EMT Practice: Systems, Safety and Care Part 6

When transporting a stable patient with a paralyzed extremity, place the patient in a:

- supine position with the legs elevated 6 feet to 12 feet

- sitting position with the head at a 45• to 90• angle

- recumbent position with the paralyzed side up

- recumbent position with the paralyzed side down

When assessing for arm drift of a patient with a suspected stroke, you should:

- ask the patient to hold his or her arms up with the palms down

- ask the patient to close his or her eyes during the assessment

- observe movement of the arms for approximately 2 minutes

- expect to see one arm slowly drift down to the patient's side

When caring for a patient with documented hypoglycemia, you should be MOST alert for:

- a seizure

- an acute stroke

- a februle convulsion

- reapiratory distress

A 30-year-old male experienced a generalized (tonic-clonic) seizure, which stopped before you arrived at the scene. The patient is conscious, is answering your questions appropriately, and refuses EMS transport. Which of the following would be the MOST compelling reason to disagree with his refusal of transport?

- He is currently not prescribed any medications

- He has experienced seizures since he was 20

- His wife states that this was his "usual" seizure

- His Glascow Coma Scale (GCS) score is 15

Which of the following conditions would be the LEAST likely to mimic the signs and symptoms of a stroke?

- Hypoglycemia

- Intracranial bleeding

- Hypovolemia

- A postictal state

You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should:

- perform CPR for 5 minutes before applying the AED

- assess the patient for a facial droop and hemiparesis

- obtain a blood glucose sample to rule out hypoglycemia

- initiate CPR and attach an AED as soon as possible

Which of the following conditions would MOST likely affect the entire brain?

- Respiratory failure or cardiopulmonary arrest

- Reduced blood supply to the left hemisphere

- Ruptured cerebral artery in the occipital lobe

- Blocked cerebral artery in the frontal lobe

The MOST significant risk factor for a hemorrhagic stroke is:

- heavy exertion

- hypertension

- diabetes mellitus

- severe stress

Your patient opens his eyes, moans, and pulls away from you when you pinch his trapezius muscle. You should assign a Glasgow Coma Scale (GCS) score of:

- 9

- 8

- 7

- 6

The three major parts of the brain are the:

- cerebrum, cerebellum, and brain stem

- midbrain, cerebellum, and spinal cord

- cerebellum, medulla, and occiput

- brain stem, midbrain, and spinal cord

In cholecystitis, where is the patient likely to feel referred pain?

- Right shoulder

- Around the navel

- Right upper quadrant

- Left lower quadrant

You are assessing a patient reporting severe pain in his upper left and right abdominal quadrants radiating to the back. The patient reports that the pain got worse right after he ate lunch an hour ago. He also has nausea and vomiting, abdominal distention, and tenderness. Based on these signs and symptoms, which of the following conditions do you suspect?

- Pancreatitis

- Diverticulitis

- Esophagitis

- Appendicitis

Rebound tenderness is a result of what?

- GERD

- Ileus

- Esophageal varices

- Peritoneal irritation

Which of the following statements is true about acute renal failure?

- Kidney tissue shrinks and function diminishes over a period of years

- Often caused by diabetes or hypertension

- Requires dialysis or a kidney transplant

- Can be reversed with prompt diagnosis and treatment

What is the medical term for blood in the vomit?

- Uremia

- Melena

- Hematemesis

- Cholecystitis

What is it called when a patient tenses his abdominal muscles during your assessment?

- Guarding

- Splinting

- Tetany

- Rebound tenderness

Which of the following does NOT produce upper intestinal bleeding?

- Ulcerative colitis

- Esophageal varices

- Esophagitis

- Mallory-Weiss tear

You are assessing a 76-year-old man complaining of severe tearing radiating into his lower back. He is hypotensive and tachycardic. Which of the following should you suspect?

- Gallstones

- Cystitis

- Diverticulitis

- AAA

When assessing a patient's abdomen, what is the best position to place the patient in?

- Tradelenburg

- Supine

- Fowler

- Prone

Which of the following is a sign of peptic ulcer disease?

- Melena

- Diarrhea

- Cystitis

- Vomiting

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale and she is tachycardic. The EMT should suspect:

- esophageal varices

- esophagitis

- acute pancreatitis

- Mallory-Weiss tear

Solid abdominal organs include the:

- gallbladder and large intestine

- stomach and small intestine

- spleen, kidneys, and pancreas

- urinary bladder, colon, and ureters

In contrast to the parietal peritoneum, the visceral peritoneum:

- lines the walls of the abdominal cavity and is stimulated when the solid abdominal organs contract.

- is less likely to become inflamed or infected because it lines the abdominal organs themselves.

- is supplied by the same nerves from the spinal cord that supply the skin of the abdomen.

- is supplied by nerves of the autonomic nervous system, which are less able to localize pain or sensation.

A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to:

- protect her airway from aspiration.

- keep her supine and keep her warm.

- rapidly transport her to the hospital.

- give her high-flow supplemental oxygen.

An important aspect in the treatment of a patient with severe abdominal pain is to:

- encourage the patient to remain in a supine position.

- administer analgesic medications to alleviate pain.

- give 100% oxygen only if signs of shock are present.

- provide emotional support en route to the hospital.

Urinary tract infections are more common in ____________.

- active adults

- sedentary adults

- women

- men

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called:

- visceral pain.

- remote pain.

- referred pain.

- radiating pain.

Which of the following statements regarding dialysis is correct?

- Hemodialysis is effective but carries a high risk of peritonitis.

- Acute hypertension is a common adverse effect of dialysis.

- The purpose of dialysis is to help the kidneys retain salt and water.

- Patients who miss a dialysis treatment often present with weakness.

Functions of the liver include:

- secretion of bile and filtration of toxic substances.

- release of amylase, which breaks down starches into sugar.

- production of hormones that regulate blood sugar levels.

- absorption of nutrients and toxins.

The parietal peritoneum lines the:

- surface of the abdominal organs.

- retroperitoneal space.

- lungs and chest cavity.

- walls of the abdominal cavity

Which of the following is characteristic of peptic ulcer disease (PUD)?

- Burning or pain in the stomach that subsides immediately after eating

- The passage of bright red blood in the stool or coughing up blood

- Symptom relief after taking nonsteroidal anti-inflammatory drugs

- Sharp pain that is typically located in both lower abdominal quadrants

A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to:

- be alert for signs and symptoms of shock.

- transport him in a supine position.

- assess his blood pressure to determine perfusion adequacy.

- determine the exact location and cause of his pain.

A strangulated hernia is one that:

- spontaneously reduces without any surgical intervention.

- is reducible if surgical intervention occurs within 2 hours.

- can be pushed back into the body cavity to which it belongs.

- loses its blood supply due to compression by local tissues.

A 60-year-old female presents with a tearing sensation in her lower back. Her skin is sweaty and she is tachycardic. The EMT should suspect:

- kidney stones.

- aortic aneurysm.

- strangulated hernia.

- acute pancreatitis.

Most patients with abdominal pain prefer to:

- lie in a supine position with their knees in a flexed position.

- lie on their side with their knees drawn into the abdomen.

- sit in a semi-Fowler position with their knees slightly bent.

- sit fully upright because it helps relax the abdominal muscles.

Peritonitis may result in shock because:

- fluid shifts from the bloodstream into body tissues.

- severe pain causes systemic dilation of the vasculature.

- intra-abdominal hemorrhage is typically present.

- abdominal distention impairs cardiac contractions.

When assessing a patient with abdominal pain, you should:

- observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated.

- ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area.

- palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

- visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition.

The MOST important treatment for a patient with severe abdominal pain and signs of shock is:

- giving oral fluids to maintain perfusion.

- positioning the patient on his or her side.

- transporting the patient without delay.

- administering high-flow oxygen.

Which of the following organs assists in the filtration of blood, serves as a blood reservoir, and produces antibodies?

- Kidney

- Liver

- Spleen

- Pancreas

Injury to a hollow abdominal organ would MOST likely result in:

- leakage of contents into the abdominal cavity.

- impairment in the blood's clotting abilities.

- profound shock due to severe internal bleeding.

- pain secondary to blood in the peritoneum.

Diabetes is a metabolic disorder in which the body's ability to metabolize what is impaired?

- Fats

- Protein

- Glucose

- Electrolytes

What is the function of insulin in the body?

- It regulates oxygen flow to the cells.

- It regulates chemical production in the endocrine glands.

- It enables glucose in the blood to enter cells.

- It prevents glucose from oversaturating cells.

What is released when the concentration of glucose drops in the blood?

- Epinephrine

- Glucagon

- Dopamine

- Insulin

Which of the following is the most common metabolic disease of childhood?

- Diabetes mellitus type 2

- Ketoacidosis

- Hyperosmolar hyperglycemic nonketotic syndrome

- Diabetes mellitus type 1

Which of the following organs can rapidly sustain permanent damage when the body's glucose level is too low?

- Brain

- Liver

- Heart

- Kidney

Which of the following is a normal glucose level in an adult?

- 200 mg/dL

- 80 mg/dL

- 140 mg/dL

- 20 mg/dL

You are treating a 36-year-old patient displaying the following signs and symptoms: rapid, shallow respirations; pale, cool, clammy skin; tachycardia; weakness on the left side of the body; and confusion and irritability. What should you suspect?

- Symptomatic hyperglycemia

- DKA

- Symptomatic hypoglycemia

- Vasoocclusive crisis

The condition in which blood clots as a result of an abnormality of the system of coagulation is called what?

- Hemophilia

- Thrombophilia

- Sickle cell disease

- Thrombosis

Which of the following is classified as an autoimmune disorder?

- Sickle cell disease

- Acidosis

- Type 1 diabetes

- type 2 diabetes

In which condition are you most likely to encounter a vasoocclusive crisis?

- Hemophilia

- Sickle cell disease

- Thrombophilia

- Symptomatic hypoglycemia

Which of the following conditions is the diabetic patient at an increased risk of developing?

- Hepatitis B

- Alcoholism

- Blindness

- Depression

A patient with hypoglycemia will often present with which of the following signs/symptoms?

- Pale, cool, and clammy skin

- Deep, rapid respirations

- Hypertension

- Warm, red, and dry skin

Which of the following statements regarding glucose is correct?

- Most cells will function normally without glucose.

- The brain requires insulin to allow glucose to enter the cells.

- The brain requires glucose as much as it requires oxygen.

- Blood glucose levels decrease in the absence of insulin.

A 66-year-old woman experienced a sudden onset of difficulty breathing. She has a history of type 2 diabetes and deep vein thrombosis (DVT). On the basis of her medical history, which of the following should the EMT suspect?

- Congestive heart failure

- Diabetic ketoacidosis

- Pulmonary embolism

- Severe hypoglycemia

Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT:

- checking the medication's expiration date.

- requesting permission from medical control.

- ensuring the absence of a gag reflex.

- assessing the patient's mental status.

You are treating a 40-year-old male with a documented blood sugar reading of 480 mg/dL. The patient is semiconscious and breathing shallowly, and is receiving assisted ventilation from your partner. You should recognize that definitive treatment for this patient includes:

- dextrose.

- oxygen.

- insulin.

- glucagon.

The main function of the endocrine system is to _________.

- maintain homeostasis

- regulate blood flow

- produce glandular secretions

- regulate glucose and calcium

A patient with an altered mental status; high blood glucose levels; and deep, rapid breathing may have a condition known as __________.

- hyperosmolar hyperglycemic nonketotic coma

- hyperglycemic crisis

- hypoglycemic crisis

- diabetic ketoacidosis

Symptomatic hypoglycemia will MOST likely develop if a patient:


- takes too much of his or her prescribed insulin.

- eats a regular meal followed by mild exertion.

- misses one or two prescribed insulin injections.

- markedly overeats and misses an insulin dose.

A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days' duration. Her blood glucose level reads 320 mg/dL. If this patient's condition is not promptly treated, she will MOST likely develop:

- acidosis and dehydration.

- irreversible renal failure.

- severe insulin shock.

- hypoxia and overhydration.

The normal blood glucose level is between:

- 30 and 150 mg/dL.

- 60 and 80 mg/dL.

- 160 and 200 mg/dL.

- 80 and 120 mg/dL.

During your assessment of a 19-year-old male, you are told that he is being treated with factor VIII. This indicates that:

- he has hemophilia A.

- he has a thrombosis.

- he has thrombophilia.

- his blood clots too quickly.

Excessive eating caused by cellular "hunger" is called:

- polyphagia.

- polydipsia.

- dysphasia.

- dyspepsia.

A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing:

- hyperglycemia.

- hypoglycemia.

- an acute stroke.

- a heart attack.

Which of the following statements regarding sickle cell disease is correct?

- In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.

- Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly.

- Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a blood vessel.

- The red blood cells of patients with sickle cell disease are round and contain hemoglobin.

A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2 diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your assessment reveals that the patient is unresponsive. You should:

- open and maintain her airway and assess breathing.

- administer 100% oxygen via a nonrebreathing mask.

- assess for the presence of a medical identification tag.

- administer oral glucose between her cheek and gum.

In contrast to type 1 diabetes, type 2 diabetes:

- occurs when antibodies attack insulin-producing cells.

- is caused by resistance to insulin at the cellular level.

- is caused by a complete lack of insulin in the body.

- is commonly diagnosed in children and young adults.

The EMT should assess for hypoglycemia in small children with a severe illness or injury because:

- illness or injury causes the pancreas to produce less insulin.

- a child's cells do not uptake glucose as rapidly as adults' do.

- children overproduce insulin during severe illness or injury.

- children cannot store excess glucose as effectively as adults.

The two main types of cells contained in blood are called _________.

- platelets and plasma

- transport and clotting

- erythrocytes and leukocytes

- hemoglobin A and S

Classic signs and symptoms of hypoglycemia include:

- cool, clammy skin; weakness; tachycardia; and rapid respirations.

- warm, dry skin; irritability; bradycardia; and rapid respirations.

- warm, dry skin; hunger; abdominal pain; and deep, slow respirations.

- cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.

You are responding to a call where an 8-year-old has been stung by a wasp. His skin is pale with patches of raised red spots on his hands, arms, and face. These spots are most likely what?

- A fungal infection

- Acne

- Angioedema

- Urticaria

Why is epinephrine used for anaphylaxis?

- It stops the allergic reaction from progressing.

- It reverses bronchoconstriction and vasodilation.

- It slows tachycardia.

- It decreases blood flow.

What is an allergen?

- A substance that causes an allergic reaction

- A chemical substance released by the immune system in allergic reactions that is responsible for many of the symptoms of anaphylaxis, such as vasodilation

- A poison or harmful substance

- A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction

An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as what?

- Urticaria

- Allergic reaction

- Anaphylaxis

- Angioedema

You are treating a child with a bee sting. The stinger is still embedded in the child's skin. What should you do?

- Scrape the skin with the edge of a stiff object.

- Leave the stinger in place.

- Remove the stinger with tweezers.

- Squeeze the area around the stinger.

You have responded to a scene where the 33-year-old male patient is in obvious respiratory distress, breathing rapidly with audible wheezing. The patient's skin is flushed, red, and covered in hives. When you attempt to question the patient, you find he can speak in only two- to three-word sentences. Respirations are 28 breaths/min and labored. Pulse is 120 beats/min. Skin is pale and cool with widespread urticaria and angioedema of the lips. Blood pressure is 88/60 mm Hg, and SpO2 is 88%. Which of the following interventions should you administer first?

- Give the patient a nonsteroidal anti-inflammatory drug (NSAID).

- Administer epinephrine.

- Give the patient an antihistamine.

- Provide high-concentration oxygen.

When assessing a patient's breathing, you hear wheezing in all lung fields. What are you hearing?

- Crackling, moist breath sounds

- A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways

- A high-pitched whistling sound caused by bronchoconstriction

- A high-pitched noise heard primarily on inspiration

What is a wheal?

- Swelling of the tongue

- A poison or harmful substance

- A raised, swollen, well-defined area on the skin

- Widespread areas of generalized itching and/or burning that appear as multiple raised areas on the skin

Which of the following patients has the most significant chance of having a contraindication to epinephrine?

- A teenager with no history of allergies

- A 6-year-old with significant peanut allergies

- An 80-year-old male with a history of acute coronary syndrome

- A 47-year-old female with bronchospasms

What is the common dose of epinephrine contained in an adult EpiPen?

- 3 mg

- 0.3 mg

- 0.15 mg

- 1 mg

The stinger from a honeybee should be:

- squeezed with tweezers and removed.

- scraped away from the skin.

- left in place and covered.

- irrigated with copious amounts of water.

A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment of this patient?

- Administer oxygen, transport at once, and request a paramedic intercept.

- Remain at the scene with the patient and request a paramedic ambulance.

- Ask the patient if he has any diphenhydramine tablets that you can administer.

- Quickly determine if there are any bystanders who may carry epinephrine.

When a foreign substance invades the body, the body will __________.

- protect itself

- go on alert

- attempt to inactivate the foreign substance

- All of these answers are correct.

Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm.

- parasympathetic

- respiratory

- sympathetic

- cardiac

The effects of epinephrine are typically observed within _________ following administration.

- 30 minutes

- 1 minute

- 1 hour

- 30 seconds

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg.

- 0.1; 0.01

- 0.03; 0.3

- 0.01; 0.1

- 0.3; 0.15

Urticaria is the medical term for:

- burning.

- hives.

- swelling.

- a wheal.

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction?

- The patient's general physical appearance

- The time of year in which the exposure occurred

- The patient's family history

- The environment in which the patient is found

Anaphylaxis caused by stinging insects is typically an allergic reaction to ____________ rather than the bite or sting itself.

- injected poison

- irritating toxin

- deadly venom

- All of these answers are correct.

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction?

- Flushed, itching, or burning skin

- A sense of impending doom

- Tightness in the chest or throat

- All of these answers are correct.

Which of the following medications blocks the release of histamines?

- Diphenhydramine (Benadryl)

- Epinephrine (Adrenalin)

- Albuterol (Ventolin)

- Acetaminophen (Tylenol)

After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old woman with an allergic reaction, you note improvement in her breathing and dissipation of her hives. However, she is still anxious and tachycardic. You should:

- consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

- contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.

- transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine.

- monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.

Anaphylaxis is MOST accurately defined as a(n):

- allergic reaction that causes bronchodilation and vasoconstriction.

- moderate allergic reaction that primarily affects the vasculature.

- severe allergic reaction that typically resolves without treatment.

- extreme allergic reaction that may affect multiple body systems.

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________.

- quickly, within 30 minutes.

- slowly, over more than 30 minutes.

- slowly, over several hours.

- quickly, within 30 seconds.

A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should:

- administer oxygen and transport her to the hospital.

- advise her to see her physician as soon as possible.

- request a paramedic unit to administer epinephrine.

- position her legs well above the level of her heart.

At the site of the injury, signs and symptoms of an animal or insect bite or sting may include pain, localized heat, and a wheal, which appears as __________.

- a series of small, raised pustules

- an uncomfortable depression in the skin

- a raised, well-defined area of the skin

- a large area of red, blotchy skin

The goal of invaders such as bacteria and viruses is to __________.

- spread disease and destruction

- cause an immune response

- kill their human host

- use a human body as a home

Patients may experience allergic reactions to which of the following substances?

- Plant material

- Food and medications

- All of these answers are correct.

- Insect or animal bites and stings

Care for a victim of an immunologic emergency who is severely hypotensive should include which of the following?

- Routine spinal immobilization due to the potential for traumatic injury

- Position the patient's airway and initiate positive-pressure ventilations.

- Initiate basic life support measures, including the use of an automated external defibrillator, if necessary.

- Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature.

Which of the following sounds indicates swelling of the upper airway?

- Wheezing

- Rales

- Stridor

- Rhonchi