) 1,000 mL Ans: D 187\. You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: A\) immediately stabilize both lower extremities. B\) remove his helmet and apply a cervical collar. C\) manually stabilize his head and assess his airway. D\) carefully straighten his legs and assess distal pulses. Ans: C 188\. A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient\'s friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The MOST effective way to treat this situation is to: A\) attach a portable ventilator that provides positive end-expiratory pressure. B\) insert a nasogastric tube and remove any water from the patient\'s stomach. C\) increase your ventilation rate to 15 breaths/min and provide higher volume. D\) administer morphine sulfate to promote venous pooling and decreased preload. Ans: A 189\. A 45-year-old man presents with severe cramps in his legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95°F and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. His blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The MOST appropriate treatment for this patient involves: A\) giving him a salt-containing solution to drink, applying chemical ice packs to the back of his neck, and discouraging further activity for the day. B\) administering high-flow oxygen, gently massaging his lower extremities to enhance circulation, administering 1 µg/kg of fentanyl IM, and transporting. C\) offering him oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation. D\) having him chew salt tablets, starting an IV with D5W at a keep-vein-open rate, administering 12.5 mg of promethazine IV, and transporting to the hospital. Ans: C 190\. A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should be MOST suspicious that this patient has a(n): A\) poorly healed diabetic ulcer. B\) local reaction to an ant bite. C\) infection caused by a tick. D\) brown recluse spider bite. Ans: D 191\. Any diver who loses consciousness immediately following a dive should be assumed to have experienced: A\) barotrauma. B\) nitrogen narcosis. C\) an air embolism. D\) decompression sickness. Ans: C 192\. Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for: A\) nitrogen narcosis. B\) a tension pneumothorax. C\) decompression sickness. D\) an arterial gas embolism. Ans: D 193\. Law enforcement requests your assistance for a 40-year-old man whom they found in an alley. According to one police officer, the patient is "probably drunk." The outside temperature is 37°F with a light wind and drizzle. The patient, who is conscious but confused, is shivering and has slurred speech. His skin is cold and pale, his heart rate is 68 beats/min and regular, and his respirations are 24 breaths/min and regular. After moving the patient into the warmed ambulance, you should: A\) assess his blood pressure, apply chemical heat packs to his neck, groin, and axillae, infuse 250 to 500 mL of warm normal saline, and administer one or two tubes of oral glucose. B\) remove his wet clothing, apply warm blankets, administer supplemental oxygen, assess his blood glucose level and blood pressure, and start an IV with warm normal saline. C\) apply warm layered blankets, administer 100 mg of thiamine IM, administer oxygen via nasal cannula, start an IV line with lactated Ringer\'s solution, and administer 25 grams of 50% dextrose. D\) remove his wet clothing, apply chemical heat packs directly to the groin, assess his blood glucose level and treat with dextrose if it is less than 80 mg/dL, and administer high-flow oxygen. Ans: B 194\. On the ECG, an Osborne wave can be recognized as: A\) a negative deflection that produces a biphasic P wave. B\) acute widening of the QRS complex during the R wave. C\) an upward slurring at the beginning of the QRS complex. D\) a positive deflection immediately after the QRS complex. Ans: D 195\. How does CPR change after an advanced airway device is inserted? A\) One breath should be delivered every 10 to 12 seconds. B\) Ventilations should be faster after the device is inserted. C\) Ventilations should be asynchronous with chest compressions. D\) Cycles of 30 compressions and 2 breaths should be delivered. Ans: C 196\. You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that: A\) the patient is defibrillated one time every 60 seconds as necessary. B\) the person managing the airway delivers one breath every 3 to 5 seconds. C\) no one person performs chest compressions for more than 5 minutes at a time. D\) compressions are hard and fast, with full chest recoil between compressions. Ans: D 197\. Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT: A\) epinephrine. B\) cardiac pacing. C\) vasopressin. D\) IV fluid boluses. Ans: B 198\. A 6-year-old, 40-pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to: A\) defibrillate with 70 joules. B\) insert an advanced airway. C\) check for a carotid pulse. D\) insert an IO catheter. Ans: A 199\. A patient remains in pulseless ventricular tachycardia despite two shocks, a dose of epinephrine, high-quality CPR, and 300 mg of amiodarone. Following the next shock, you should resume CPR and then: A\) cardiovert with 100 biphasic joules. B\) administer 150 mg of amiodarone. C\) double the dose of the epinephrine. D\) administer 1.5 mg/kg of lidocaine. Ans: B 200\. After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus tachycardia. In addition to continuing ventilations, what should be done next? A\) Amiodarone infusion B\) Hypothermia treatment C\) Dopamine infusion D\) Crystalloid fluid bolus Ans: B 201\. You and your partner are off duty and are playing golf. Suddenly, you see an elderly man grab his chest and collapse to the ground. You should: A\) tell your partner to call 9-1-1 as you proceed to assess the man. B\) both proceed to the man and begin two-rescuer CPR if needed. C\) perform 2 minutes of CPR if needed and then call an ambulance. D\) tell the man\'s golf buddy to perform a precordial thump at once. Ans: A 202\. You and your partner arrive at the scene of an unresponsive middle-aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient? A\) Five minutes of CPR prior to analyzing his cardiac rhythm B\) CPR at the appropriate rate and with minimal interruptions C\) Prompt insertion of an advanced airway to prevent aspiration D\) Immediate defibrillation for presumed ventricular fibrillation Ans: B 203\. You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next: A\) give 300 mg of amiodarone via rapid IV or IO push. B\) give 40 units of vasopressin while CPR is ongoing and reassess in 2 minutes. C\) push the synchronize button on the defibrillator and cardiovert with 200 joules. D\) give 1 to 2 g of magnesium sulfate without interrupting chest compressions. Ans: D 204\. A patient with severe dehydration is found to be hypotensive during your assessment. The MOST important intervention in this case is: A\) applying blankets to keep the patient warm. B\) immediate fluid resuscitation at the scene. C\) transport with fluid resuscitation en route. D\) high-flow oxygen via nonrebreathing mask. Ans: C 205\. A patient with suspected internal bleeding has a systolic BP of 104 mm Hg. What is the appropriate fluid management? A\) 500 mL, repeated one time B\) Fluid challenge is not necessary C\) 250 mL, repeated twice D\) h5 to 10 mL/kg, repeated one time Ans: B 206\. 73. A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of \_\_\_\_\_\_\_\_\_\_\_\_\_ shock A\) neurogenic B\) obstructive C\) psychogenic D\) hypovolemic Ans: C 207\. Anaerobic metabolism is the process in which: A\) the cells produce carbon dioxide and water. B\) adequate amounts of oxygen reach the cell level. C\) the adrenal glands fail to release catecholamines. D\) inefficient cellular metabolism produces lactic acid. Ans: D 208\. By which of the following mechanisms do patients with septic shock become hypovolemic? A\) Sustained systemic vascular dilation B\) Fluid leakage out of the vascular space C\) Spontaneous destruction of red blood cells D\) Frequent and severe vomiting and diarrhea Ans: B 209\. Carbonic acid is formed by the combination of: A\) water and bicarbonate. B\) water and hemoglobin. C\) lactate and pyruvic acid. D\) water and carbon dioxide. Ans: D 210\. If you can feel a pulse over the femoral artery of an adult, but are unable to feel a pulse over the radial artery, his or her systolic blood pressure is MOST likely between \_\_\_ and \_\_\_ mm Hg. A\) 60, 70 B\) 70, 80 C\) 80, 90 D\) 90, 100 Ans: B 211\. Shock in the trauma patient should be considered \_\_\_\_\_\_\_\_\_\_\_\_\_ until proved otherwise. A\) hemorrhagic B\) distributive C\) obstructive D\) neurogenic Ans: A 212\. Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock? A\) They cause platelets to clump together. B\) They do not expand the circulating volume. C\) They do not have oxygen-carrying capacity. D\) They increase the viscosity of the blood. Ans: C 213\. According to the Apgar score, a newborn with a heart rate of 80 beats/min and slow, irregular breathing should receive a combined score of: A\) 2. B\) 3. C\) 4. D\) 5. Ans: A 214\. After performing the initial steps of resuscitation, you assess a newborn and note that its respirations are poor and its pulse rate is 50 beats/min. You should: A\) immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn\'s pulse rate in 30 seconds. B\) begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation. C\) begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube. D\) perform tactile stimulation for 30 seconds, reassess the infant\'s respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement. Ans: B 215\. Chest compressions are indicated in the newborn if its heart rate remains less than \_\_\_\_ beats/min despite effective positive-pressure ventilations for \_\_\_\_ seconds. A\) 80, 30 B\) 60, 30 C\) 60, 60 D\) 80, 60 Ans: B 216\. During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment of the newborn reveals that it is active, has a strong cry, and has a heart rate of 110 beats/min. You should: A\) deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator. B\) avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an ET tube. C\) preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation. D\) ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring. Ans: D 217\. Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will MOST likely cause improvement in this newborn\'s condition? A\) 0.3 mg of naloxone B\) 32 mL of normal saline C\) 6.5 mL of 10% dextrose D\) 0.06 mg of epinephrine Ans: B 218\. You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather in the vicinity. A peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn\'s heart rate suddenly drops more. You should: A\) abort the intubation attempt and continue ventilations. B\) continue the intubation attempt and administer atropine. C\) administer 0.1 to 0.3 mL/kg of epinephrine rapid IV push. D\) ensure that chest compressions are of adequate rate and depth. Ans: A 219\. You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant\'s abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The MOST appropriate intervention involves: A\) intubating immediately. B\) suctioning the oropharynx. C\) inserting an orogastric tube. D\) manual gastric decompression. Ans: C 220\. A 10-month-old infant presents with an acute onset of increased work of breathing. According to the infant\'s mother, the child was crawling around in the living room prior to the event and was fine 10 minutes earlier. Your assessment reveals that the infant appears alert to his surroundings, has loud inspiratory stridor, and pink skin. You should: A\) look inside the infant\'s mouth using a tongue blade and penlight. B\) avoid agitating the infant, offer supplemental oxygen, and transport. C\) deliver five sharp back slaps between the infant\'s shoulder blades. D\) apply a pediatric nonrebreathing mask and transport expeditiously. Ans: B 221\. A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child\'s grandmother, his symptoms began suddenly about 30 minutes ago. You should be MOST suspicious for: A\) acute viral croup. B\) bacterial epiglottitis. C\) subglottic narrowing. D\) laryngotracheobronchitis. Ans: B 222\. A 13-year-old, 40-pound girl is experiencing an acute asthma attack that has been unresponsive to 3 puffs of her albuterol inhaler. She is conscious and alert, but is notably dyspneic and has diffuse wheezing. In addition to administering supplemental oxygen, you should: A\) give 0.35 mg of epinephrine 1:1,000 SQ. B\) give 0.5 mg of nebulized ipratropium. C\) administer another 2.5-mg dose of albuterol. D\) assist her ventilations with a bag-mask device. Ans: B 223\. A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should: A\) manually stabilize her head and neck in a neutral position, insert a nasal airway, and hyperventilate her at a rate of 35 breaths/min. B\) suction her mouth and nose for no longer than 15 seconds, insert an oral airway, and apply high-flow oxygen with a pediatric nonrebreathing mask. C\) open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device. D\) insert an oral airway, apply a cervical collar, preoxygenate her with a bag-mask device and 100% oxygen for 30 seconds, and intubate her trachea. Ans: C 224\. A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child\'s mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child\'s ventilations with high-flow oxygen, your partner informs you that the child\'s heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should: A\) ask your partner to insert an IO catheter and administer epinephrine 1:10,000. B\) attempt immediate transcutaneous pacing while continuing ventilation assistance. C\) establish immediate vascular access and administer 0.02 mg/kg of atropine sulfate. D\) initiate one-rescuer CPR while your partner attempts to establish vascular access. Ans: D 225\. A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should: A\) apply chemical ice packs to the child\'s face to try to slow her heart rate. B\) establish vascular access and administer a 20-mL/kg normal saline bolus. C\) start an IV line and give adenosine while monitoring her cardiac rhythm. D\) transport immediately and establish vascular access en route to the hospital. Ans: B 226\. A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves: A\) administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations. B\) conducting a focused history and physical exam and allowing him to breathe room air to see if his oxygen saturation falls. C\) recognizing that the child is in respiratory failure and making immediate preparations to perform endotracheal intubation. D\) assisting his ventilations with a bag-mask device and determining if his tachycardia is ventricular or supraventricular in origin. Ans: A 227\. Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should: A\) closely monitor the child\'s cardiac rhythm. B\) premedicate with 0.04 mg/kg of atropine. C\) limit your intubation attempt to 10 seconds. D\) use a curved blade instead of a straight blade. Ans: A 228\. If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should position him or her supine and then: A\) visualize the upper airway. B\) perform chest compressions. C\) assess for a carotid pulse. D\) perform abdominal thrusts. Ans: B 229\. Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform: A\) intubation. B\) cardioversion. C\) defibrillation. D\) CPR for 5 minutes. Ans: C 230\. The pediatric assessment triangle will help answer all of the following questions, EXCEPT: A\) "Is the child sick or not sick?" B\) "Will the child cooperate during my exam?" C\) "Does the child require emergency treatment?" D\) "What is the most likely physiologic abnormality?" Ans: B 231\. To maintain a neutral airway position in an unresponsive infant, you should: A\) slightly extend the infant\'s head. B\) pad underneath the infant\'s occiput. C\) place a towel roll under the shoulders. D\) insert an appropriate-sized oral airway. Ans: C 232\. Ventilating a child too fast with a bag-mask device may cause: A\) cerebral vasodilation B\) severe hypercarbia C\) reflex hypertension D\) decreased preload Ans: D 233\. You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child\'s residence, you can hear a loud, barking cough. You find the child sitting on his mother\'s lap. He is conscious and appears alert to his surroundings. According to the child\'s mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should: A\) administer high-flow oxygen via pediatric nonrebreathing mask, keep him calm, and transport. B\) establish vascular access, give an appropriate dose of methylprednisolone, and transport. C\) administer 0.5 mL of racemic epinephrine via nebulizer, apply the cardiac monitor, and transport. D\) allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital. Ans: D 234\. Your primary assessment of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should: A\) continue high-quality CPR and reassess in 2 minutes. B\) defibrillate with 40 joules and immediately resume CPR. C\) start an IV and administer 0.2 mg of epinephrine 1:10,000. D\) charge the defibrillator to 80 joules while CPR is ongoing. Ans: B 235\. A 71-year-old man with a history of emphysema, coronary artery disease, and hypertension presents with increased shortness of breath and fatigue. His oxygen saturation is 80% on home oxygen at 2 L/min via nasal cannula. His blood pressure is 140/76 mm Hg, pulse rate is 104 beats/min, and respirations are 28 breaths/min and labored. His medications include an albuterol inhaler, prednisone, hydrochlorothiazide, and lisinopril. Auscultation of his lungs reveals scattered wheezing in all fields. Which of the following prehospital interventions is NOT indicated for this patient? A\) Nebulized ipratropium B\) Subcutaneous epinephrine C\) High-flow oxygen therapy D\) Continuous positive airway pressure Ans: B 236\. An 82-year-old man presents with confusion that has worsened progressively over the past 2 weeks. Because of his confusion and the fact that he is hearing impaired, you obtain the majority of your medical history information from his daughter. She tells you that her father has high blood pressure but refuses to take medication for it. She also tells you that she thinks he fell about 3 weeks ago, although he denies falling. The patient\'s blood pressure is 168/98 mm Hg, pulse rate is 60 beats/min and occasionally irregular, and respirations are 22 breaths/min and regular. This patient MOST likely: A\) has an acute onset of dementia. B\) is experiencing a subdural hematoma. C\) had a stroke secondary to atrial fibrillation. D\) has normal age-related physiologic changes. Ans: B 237\. Failure of the heart\'s primary pacemaker and the development of alternate pacemakers in the atria would MOST likely result in: A\) junctional rhythms. B\) atrioventricular block. C\) ventricular ectopy. D\) atrial fibrillation. Ans: D 238\. 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 Ans: D 239\. You are assessing an 80-year-old man who complains of generalized weakness. He denies chest pain or shortness of breath and tells you that he has become progressively weaker over the past 3 days. His medical history is significant for two prior heart attacks, hypertension, chronic renal insufficiency, and atrial fibrillation. His blood pressure is 108/60 mm Hg, pulse rate is 94 beats/min and irregular, and respirations are 20 breaths/min and unlabored. Auscultation of his lungs reveals scattered crackles, and the ECG reveals atrial fibrillation. In addition to administering supplemental oxygen, you should: A\) start an IV with D5W, assess his blood glucose level, and administer half the usual dose of diltiazem to lower the rate of his atrial fibrillation. B\) obtain a 12-lead ECG tracing, start an IV line with normal saline and give a 250-mL fluid bolus, reassess his blood pressure, and transport him. C\) establish vascular access, administer 2 mg of morphine to treat his apparent pulmonary edema, continue to monitor the ECG, and transport. D\) obtain a 12-lead ECG tracing, assess his blood glucose level, establish vascular access and set the rate to keep the vein open, and transport to the hospital. Ans: D 240\. You are called to a residence for a 74-year-old woman who fainted. During your assessment, the patient\'s son tells you that he was standing next to his mother when she fainted and that he caught her before she fell to the floor. He further tells you that his mother has angina and kidney disease. The patient is now conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 110 beats/min and weak, and respirations are 22 breaths/min and regular. As your partner administers supplemental oxygen to the patient, you should: A\) assess for the presence of a nitroglycerin patch on the patient and remove it if she is wearing one. B\) quickly establish vascular access and administer a 20-mL/kg bolus of an isotonic crystalloid. C\) obtain a detailed list of all of the patient\'s medical problems and the medications that she is taking. D\) perform a rapid head-to-toe assessment to determine if she has gross injuries or any hidden conditions. Ans: A 241\. 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. Ans: C 242\. During your assessment of a 4-year-old female, you find injury patterns that are highly suggestive of abuse. The child\'s mother is present; she is apprehensive and is hesitant to allow you to transport her daughter. Your MOST appropriate action should be to: A\) ask the mother to leave the room so that you can ask the girl if the injuries that she has were intentionally inflicted by someone else. B\) advise the mother that the child\'s injuries are inconsistent with accidental trauma and let her know that the child needs to be transported. C\) ask your partner to retrieve an extra set of latex-free gloves from the ambulance, as this will enable him or her to discreetly call the police. D\) act as though you are not suspicious, but call the child\'s father and inquire about the relationship between the child and her mother. Ans: C 243\. 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. Ans: B 244\. 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. Ans: D 245\. When treating a dialysis patient, it is especially important to: A\) keep the patient in a supine position. B\) elevate the arm with the AV fistula. C\) carefully titrate any IV fluids given. D\) treat acidosis with sodium bicarbonate. Ans: C 246\. You would MOST likely encounter the presence of a ventricular assist device in a patient who: A\) has severe emphysema. B\) has pulmonary hypertension. C\) is awaiting a heart transplant. D\) has transient right heart failure. Ans: C 247\. Air ambulances are advantageous for all of the following reasons, EXCEPT: A\) the ability to access remote areas. B\) faster transport to definitive care. C\) the availability of specialized equipment. D\) more experience of the flight paramedics. Ans: D 248\. In which of the following situations should a helicopter generally NOT be utilized? A\) A patient in cardiopulmonary arrest who has been unresponsive to defibrillation B\) Spinal injury in which the terrain over which the patient must be carried is rough C\) Suspected internal hemorrhage in a hypotensive patient who lives in a rural area D\) Motor vehicle crash involving a patient whose extrication will take 45 minute Ans: A 249\. Safe practices when parking your emergency vehicle on a roadway at night include all of the following, EXCEPT: A\) using your emergency flashers. B\) leaving the headlights on. C\) wearing a reflective vest. D\) turning off the strobe lights. Ans: B 250\. The paramedic