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Emergency Care (EMT), 13th Edition Test Bank

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    Exam Name___________________________________ MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following BEST describes a communication system capable of identifying the number and location of the phone from which a caller is calling? 1) A) Enhanced 911 B) Advanced 911 C) Data display 911 D) Priority dispatch 911 Answer: A Explanation: A) CORRECT. An enhanced 911 system has the capability of automatically identifying the caller's phone number and location. B) INCORRECT. Advanced 911 is an emergency texting system rather than a system for locating callers. C) INCORRECT. Data display 911 does not refer to a system capable of identifying a caller's location. D) INCORRECT. Priority dispatch 911 would refer more to an internal communication center protocol than a system for displaying locations and phone numbers. 2) Which of the following is the most common gateway for hospital services for patients who need emergency medical assistance? 2) A) Emergency medical dispatch center B) Emergency medical services system C) Surgical services department D) Emergency department Answer: D Explanation: A) INCORRECT. An emergency medical dispatch center coordinates transports to the hospitals, but is not involved in determining or promoting specific hospital services. B) INCORRECT. The EMS system is not generally involved with hospital services other than the emergency department. C) INCORRECT. Although an important component of a hospital's services, not all emergency medical patients will require surgery. D) CORRECT. The emergency department serves as the gateway for the rest of the services offered by a hospital. 3) The National Registry of Emergency Medical Technicians (NREMT) was founded to establish which of the following? 3) A) Quality oversight of emergency medical services practices B) Quality improvement and quality assurance programs for emergency medical services C) An education curriculum for EMT courses D) National standards for emergency medical services personnel Answer: D Explanation: A) INCORRECT. The NREMT created the standards used for modern EMS, but the organization does not oversee or determine the quality of provided services. B) INCORRECT. The NREMT developed the professional standards for emergency care personnel, but is not involved in quality improvement or any assurance of the care provided. C) INCORRECT. Although EMT course curricula are based on the standards provided by the NREMT, the National Registry was not founded to create them. D) CORRECT. In 1970, the National Registry of Emergency Medical Technicians (NREMT) was founded to establish national standards within the industry. 1

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    4) What is NOT one the common settings that an EMT may work in? 4) A) Ambulance services B) Rural/wilderness settings C) Fire departments D) Hospitals Answer: D Explanation: A) INCORRECT. One common setting that EMTs work in is ambulance services. B) INCORRECT. One common setting that EMTs work in is rural/wilderness settings. C) INCORRECT. One common setting that EMTs work in is fire departments. D) CORRECT. EMTs do not work in a hospital. 5) What BEST describes the level of EMS training that emphasizes use of advanced airway devices and some prehospital medication administration? 5) A) Advanced EMT B) EMT C) Emergency Medical Responder D) Paramedic Answer: A Explanation: A) CORRECT. The Advanced EMT (AEMT) provides basic - level care and transportation as well as some advanced - level care, such as use of advanced airway devices, monitoring of blood glucose levels, and administration of some medications, which may include intravenous and intraosseous administration. B) INCORRECT. EMTs provide basic - level medical and trauma care but cannot manage advanced airways or administer medications. C) INCORRECT. The first level of EMS training (Emergency Medical Responder) is primarily focused on activating the EMS system and immediate care for life - threatening injuries. D) INCORRECT. The Paramedic performs all of the skills of the EMT and AEMT plus advanced - level skills. The Paramedic provides the most advanced level of prehospital care. 6) Which of the following agencies is responsible for establishing EMS system assessment programs? 6) A) Department of Health and Human Services (HHS) B) National Highway Traffic Safety Administration (NHTSA) C) United States Health Services Agency (HSA) D) National Transportation Safety Board (NTSB) Answer: B Explanation: A) INCORRECT. The Department of Health and Human Services (HHS) is not responsible for EMS system assessment programs. B) CORRECT. The National Highway Traffic Safety Administration (NHTSA) Technical Assistance Program has established assessment programs with set standards for EMS systems. C) INCORRECT. The United States Department of Health and Human Services has no oversight of EMS systems. D) INCORRECT. The National Transportation Safety Board (NTSB) does not establish EMS system assessment programs. 2

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    7) Upon arrival at the hospital, the EMT advises hospital personnel of the patient's condition, observations from the scene, treatment rendered, and other pertinent data to assure continuity of care. This process is known as which of the following? 7) A) Definitive care B) Transfer of care C) End of tour D) Breach of duty Answer: B Explanation: A) INCORRECT. Definitive care refers to the type of care ultimately needed by a patient, not to the process of transferring the patient to hospital staff. B) CORRECT. Providing the receiving hospital staff with information on the patient's condition, observations of the scene, and other pertinent data so that there will be continuity of care is part of the transfer of care process. C) INCORRECT. The end of tour generally refers to the end of a scheduled EMS shift and is not related to patient care. D) INCORRECT. A breach of duty occurs when an EMT has a responsibility to care for a patient and does not follow through. 8) What is the minimum level of certification required of ambulance personnel responsible for direct patient care? 8) A) Emergency Medical Technician B) Emergency Ambulance Driver C) Emergency Medical Responder D) Advanced EMT Answer: A Explanation: A) CORRECT. In most areas, the Emergency Medical Technician (EMT) is considered the minimum level of certification for ambulance personnel. B) INCORRECT. Most ambulance personnel are expected to be at the EMT level or higher. C) INCORRECT. An Emergency Medical Responder (EMR) is below the EMT certification level, and below the minimum usually expected for ambulance personnel. D) INCORRECT. Advanced EMTs have a higher level of certification than what is commonly required as the minimum for ambulance personnel. 3

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    9) You and your new EMT partner arrive first on the scene of a single car rollover on the shoulder of a busy highway. You pull off in a safe location and just as you stop the ambulance, your partner throws the passenger door open, steps out of the truck, and begins jogging through the scattered debris toward the overturned car. You shout for him to stop and he looks back at you, but then continues to the vehicle and begins assessing the driver. Later, as you are restocking in the ambulance bay of the local trauma center your partner tells you that he thinks you acted unprofessionally by shouting at him. What is the best way to respond? 9) A) An EMT should never hurry to assist a patient. B) The On - Duty Supervisor should be called. C) New EMTs should expect partners to yell at them occasionally. D) Shouting was an attempt to protect the EMT from a potentially unsafe scene. Answer: D Explanation: A) INCORRECT. Emergency medical care sometimes does require responders to act quickly, but never when it places others on scene in danger. B) INCORRECT. It is important for EMT partners to be able to communicate effectively and professionally when debriefing calls. Generally, a Supervisor should only become involved if the EMTs cannot resolve a conflict themselves or if they need a specific question answered. C) INCORRECT. Although sometimes the noise level of a situation requires responders to raise their voices to be heard, expecting to be yelled at simply because one is a new EMT is not professional or correct. D) CORRECT. Quickly entering a dangerous scene without taking proper precautions will create additional risks. A professional EMT should always be concerned about the safety of everyone on scene; not just themselves and the patients, but other responders as well. In this case, shouting at the EMT was an appropriate attempt to prevent him from entering an unsafe situation. 10) Which of the following is a personal trait an EMT should demonstrate? 10) A) Strong communication B) Good eyesight C) Self - starter D) Strong student Answer: C Explanation: A) INCORRECT. Strong communication is obviously important for an EMT, but it is the result of certain personal traits (respectful, able to listen, controlled in tone, etc.) N not a personal trait itself. B) INCORRECT. Good eyesight is a critical physical trait for an EMT to have. C) CORRECT. One of the personal traits of an effective EMT is that of being a self - starter. D) INCORRECT. Being a strong student is a good quality, but personal traits relate to the behavior and demeanor of the EMT, not her strength in a particular task. 4

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    11) Which of the following BEST describes a person who speaks up on behalf of the patient and supports his cause? 11) A) Guardian B) Advocate C) Assistant D) Representative Answer: B Explanation: A) INCORRECT. A guardian is generally someone who is legally responsible for a patient, whether or not they support or advocate for them. B) CORRECT. EMTs should be advocates for their patients, speaking up for them and supporting them in getting appropriate care. C) INCORRECT. A person who assists a patient with tasks may not necessarily speak up for the patient or support them in seeking better care. D) INCORRECT. The term "representative" does not indicate the same level of personal involvement in a patient's care and outcome as an "advocate" has. EMTs should always see themselves as advocates for their patients. 12) The application of oxygen for a patient who is short of breath without having to contact the physician in the emergency department is an example of which of the following? 12) A) Standards of care B) Breach of duty C) On - line medical direction D) Standing orders Answer: D Explanation: A) INCORRECT. Standards of care refer to the expected actions of an EMT as compared to a reasonable person with the same level of training and in the same situation. It is not related to the authorization of specific skills. B) INCORRECT. A breach of duty occurs when an EMT has a responsibility to care for a patient and does not follow through. C) INCORRECT. On - line medical directions are orders from an on - duty physician given by radio or phone. D) CORRECT. Standing orders are physician issued policies or protocols that authorize EMTs to perform particular skills in certain situations. 13) Which of the following is a physical trait necessary for performing the duties of an EMT? 13) A) Ability to speak clearly B) Ability to remain calm in stressful situations C) Ability to lift and carry 200 pounds D) Nonjudgmental and fair Answer: A Explanation: A) CORRECT. An important requirement of an EMT is to have the physical ability to give and receive oral and written instructions. B) INCORRECT. An EMT's ability to remain calm in stressful situations is a critical personal trait. C) INCORRECT. An EMT would not be expected to lift or carry over 125 pounds, so it would not be considered a necessary ability to carry 200 pounds. D) INCORRECT. Being nonjudgmental and fair are important personal attributes for an EMT to have, but they are not physical traits. 5

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    14) What BEST describes the level of EMS training that emphasizes activation of the EMS system and provides immediate care for life - threatening problems? 14) A) Emergency Medical Dispatcher B) EMT C) Emergency Medical Responder D) Cardiac care responder Answer: C Explanation: A) INCORRECT. The Emergency Medical Dispatcher is responsible for coordinating the appropriate EMS response and potentially providing important instructions to the person calling for assistance. B) INCORRECT. EMTs provide basic - level medical and trauma care and transportation to a medical facility. C) CORRECT. The emphasis of an Emergency Medical Responder is on activating the EMS system and providing immediate care for life - threatening injuries, controlling the scene, and preparing for the arrival of the ambulance. D) INCORRECT. A cardiac care responder is not a recognized level of EMS training. 15) Which of the following is a role of the EMT in the quality improvement process? 15) A) Writing complete patient care reports B) Assuring personal safety C) Critiquing performance of one's partner D) Taking responsibility for the actions of one's partner Answer: A Explanation: A) CORRECT. Since much of an EMS system's clinical quality improvement data comes from patient care documentation, ensuring that each report is complete and accurate is a very important part of an EMT's involvement in quality improvement. B) INCORRECT. Although assuring personal safety is a very important responsibility for EMTs, it is not a role in the quality improvement process. Continuing education, equipment maintenance, gathering feedback from patients and hospital staff, preparing complete and accurate patient documentation, and getting involved in the EMS system's structured quality improvement program are all examples of roles for the EMT in a QI process. C) INCORRECT. Critiquing the performance of other emergency responders is not a primary role for EMTs in the quality improvement process. An EMT can best assist the process by preparing carefully written documentation, being involved in the system's quality improvement process, obtaining feedback from patients and hospital staff, maintaining equipment, and continuing his education. D) INCORRECT. The primary roles of an EMT in quality improvement include; preparing carefully written documentation, involvement in the system's quality improvement process, obtaining feedback from patients and hospital staff, maintaining equipment, and continuing education. Taking responsibility for the actions of others is not a part of the quality improvement process. 6

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    16) What level of emergency medical training provides the most advanced pre - hospital care? 16) A) Advanced EMT B) Paramedic C) Emergency Medical Technician D) Emergency Medical Responder Answer: B Explanation: A) INCORRECT. The AEMT provides basic - level care and transportation as well as some advanced - level care in the pre - hospital setting. B) CORRECT. The Paramedic performs all of the skills of the EMT and AEMT plus advanced - level skills. The Paramedic provides the most advanced level of prehospital care. C) INCORRECT. EMTs provide basic - level medical and trauma care and transportation to a medical facility. D) INCORRECT. Emergency Medical Responders are trained to activate the EMS system, provide immediate care for life - threatening injuries, control the scene, and prepare for the arrival of the ambulance. 17) After delivering a patient to the emergency department, you discuss with hospital staff the details of your care and ask for suggestions to improve your care. This is an example of your role in which of the following? 17) A) Continuing education B) Transfer of care C) Quality improvement D) Patient advocacy Answer: C Explanation: A) INCORRECT. Continuing education is ongoing structured training designed to supplement the EMT's original course. B) INCORRECT. Transfer of care is the process of turning care of a patient over to those with higher levels of training. C) CORRECT. Continuous self - review through numerous means with the purpose of identifying aspects of the system that require improvement is known as quality improvement. D) INCORRECT. A patient advocate is the person who speaks up for the patient and pleads her cause. 18) Which of the following refers to a program or process for evaluating and improving the effectiveness of an EMS system? 18) A) Total quality system B) Quality improvement C) Process Improvement Plan (PIP) D) System effectiveness management Answer: B Explanation: A) INCORRECT. The term "total quality system" does not refer to a program for improving the effectiveness of EMS systems. B) CORRECT. Quality improvement (QI) consists of continuous self - review with the purpose of identifying aspects of the EMS system that require improvement, with subsequent action plans to make subsequent changes. C) INCORRECT. A program or process for evaluating and improving the effectiveness of an EMS system is not referred to as a Process Improvement Program. D) INCORRECT. System effectiveness management does not refer to a program of evaluating and improving an EMS system. 7

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    19) The EMT's role in the quality improvement process includes becoming involved in the quality process, keeping carefully written documentation, obtaining feedback from patients and the hospital staff, continuing your education, and which of the following? 19) A) Being a member of the QI committee B) Providing quality care C) Maintaining your equipment D) Writing protocols and standing orders Answer: C Explanation: A) INCORRECT. Although it can be beneficial, being a member of the QI committee is not an expected role for an EMT in the quality improvement process. B) INCORRECT. Providing quality care is an expectation of all EMTs, but it not part of the quality improvement process. C) CORRECT. Maintaining equipment properly is an important role the EMT plays in the quality improvement process. D) INCORRECT. The Medical Director is responsible for writing protocols and standing orders. 20) You and your EMT partner are assigned to spend a day at the senior center where you are to inspect the rooms and common areas for fall hazards. Your partner is upset that he is not in the ambulance where the "action is." He complains that "looking for loose rugs" is a waste of his time. What would be the best response to his complaints? 20) A) Injury prevention in the community is an important component of EMS. B) It minimizes the number of 911 calls late at night. C) It is good practice for the next emergency call. D) It makes the taxpayers happy. Answer: A Explanation: A) CORRECT. Illness and injury prevention is an important component of EMS as EMTs are always in the field, and the role of EMS in public health is expected to only increase in the future. B) INCORRECT. Blood pressure screening clinics do not impact the number of late night 911 calls. C) INCORRECT. EMTs should already have competency in blood pressure techniques prior to hosting any screening clinics. D) INCORRECT. Although community relations are important, it is not the primary reason for checking blood pressures. 21) Which of the following is a personality trait required of EMTs? 21) A) Ability to dominate the patient B) Awareness of problems with color vision C) Control of personal habits D) Ability to lift and carry 125 pounds Answer: C Explanation: A) INCORRECT. Although the ability to dominate others may be considered a personality trait, it is not one required to be an EMT. B) INCORRECT. Awareness of a physical problem, such as color vision, is not related to the qualities that make up a person's character. C) CORRECT. To reduce the chances of providing improper care or causing patient discomfort, EMTs should be able to control their personal habits appropriately. D) INCORRECT. A physical ability is not a personality trait. 8

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    22) Which of the following is a component of patient advocacy? 22) A) Granting patient wishes and not reporting spousal abuse to the authorities B) Building rapport with the patient during transport to the hospital C) Immobilizing the neck of a patient with a possible spinal injury D) Providing oxygen to a patient that is short of breath Answer: B Explanation: A) INCORRECT. Patient advocacy is not supporting a patient whose wishes will ultimately be harmful or against the law. B) CORRECT. Building rapport with the patient is a critical component of advocacy. Without it, the EMT won't be able to know the patient's needs or challenges enough to effectively speak on their behalf. C) INCORRECT. This is simply an example of patient care. Advocacy is working to understand the patient so that the EMT can speak up for them and promote their needs. D) INCORRECT. Advocacy is about truly understanding the patient and speaking up for them to promote the best care possible, not simply providing an intervention. 23) To be compassionate and empathetic, to be accurate with interviews, and to inspire confidence are all examples of which of the personal traits of a quality EMT? 23) A) Emotionally stable B) Able to listen to others C) Judgmental but fair D) Pleasant Answer: B Explanation: A) INCORRECT. Emotional stability is the ability to overcome the unpleasant aspects of an emergency so that needed care may be rendered and any uneasy feelings that exist afterward may be resolved. B) CORRECT. To be compassionate and empathetic, to be accurate with interviews, and to inspire confidence are examples of the ability to listen to others. C) INCORRECT. Being nonjudgmental and fair means treating all patients equally regardless of race, religion, or culture. D) INCORRECT. Inspiring confidence and helping to calm the sick and injured are examples of being pleasant. 24) Which of the following BEST describes a list of steps the EMT should perform while assessing and managing emergency medical situations? 24) A) On - line medical direction B) Protocols C) Standard operating procedures D) Standing orders Answer: B Explanation: A) INCORRECT. On - line medical direction consists of orders from the on - duty physician given directly to an EMT in the field by radio or telephone. B) CORRECT. Protocols, which are developed by an agency's Medical Director, are lists of steps for assessment and interventions to be performed in different situations. C) INCORRECT. Standard operating procedures are a collection of policies around EMS agency operations and generally do not apply specifically to medical assessment or management. D) INCORRECT. Standing orders, also called off - line medical direction, allow EMTs to give certain medications or perform certain procedures without speaking to the Medical Director or another physician. 9

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    25) Which of the following is the primary responsibility of the EMT? 25) A) Maintain personal health and safety B) Provide emergency care C) Protect and stabilize the patient D) Communicate with other responders on the scene Answer: A Explanation: A) CORRECT. It is not possible to help a patient if you are not physically capable or are injured while performing your job, so your first responsibility is to keep yourself healthy and safe. B) INCORRECT. Providing emergency care is the EMT's purpose , but maintaining her own personal health and safety is the EMT's primary responsibility . C) INCORRECT. Although protecting and stabilizing the patient is an important aspect of the EMT's job, maintaining personal health and safety first is the priority. D) INCORRECT. Communicating with other emergency responders is necessary for effective scene safety and coordination, but the first priority for any EMT is to ensure their own health and safety. 26) Who is responsible for on - scene safety of EMS providers? 26) A) Triage officer B) All crew members C) Traffic director D) Law enforcement Answer: B Explanation: A) INCORRECT. The triage officer is not solely responsible for the on - scene safety of EMS providers. B) CORRECT. It is the responsibility of all EMS crew members to keep themselves, the patient(s), and bystanders safe. C) INCORRECT. The on - scene safety of EMS providers is not the responsibility of a traffic director. D) INCORRECT. Law enforcement personnel can be an important part of scene safety, but they are not necessarily responsible for the safety of EMS crews. 27) You have just come on duty. The EMT on the previous shift complains to you that the QI manager was giving him grief because he did not document three sets of vital signs on the patient record. The EMT is angry and does not understand why documenting three sets of vital signs is so important. What is the best answer you could give him? 27) A) Vital signs are something you have to fill out because the state requires it. B) It is important you show the QI manager that you are a team player. C) The report looks better when all the boxes are filled out. D) The recording of three sets of vital signs demonstrates that you were trending the patient's condition. Answer: D Explanation: A) INCORRECT. The local or state governmental authority may or may not require three sets of vital signs; regardless, this should not be the primary reason to document them. B) INCORRECT. Teamwork is an important trait in an EMT, but is not the driving factor for recording vital signs. C) INCORRECT. QI is not concerned with how the report looks, but rather that the information in the report is complete and accurate. D) CORRECT. Recording three sets of vital signs demonstrates that the EMT is reassessing the patient at the appropriate periodic intervals, which is important when providing care for a patient. 10

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    28) What BEST defines the evaluation of the patient's condition in order to provide emergency care? 28) A) Medical intervention B) Patient advocacy C) Patient access D) Patient assessment Answer: D Explanation: A) INCORRECT. A medical intervention is the care provided once what is wrong with the patient has been determined. B) INCORRECT. Patient advocacy is speaking up for the patient. C) INCORRECT. Patient access means getting to the patient's location. D) CORRECT. Patient assessment is used to find out enough about what is wrong with your patient to be able to provide the appropriate emergency care. 29) In 1966 the National Highway Safety Act charged which of the following agencies with the development of emergency medical service standards? 29) A) U.S. Department of Homeland Security B) U.S. Department of the Interior C) U.S. Department of Transportation D) U.S. Department of Health Services Answer: C Explanation: A) INCORRECT. Although the U.S. Department of Homeland Security is tasked with protecting the nation from threats, it was established in 2002 and did not exist in 1966. It was the U.S. Department of Transportation that was charged with developing EMS standards. B) INCORRECT. The U.S. Department of the Interior is charged with the management and conservation of federal land and the country's natural resources. The Department of Transportation was charged with developing EMS standards. C) CORRECT. In 1966 the National Highway Safety Act charged the United States Department of Transportation (DOT) with developing EMS standards and assisting the states to upgrade the quality of their prehospital emergency care. D) INCORRECT. Although the U.S. Department of Health and Human Services is charged with protecting the health of all Americans, the United States Department of Transportation was assigned the task of developing emergency medical service standards. 30) During the new employee orientation, the training officer meets with the new EMTs and explains to them the monthly training schedule and the classes they must attend for EMT recertification. One of the new EMTs asks the training officer why they have to keep taking EMT courses if they already passed the EMT examination. What is the best answer? 30) A) EMS is constantly evolving in response to evidence - based research. B) It looks good to a jury should the service be sued. C) EMTs forget everything once they pass the EMT exam. D) The state requires the training. Answer: A Explanation: A) CORRECT. Evidence - based scientific research is what drives changes in EMS. New and improved treatment techniques are derived from this research and the EMT needs to keep abreast of these dynamic changes to his profession. B) INCORRECT. Although continuing education can demonstrate to a jury that the service is providing adequate training, one of the goals of continuing education is to prevent lawsuits from happening in the first place, rather than to look good once a lawsuit has been filed. C) INCORRECT. Continuing education does provide EMTs with a good review of rarely used material; however, it is not accurate that EMTs forget everything once they pass the EMT exam. D) INCORRECT. Although continuing education is mandated by most states, it is not the reason continuing education is performed. 11

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    31) A fellow EMT is talking with the Medical Director at a staff meeting. The EMT states that the neighboring ambulance service is carrying special clotting bandages for serious bleeding wounds. The special bandages cost five times as much as the regular bandages, but the EMT claims they work ten times better. The EMT wants the Medical Director to approve the bandages for use in their ambulances. The Medical Director responds to the EMT by saying he will not approve the bandages until he can prove they are worth the additional cost. How can the EMT best prove the worth of the special bandages? 31) A) Perform a literature search to see what studies have been done on the special bandages and report the findings to the Medical Director. B) Call the manufacturer of the special bandage and request literature to give to the Medical Director. C) Order a small number of the special bandages and compare them side - by - side to the regular bandages. D) Have a member of the other ambulance service call the Medical Director to provide firsthand information on how the special bandages are much better. Answer: A Explanation: A) CORRECT. Finding objective, unbiased, evidence - based research that validates the claims of the special bandage is the only way to actually prove that the special bandages are superior. B) INCORRECT. Literature from the manufacturer is designed to sell the bandages and will only present the positives of the bandages without any negative information. C) INCORRECT. Product testing of the bandages is a good idea to determine how the bandages will work for that particular service, but does not provide proof that they are actually better. D) INCORRECT. Firsthand accounts or anecdotal information do not provide any actual scientific proof that the special bandages are superior. 32) You respond to a 35 - year - old male patient who fell 50 feet from a bluff. Your authority to provide emergency care is an extension of the Medical Director's license to practice medicine. You are acting as a(n) ________ of the Medical Director. 32) A) designated agent B) subordinate C) employee D) extension Answer: A Explanation: A) CORRECT. An EMT at a basic or advanced level is operating as a designated agent of the Medical Director. B) INCORRECT. Being a subordinate of the Medical Director does not provide any authority to provide emergency care. C) INCORRECT. An EMS system's Medical Director does not directly employ EMTs, and simply being an employee does not provide the authority to provide care. D) INCORRECT. An EMT does not provide care as an extension of the Medical Director. 12

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    33) Why is it important for EMTs to participate in quality improvement programs? 33) A) To identify problems and develop a plan to prevent their recurrence B) To ensure that individuals making false calls for EMS are prosecuted C) To identify problem employees and create a corrective action plan D) To ensure adequate personnel are available for emergencies Answer: A Explanation: A) CORRECT. EMS quality improvement programs consist of continuous self - review with the purpose of identifying aspects of the system that require improvement. Once a problem is identified, a plan is developed and implemented to prevent further occurrences of the same problem. It is critical that EMTs participate in this process because they usually have the best visibility to challenges within the system and can provide valuable insight into how to improve. B) INCORRECT. The aim of any EMS quality improvement program is to continually improve the care and operations within the system — not to identify challenges with particular individuals in the community. EMTs play a critical part in quality improvement by identifying areas in need of improvement, participating in the improvement process and supporting the changes. C) INCORRECT. EMTs should participate in Quality Improvement (QI) programs to assist in bettering their EMS systems and processes, not to pinpoint and create action plans for specific individuals. D) INCORRECT. An EMT's participation in an EMS quality improvement program is not necessarily about adequate staffing. It is about the EMT helping to identify and fix any components in the system that cause inefficiencies and challenges to patient care. 34) You and another new EMT are studying your local protocols. The other EMT notices that you may give oral glucose without utilizing on - line medical control, but you must get an on - line order from a physician before assisting a patient in taking his nitroglycerin for chest pain. The EMT asks you why some drugs require on - line medical control while others do not. What is the best answer to give him? 34) A) Glucose is only sugar so it cannot hurt the patient. B) The physician does not trust EMTs. C) The physician wants to be sure it is appropriate for the patient. D) The patient's nitroglycerin might be expired. Answer: C Explanation: A) INCORRECT. Although glucose is sugar and relatively safe, it can be harmful if given to an unresponsive patient. But ultimately, this answer does not explain why not to give nitroglycerin without a physician's order. B) INCORRECT. The reason protocols are written is not because physicians do not trust EMTs; they are written because EMTs do not have the advanced training that physicians have. C) CORRECT. Nitroglycerin, although indicated for most chest pain patients, is not appropriate for all cardiac patients. The physician, with his advanced training, is better suited to make that determination. D) INCORRECT. Although medications may be expired, this does not require contacting medical control to confirm. 13

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    35) What has the modern emergency medical services (EMS) system been developed to provide? 35) A) Prompt emergency response B) Prehospital care C) Safe emergency transportation D) Trained medical personnel Answer: B Explanation: A) INCORRECT. Prompt responses are an important part of any EMS system, but not what they were specifically developed to provide. B) CORRECT. In 1966 the National Highway Safety Act charged the United States Department of Transportation (DOT) with assisting the states in upgrading the quality of their prehospital emergency care. C) INCORRECT. Safe emergency transportation is only part of what modern EMS systems were developed for. D) INCORRECT. Modern EMS systems were designed to provide more than just trained medical personnel. 36) A written authorization for an EMS provider to perform a particular skill in a specific situation is a(n): 36) A) standard of care. B) standing order. C) on - line protocol. D) direct medical order. Answer: B Explanation: A) INCORRECT. Standard of care refers to the expected actions of an EMT as compared to a reasonable person with the same level of training and in the same situation. It is not related to the authorization of specific skills. B) CORRECT. A standing order is a policy or protocol issued by a Medical Director that authorizes EMTs and others to perform particular skills in certain situations. C) INCORRECT. Any "on - line" direction indicates a verbal order from a physician to an EMT, usually by phone or radio. D) INCORRECT. A direct medical order would generally come from a physician in a specific situation and is considered "on - line" direction. 14

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    37) Which of the following BEST describes the purpose of the modern emergency medical services (EMS) system? 37) A) To have trained personnel knowledgeable in all aspects of prehospital care B) To have trained personnel respond quickly and provide emergency care on the scene, during transport, and at the hospital C) To have trained personnel understand the limitations of their training and "do no harm," while providing prompt transport to the hospital D) To have trained personnel capable of assessing and caring for injured and ill patients on the scene Answer: B Explanation: A) INCORRECT. Although knowledge is an important aspect of an emergency care provider's job, the modern Emergency Medical Services (EMS) system was specifically developed to get trained personnel to patients as quickly as possible and to provide emergency care on the scene, en route to the hospital, and at the hospital until care is assumed by the hospital staff. B) CORRECT. The modern Emergency Medical Services (EMS) system has been developed to get trained personnel to patients as quickly as possible and to provide emergency care on the scene, en route to the hospital, and at the hospital until care is assumed by the hospital staff. C) INCORRECT. Although understanding limitations and doing "no harm" are important aspects of an emergency care provider's job, the modern Emergency Medical Services (EMS) system was developed to get trained personnel to patients as quickly as possible and to provide emergency care on the scene, en route to the hospital, and at the hospital until care is assumed by the hospital staff. D) INCORRECT. In addition to having trained personnel able to help patients on scene, the modern Emergency Medical Services (EMS) system also aims to provide that same assistance while en route to the hospital and at the hospital until hospital staff can take over care. 38) Who assumes the ultimate responsibility for patient care rendered by the EMT? 38) A) Director of quality assurance B) EMT C) Medical Director D) EMS supervisor Answer: C Explanation: A) INCORRECT. In every EMS service or agency, the Medical Director is ultimately responsible for the patient care provided by the EMTs. B) INCORRECT. Since every EMT operates under the license of the EMS service's Medical Director it is the Medical Director, not the EMT , who is ultimately responsible for the patient care. C) CORRECT. The Medical Director of an EMS agency or service is ultimately responsible for all patient care because the EMTs work under the Medical Director's license. D) INCORRECT. Although an EMS supervisor can be involved, the EMS service's Medical Director assumes ultimate responsibility for the care provided by an EMT. 15

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    39) Which of the following groups is credited with developing the earliest documented emergency medical service? 39) A) The Spanish B) The French C) The Mayans D) The Egyptians Answer: B Explanation: A) INCORRECT. The Spanish did not develop the first documented emergency medical service; the French did in the 1700s. B) CORRECT. The earliest documented emergency medical service was in 1790 when the French began transporting wounded soldiers from the scenes of battle to waiting physicians. C) INCORRECT. The earliest documented emergency medical service was in France in 1790, nearly a thousand years after the Mayan civilization disappeared. D) INCORRECT. Although known for progress in technical areas, the Egyptians were not responsible for the first documented emergency medical service. In 1790, the French first began transporting wounded soldiers away from battlefields and to waiting medical care. 40) Centralized coordination of emergency medical access, transportation, and care most refers to which of the following? 40) A) Resource management B) Central deployment C) Emergency preparedness plan D) Trauma system Answer: A Explanation: A) CORRECT. Resource management refers to the centralized coordination of an emergency response so that all victims have equal access to basic emergency care and are transported by certified personnel, in a licensed and equipped ambulance, to an appropriate facility. B) INCORRECT. The centralized coordination of emergency medical access, transportation, and care within an EMS system is not referred to as central deployment. C) INCORRECT. Emergency preparedness plans are usually developed to guide the actions of a specific group of people at the outset of an emergency, with the goal of protecting people and/or property. They generally will not address the specifics of medical care or transport. D) INCORRECT. A trauma system is an organized, coordinated effort between facilities and responders within a defined geographic area to deliver a full range of care to injured patients. It does not address the coordination of basic (non - trauma) emergency care or transportation. 41) Which of the following best describes training that supplements the EMT's original training and that is usually taken in regular intervals? 41) A) Recertification B) EMT training program C) Distance education D) Continuing education Answer: D Explanation: A) INCORRECT. Recertification refers to the renewal of an EMT certificate, not specifically to regular ongoing training. B) INCORRECT. An EMT training program is the initial certification course, not the supplemental training that follows it. C) INCORRECT. Distance education refers to the way training or courses are delivered, not specifically to the topic. D) CORRECT. Ongoing education that supplements an EMT's original training is called Continuing Education (CE). 16

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    Answer Key Testname: C1 1) A 2) D 3) D 4) D 5) A 6) B 7) B 8) A 9) D 10) C 11) B 12) D 13) A 14) C 15) A 16) B 17) C 18) B 19) C 20) A 21) C 22) B 23) B 24) B 25) A 26) B 27) D 28) D 29) C 30) A 31) A 32) A 33) A 34) C 35) B 36) B 37) B 38) C 39) B 40) A 41) D 17

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    Exam Name___________________________________ MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following does NOT occur during inspiration? 1) A) Chest cavity increases in size B) Intercostal muscles contract C) Diaphragm lowers D) Diaphragm relaxes Answer: D Explanation: A) INCORRECT. During inhalation, the ribs move upward and outward; the expanding size of the chest cavity then causes air to flow into the lungs. B) INCORRECT. During the process of inspiration, the intercostal muscles contract. C) INCORRECT. The diaphragm lowers during inspiration. D) CORRECT. The diaphragm does not relax during inspiration; it contracts to expand the size of the chest cavity. 2) Which of the following is the most proper dose of inhaled medication the EMT can assist the patient with administering? 2) A) One spray B) As needed until respiratory status improves C) The number of sprays directed by medical control D) Two sprays Answer: C Explanation: A) INCORRECT. Each patient situation is different, and one spray may not be adequate. B) INCORRECT. Sometimes the inhaled medication will not be effective, and continuing to administer it indefinitely is not proper patient care. C) CORRECT. EMTs should always follow medical direction (whether verbal or written in standing orders) when assisting patients with inhaled medication. D) INCORRECT. Two sprays may work with some patients but not with others. 3) In which of the following circumstances is medical direction necessary when assisting a patient with the use of a prescribed inhaler? 3) A) Patient has already overused the inhaler before your arrival. B) Medical control is not necessary since assistance with inhaled medications is in the EMT scope of practice. C) Medical control is necessary in all situations in which an EMT assists with a prescribed inhaler. D) The inhaler belongs to another family member, not the patient. Answer: C Explanation: A) INCORRECT. Patient use of the inhaler prior to EMS arrival does not negate the requirement for medical direction before assisting the patient with using it again. B) INCORRECT. Assisting a patient with a prescribed inhaler without medical direction is not within an EMT's scope of practice. C) CORRECT. EMTs will need to get permission from medical direction before helping any patient use an inhaler. This can be accomplished by phone/radio or by standing order, depending on local protocols. D) INCORRECT. An inhaler prescribed to someone other than the patient should definitely not be administered without specific medical direction. 1

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    4) Your patient is a 15 - year - old male with a history of multiple prior hospitalizations for asthma. Upon your arrival the patient responds only to painful stimuli and is making very weak respiratory effort. Which of the following should you do next? 4) A) Contact medical control. B) Assist the patient's ventilations with a bag - valve - mask device and supplemental oxygen. C) Assist the patient with his inhaler. D) Check the patient's oxygen saturation level. Answer: B Explanation: A) INCORRECT. There is no specific reason to contact medical control, and delaying care would be detrimental. B) CORRECT. This patient needs immediate ventilatory assistance with supplemental oxygen. C) INCORRECT. It would be ineffective to help an unresponsive, inadequately breathing patient with an inhaler. D) INCORRECT. Obtaining a pulse oximetry reading on this patient would not be a priority. 5) Your patient is a 24 - year - old woman with asthma who is struggling to breathe and is very agitated. She has cyanosis of her lips and nail beds, and is cool and clammy to the touch. When you attempt to assist her ventilations with a bag - valve - mask device, she becomes combative and repeatedly pushes the mask away from her face. Which of the following is the BEST option? 5) A) Use a nasal cannula to administer supplemental oxygen. B) Wait for the patient's level of consciousness to decrease so that she can no longer resist your attempts to ventilate. C) Have your partner restrain the patient's hands so you can ventilate her. D) Begin transport immediately and contact medical control for advice. Answer: D Explanation: A) INCORRECT. Although better than no supplemental oxygen, applying a nasal cannula to this patient is not the EMT's best option. B) INCORRECT. Allowing a patient to become unresponsive before providing care is dangerous and not appropriate care. C) INCORRECT. Restraining a patient to provide ventilations is never appropriate. D) CORRECT. In the rare circumstance when a patient with inadequate breathing is conscious enough to fight artificial ventilation, transport immediately and consult medical direction. 2

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    6) While assessing the airway of a pediatric patient, you will notice that it is different than that of an adult. Which of the following is one of those differences? 6) A) The chest wall is softer, making it easier for the chest to expand. B) The tongue is smaller, taking up less room in the mouth and allowing larger objects to occlude the airway. C) The cricoid cartilage is less developed, reducing the possibility that it can be completely occluded. D) The trachea is smaller, softer, and more flexible, allowing it to be more easily obstructed. Answer: D Explanation: A) INCORRECT. With the pediatric chest wall being softer and weaker than an adult's, chest expansion can be more difficult which is why children depend more on the diaphragm for breathing. B) INCORRECT. A child's tongue is proportionally larger than that of an adult. C) INCORRECT. The underdeveloped parts of a pediatric airway generally increase the chances of occlusion. D) CORRECT. A pediatric patient's trachea is softer and more flexible than that of an adult, making proper airway positioning critical; bending the pediatric trachea too much can result in collapse and will obstruct breathing. 7) What condition is when there is an infection in one or both lungs caused by bacteria, viruses, or fungi? 7) A) Pneumonia B) Pulmonary embolism C) Pulmonary edema D) Asthma Answer: A Explanation: A) CORRECT. Pneumonia is an infection of one or both lungs caused by bacteria, viruses, or fungi. B) INCORRECT. A pulmonary embolism is when a blood clot, air, or fat gets stuck in the blood vessels and blocks and artery in the lungs. C) INCORRECT. Pulmonary edema is when fluid accumulates in the lungs, preventing them from breathing adequately. D) INCORRECT. Asthma is a chronic disease that has episodic exacerbation or flares. During an asthma attack, the small bronchioles that lead to the air sacs of the lungs become narrowed because of contractions of the muscles that make up the airway. 8) While caring for a 3 - year - old child, you should be concerned if his respiratory rate exceeds ________ breaths per minute. 8) A) 16 B) 30 C) 20 D) 24 Answer: B Explanation: A) INCORRECT. A 3 - year - old child is breathing normally if the rate is above 16 per minute. B) CORRECT. If a 3 - year - old patient is breathing faster than 30 times per minute, there would be reason for concern. C) INCORRECT. It is normal for toddlers to breathe faster than 20 times per minute. D) INCORRECT. A 3 - year - old patient with a respiratory rate of 24 or even a little higher would not necessarily be reason for concern. 3

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    9) You are responding to a 54 - year - old female patient in respiratory distress. The patient is on home oxygen by nasal cannula at 1 lpm. The patient has diminished lung sounds bilaterally with wheezes. She appears malnourished and has a barrel chest. What condition do you suspect? 9) A) Congestive heart failure B) Asthma C) Chronic obstructive pulmonary disease D) Bronchitis Answer: C Explanation: A) INCORRECT. Congestive heart failure would have crackles (rales) or some form of wet lung sounds. B) INCORRECT. Asthma patients do not have barrel chests and are usually not on home oxygen. C) CORRECT. Home oxygen administration and barrel chests are the classic signs of emphysema, which is one disease in the COPD classification. Patients with exacerbation of COPD have lung sounds that are diminished and/or have wheezes. D) INCORRECT. Bronchitis is an acute infection that presents with green - or yellow - tinged phlegm and fever. 10) Which of the following is true concerning expiration? 10) A) The chest cavity increases in size. B) The intercostal muscles contract to force air out of the lungs. C) The diaphragm moves upward. D) The ribs move upward and outward. Answer: C Explanation: A) INCORRECT. Expiration occurs when the chest cavity gets smaller. B) INCORRECT. When the intercostal muscles contract, air is pulled into the lungs. C) CORRECT. The diaphragm contracts and moves downward during inspiration and upward during expiration. D) INCORRECT. The ribs move upward and outward during inspiration . 11) You are ventilating a 6 - year - old child and note that his heart rate has decreased from 70 to 54. Which of the following is NOT appropriate? 11) A) Check the flow of oxygen reaching the bag - valve - mask device. B) Increase the force of ventilations. C) Insert an oropharyngeal airway and continue ventilating. D) Notify medical control that the patient's condition has improved. Answer: D Explanation: A) INCORRECT. Since the response to ventilation is inadequate, it would be appropriate to reassess the equipment to see if something is not working correctly. B) INCORRECT. This patient is obviously not getting adequate respirations; increasing the force of ventilations may help. C) INCORRECT. Since the ventilations are not adequate, better airway management may improve the outcome. D) CORRECT. A decreasing heart rate while ventilating a pediatric patient is actually a deterioration of the patient's condition. 4

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    12) The EMTs should provide patients with viral respiratory infections: 12) A) antibiotics. B) a prescribed inhaler. C) a small - volume nebulizer. D) oxygen. Answer: D Explanation: A) INCORRECT. Because a viral respiratory infection is viral so antibiotics do not help and should not be given. In fact, giving this type of patient antibiotics could actually make things worse by promoting antibiotic resistance. B) INCORRECT. A prescribed inhaler is given to a patient with asthma, not a viral respiratory infection. C) INCORRECT. A small - volume nebulizer is given to a patient with asthma, not a viral respiratory infection. D) CORRECT. The EMT should administer oxygen to this patient and care for the patient as with any other patient with respiratory distress. 13) Which of the following sounds may be heard in lower respiratory obstruction? 13) A) Snoring B) Wheezing C) Crowing D) Stridor Answer: B Explanation: A) INCORRECT. Upper airway obstructions, usually due to the tongue or other tissue will cause snoring respirations. B) CORRECT. Wheezes are high - pitched sounds created by air moving through narrowed passages in the lower airway. C) INCORRECT. Crowing sounds are associated with upper airway obstructions. D) INCORRECT. Stridor is described as a harsh, high - pitched breath sound which is usually caused by an upper airway problem. 14) When should the EMT most likely expect to hear wheezes in a patient complaining of shortness of breath secondary to an asthma attack? 14) A) In between breaths B) While holding his breath C) While breathing in D) While breathing out Answer: D Explanation: A) INCORRECT. There is generally never a sound heard between breaths. B) INCORRECT. If there is no movement of air in the lower airway, no wheezes would be present. C) INCORRECT. When auscultating an asthma patient, wheezes are not commonly heard during inspiration. D) CORRECT. Asthma emergencies usually cause patients to struggle when exhaling, which is often accompanied by wheezing sounds. 5

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    15) You are called to the scene of a 45 - year - old nonsmoker male with a history of asthma in respiratory distress. You find him lying supine on the couch. The patient is lethargic but can answer all your questions appropriately. He is diaphoretic, and complains of being cold, coughing, and having difficulty breathing for the past 3 days. His vital signs are blood pressure of 110/70, heart rate of 116, respiratory rate of 24, oxygen saturation of 93%, and temperature of 100.6°F. You hear rhonchi in the left lobes and he is coughing up yellow - tinged sputum. What condition do you suspect? 15) A) Asthma B) Pneumonia C) COPD D) Silent myocardial infarction Answer: B Explanation: A) INCORRECT. Rhonchi lung sounds are not indicative of asthma. B) CORRECT. Pneumonia has rhonchi lung sounds that can be one - sided or bilateral with fever, and yellow - or green - tinged sputum. C) INCORRECT. Chronic bronchitis is a form of COPD with similar symptoms; however, the patient has no COPD history and he is not a smoker. The symptoms are also acute, beginning only 3 days ago versus a chronic etiology. D) INCORRECT. Myocardial infarction patients generally do not have fever or yellow - tinged phlegm. Abnormal lung sounds with heart failure from a myocardial infarction will usually be crackles (rales) that are audible on both sides. 16) A patient who has shallow, slow, irregular gasping breaths is said to have ________ respirations. 16) A) agonal B) Kussmaul's C) central neurogenic D) Cheyne - Stokes Answer: A Explanation: A) CORRECT. The shallow, slow, and irregular gasps that occur just before respiratory arrest are referred to as agonal respirations. B) INCORRECT. Kussmaul's respirations are related to conditions such as diabetic ketoacidosis (DKA) and present as deep and labored breaths. C) INCORRECT. Central neurogenic respirations are a type of hyperventilation related to reduced carbon dioxide levels. D) INCORRECT. Cheyne - Stokes respirations follow a repeating pattern of deep, fast breaths followed by slow, shallow breaths. 17) Which of the following respiratory rates should be cause for alarm in a 2 - month - old child? 17) A) 32 breaths/min B) 40 breaths/min C) 28 breaths/min D) 16 breaths/min Answer: D Explanation: A) INCORRECT. A respiratory rate of 32 would be in the normal range for a 2 - month - old patient. B) INCORRECT. Although it seems rapid, a respiratory rate of 40 in an infant patient would be considered normal. C) INCORRECT. Infants normally breathe faster than adults; 28 breaths per minute would not be abnormal. D) CORRECT. 16 breaths per minute would be too slow for a normal infant. 6

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    18) Which of the following BEST defines inadequate breathing? 18) A) Wheezing noises when breathing B) Breathing faster than normal C) Breathing that is insufficient to sustain life D) Breathing slower than normal Answer: C Explanation: A) INCORRECT. The best definition of inadequate breathing is not related to the breath sounds. B) INCORRECT. A patient that is breathing faster than a normal rate is not necessarily breathing inadequately. C) CORRECT. Inadequate breathing is best defined as breathing that is insufficient to sustain life. D) INCORRECT. The speed of a patient's breathing relates to the adequacy of respiration, but it does not define it. 19) Which of the following is a benefit of using small - volume nebulizers for the treatment of respiratory problems? 19) A) The patient can easily carry this equipment in a purse or pocket. B) Nebulized medications have fewer side effects than aerosolized medications from an inhaler. C) They will work even when the patient's ventilations are inadequate. D) They allow greater exposure of the patient's lungs to the medication. Answer: D Explanation: A) INCORRECT. Small - volume nebulizers are not as conveniently carried as inhalers; they require the assembly of several pieces, liquid medication, and an oxygen source. B) INCORRECT. The medication is essentially the same and will produce the same side effects. C) INCORRECT. Nebulizers still depend on the patient being able to effectively inhale the medication. D) CORRECT. Nebulizers produce a constant flow of medication that the patient can breathe over the span of several minutes, introducing more medication into the patient's lungs. 20) Your patient is a 60 - year - old female with a sudden onset of severe difficulty breathing. She has no prior history of respiratory problems. Which of the following should be done before applying oxygen by nonrebreather mask? 20) A) Listen to the patient's breath sounds. B) Check the patient's oxygen saturation level. C) Obtain a history of the present illness. D) None of the above Answer: D Explanation: A) INCORRECT. Withholding oxygen to listen to this patient's breath sounds would serve no purpose. B) INCORRECT. There would be no benefit to the patient or the EMT by obtaining a pulse oximeter reading before providing oxygen. C) INCORRECT. Obtaining the patient's history before providing oxygen would be poor patient care. D) CORRECT. None of the options provided would be more important than providing high - concentration oxygen to this patient. 7

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    21) What is the primary effect on the body when an EMT assists a patient with a prescribed inhaler if the patient is short of breath? 21) A) Increased contraction of the diaphragm B) Relaxation of the bronchioles C) Dissolved mucus in the airways D) Decreased heart rate Answer: B Explanation: A) INCORRECT. A prescribed inhaler will not directly cause more contractions of the patient's diaphragm. B) CORRECT. The inhalers contain a drug that dilates, or enlarges, the air passages, making breathing easier. C) INCORRECT. Inhalers do not dissolve mucus. D) INCORRECT. The primary effect of a prescribed inhaler is not a decrease in heart rate, although it may be a secondary effect. 22) What is NOT one of the symptoms of a pulmonary embolus? 22) A) sudden onset of sharp chest pain B) anxiety C) pain and swelling in one or both legs D) sudden calmness Answer: D Explanation: A) I NCORRECT. A typical patient experiencing signs and symptoms of a pulmonary embolus will have a sudden onset of sharp chest pain. B) INCORRECT. A typical patient experiencing signs and symptoms of a pulmonary embolus will be anxious. C) INCORRECT. A typical patient experiencing signs and symptoms of a pulmonary embolus will have pain and swelling in one or both legs. D) CORRECT. While the signs and symptoms of a patient experiencing a pulmonary embolus are extremely varied, the patient is not likely to be calm but instead experiencing anxiety. 23) Which of the following is proper when assisting a patient with the use of a prescribed inhaler? 23) A) Do not use the patient's inhaler, because you do not know how the medication has been stored. B) Make sure that the inhaler has been kept in the refrigerator. C) Have the patient inhale deeply before delivering the spray. D) Have the patient hold the inhaled medication in his lungs as long as possible. Answer: D Explanation: A) INCORRECT. If the inhaler has been prescribed to the patient, appears to be in good working order, and the patient is having difficulty breathing, there is no good reason to withhold it. B) INCORRECT. Inhalers should be stored and used at room temperature. C) INCORRECT. The patient should be instructed to exhale fully just before using the inhaler. D) CORRECT. After the patient inhales, make sure he holds his breath as long as possible so the medication can be absorbed. 8

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    24) Which of the following patients with difficulty breathing should NOT receive supplemental oxygen? 24) A) An infant whose eyes may be damaged by excessive oxygen administration B) A patient whose oxygen saturation level is 100% on room air C) A patient with a chronic lung disease who may have a hypoxic drive D) None of these patients should have oxygen withheld. Answer: D Explanation: A) INCORRECT. Oxygen administration in the relatively brief time that an EMT will be caring for a patient will not cause ocular damage to an infant. B) INCORRECT. If the patient is having difficulty breathing, oxygen should be applied regardless of the pulse oximeter reading. C) INCORRECT. A COPD patient with a hypoxic drive will generally only have trouble with supplemental oxygen over an extended time period, such as during a hospital stay. In the prehospital setting, standard oxygen therapy should never be withheld from COPD patients. D) CORRECT. None of the options provided describe a situation where supplemental oxygen would be contraindicated. 25) Which of the following is a sign of adequate artificial ventilations in a pediatric patient? 25) A) Pulse rate slows down. B) Pulse rate increases. C) You notice cyanosis developing around the mouth. D) The breath is delivered easily. Answer: B Explanation: A) INCORRECT. A slowing pulse rate is a good sign when ventilating an adult patient, but not a pediatric one. B) CORRECT. Pediatric patients often quickly develop bradycardia with respiratory failure, so adequate ventilations will actually increase the pulse rate. C) INCORRECT. The development of cyanosis is a definite indicator that ventilations are not adequate. D) INCORRECT. The mechanical ease of ventilations is unrelated to the adequacy of them. 26) Your patient is a 30 - year - old female who may have overdosed on antidepressant medications. On your arrival, she is lying supine on her bed with her head on a pillow. She is unresponsive to painful stimuli and is snoring. She appears to be pale and her skin is cool and clammy. What should you do first? 26) A) Apply oxygen by nonrebreather mask. B) Check the patient's pulse. C) Insert an oropharyngeal airway. D) Remove the patient's pillow. Answer: D Explanation: A) INCORRECT. Although the patient may benefit from supplemental oxygen, providing it would not be the first priority in this situation. B) INCORRECT. Although the patient is unresponsive, it is apparent that she still has circulation; it would serve no purpose to check her pulse as the first step. C) INCORRECT. This unresponsive patient does require airway management, but inserting an OPA would not be the first step. D) CORRECT. The patient's snoring respirations indicate an occluded airway. Removing the pillow and opening her airway using a head - tilt, chin - lift would be the first priorities. 9

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    27) Today patients with cystic fibrosis are surviving to: 27) A) toddler years. B) infancy. C) older adulthood. D) adulthood. Answer: D Explanation: A) INCORRECT. Most cystic fibrosis patients are young, but they can typically live beyond being a toddler. B) INCORRECT. Most cystic fibrosis patients are young, but they can typically live beyond being an infant. C) INCORRECT. While patients with cystic fibrosis, on average they are not living to be an older adult. D) CORRECT. Although most patients with cystic fibrosis are children, many of these patients are now surviving to adulthood, something that was almost unheard of a generation ago. 28) You are first on the scene of a 61 - year - old female in need of assistance with her respirations. You have a pocket mask with supplemental oxygen. How can you determine that your artificial ventilation is effective? 28) A) Patient's pulse returns to normal. B) You assure oxygen is being delivered at 15 liters per minute. C) You are assisting respirations at 10 breaths per minute. D) Patient's skin color remains the same. Answer: A Explanation: A) CORRECT. When artificial ventilation is performed properly, the patient's heart rate will return to normal. B) INCORRECT. The efficacy of assisted ventilations is not determined by the oxygen flow rate. C) INCORRECT. When providing an adult patient with artificial ventilation, the EMT should maintain a rate of 12 breaths per minute. D) INCORRECT. If a cyanotic patient's skin color does not improve, it indicates inadequate ventilation. 29) Your patient is a 6 - year - old male who appears very anxious, is using increased effort during expiration, and has a fever. He is wheezing and has a respiratory rate of 34. The patient's skin is very warm and dry. He does not have any cyanosis. The child is drooling and his mother states that he complained of a sore throat and pain on swallowing earlier in the afternoon. Which of the following conditions is most likely causing the patient's distress? 29) A) COPD B) Epiglottitis C) Pneumonia D) Cystic fibrosis Answer: B Explanation: A) INCORRECT. COPD will not generally develop in pediatric patients and the condition described in the scenario is acute, not chronic. B) CORRECT. This patient's presentation (especially the drooling) should make the responding EMT suspect epiglottitis. C) INCORRECT. Other than respiratory difficulty, this patient is exhibiting none of the signs and symptoms of pneumonia. D) INCORRECT. This patient is not displaying the signs and symptoms of cystic fibrosis. 10

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    30) A ________ device works by blowing oxygen or air continuously at a low pressure to prevent a patient's alveoli from collapsing. 30) A) COPD (Chronic Obstructive Pulmonary Disease) B) CPAP (Continuous Positive Airway Pressure) C) Nonrebreather D) FROPVD (Flow - Restricted, Oxygen Powered Ventilation Device) Answer: B Explanation: A) INCORRECT. COPD is a medical condition, not a device. B) CORRECT. A CPAP device works by blowing oxygen or air continuously at a low pressure into the airway, which prevents the alveoli from collapsing at the end of exhalation, and it can also push fluid out of the alveoli back into the capillaries that surround them. C) INCORRECT. A nonrebreather mask does deliver oxygen, but it does not create enough pressure to affect the alveoli. D) INCORRECT. A Flow - Restricted, Oxygen - Powered Ventilation Device (FROPVD) does force oxygen into the patient's lungs when triggered, but not continuously. 31) Which of the following is the primary cause of COPD? 31) A) Infection B) Congenital diseases C) Air pollution D) Cigarette smoking Answer: D Explanation: A) INCORRECT. Repeated respiratory infections can sometimes lead to COPD, but this is not common. B) INCORRECT. Congenital diseases will not commonly lead to COPD. C) INCORRECT. Although extended exposure to air pollution can cause COPD, it is not the primary cause. D) CORRECT. Cigarette smoking causes the overwhelming majority of COPD cases. 32) You are on the scene of a 3 - year - old patient who is in respiratory distress. The mother states that the patient has been making a barking cough for the past 24 hours. The child is very scared and upset. He is crying inconsolably. The patient has tachypnea, but his vital signs are normal otherwise. He is leaning forward in the tripod position and is drooling profusely. What condition do you suspect? 32) A) Strep throat B) Croup C) Epiglottitis D) Child abuse Answer: C Explanation: A) INCORRECT. Strep throat usually presents as a sore throat and rarely presents with a high - pitched stridorous cough or with profound drooling. B) INCORRECT. Although croup is known for a high - pitched stridorous cough, profound drooling is not commonly present. C) CORRECT. Profound drooling is the hallmark of epiglottitis. D) INCORRECT. The patient is febrile, which indicates an infection. This, along with no clinical signs of abuse, indicates that child abuse is highly unlikely. 11

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    33) When the lung collapses without injury or any other cause, it is called which of the following? 33) A) Spontaneous pertussis B) Spontaneous pulmonary embolism C) Spontaneous pneumothorax D) COPD Answer: C Explanation: A) INCORRECT. Pertussis, or whooping cough, is unrelated to a spontaneous lung collapse. B) INCORRECT. When something that is not blood becomes lodged in a pulmonary blood vessel, it is called a pulmonary embolism; lung collapse is unrelated. C) CORRECT. When a lung collapses without injury or any other obvious cause, it is called a spontaneous pneumothorax. D) INCORRECT. Chronic obstructive pulmonary disease (COPD) does not refer a lung collapse. 34) You are on the scene of a 5 - year - old patient who is in respiratory distress. The mother states that the patient has been making a "seal bark" - sounding cough for the past 24 hours. The child is very scared. The patient has stable vital signs. He is leaning forward in the tripod position and is drooling profusely. After performing your primary assessment, what is your best treatment option? 34) A) Provide oxygen by BVM. B) Use a tongue depressor to examine the patient's mouth to determine whether the patient has strep throat or croup. C) Provide high - concentration oxygen and have the parent hold it to the patient's face. D) Calm the child as much as possible and provide oxygen by blow - by. Answer: D Explanation: A) INCORRECT. Positive pressure ventilations are not indicated in this situation, and attempting it could cause additional swelling. B) INCORRECT. Any use of a tongue depressor is contraindicated as it could increase swelling to the point the airway occludes completely. C) INCORRECT. Holding an oxygen mask to a child's face can greatly upset a child and make the swelling worse. D) CORRECT. A patient with epiglottitis should be kept as calm as possible to prevent additional swelling of the epiglottis; provide supplemental oxygen by blow - by if possible. 35) When ventilating a child with inadequate respirations, which of the following is the maximum rate at which artificial respirations should be delivered? 35) A) 12 per minute B) 24 per minute C) 20 per minute D) 15 per minute Answer: C Explanation: A) INCORRECT. 12 ventilations per minute is not the maximum rate for a pediatric patient. B) INCORRECT. A ventilation rate of 24 per minute is actually higher than the maximum rate for a child. C) CORRECT. The adequate rate for artificial ventilation is 12 breaths per minute for adults and 20 per minute for infants and children. Never hyperventilate a patient without specific medical direction. D) INCORRECT. Ventilations can be delivered to a child at a faster rate than 15 per minute. 12

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    36) You are on the scene of a person down. You arrive at a college dormitory and find a 21 - year - old patient lying supine on the floor, unresponsive. The patient is "guppy" breathing at 5 times a minute, has a strong radial pulse at 110 beats per minute, and has vomited on himself. Friends state they went out to dinner and a party. They returned to change clothes for another party and he never came out of his room. Your partner suctions the patient, inserts an oropharyngeal airway, and ventilates the patient with a bag - valve mask with high - concentration oxygen. You listen to lung sounds and there are coarse rhonchi bilaterally. What condition do you suspect? 36) A) Severe meningitis B) Status asthmaticus C) Aspiration D) Overdose Answer: C Explanation: A) INCORRECT. Rhonchi would not be auscultated in a patient with meningitis. B) INCORRECT. Status asthmaticus does not present with rhonchi. C) CORRECT. Unresponsive supine patients often aspirate emesis because they can no longer protect their airway. Aspirated emesis presents as rhonchi upon auscultation. D) INCORRECT. Overdose is a possibility, but there is no information in the question to confirm or deny the diagnosis. 37) Which of the following respiratory rates is considered an abnormal respiratory rate for an adult? 37) A) 12 breaths/min B) 8 breaths/min C) 16 breaths/min D) 20 breaths/min Answer: B Explanation: A) INCORRECT. A respiratory rate of 12 would be considered normal for most adults. B) CORRECT. An adult patient breathing 8 times per minute is most likely not breathing adequately. C) INCORRECT. 16 breaths per minute would not be abnormal for an average adult. D) INCORRECT. 20 breaths per minute is at the higher end of what rate is considered normal for an adult patient. 38) When you hear wheezes while auscultating your patient's breath sounds, which of the following is most likely the cause? 38) A) There is mucus in the air passages. B) The lower air passages in the lungs are narrowed. C) There is an upper airway obstruction. D) There is fluid in the lungs. Answer: B Explanation: A) INCORRECT. Mucus in the air passages will cause rhonchi or crackles rather than wheezing. B) CORRECT. Wheezes are high - pitched sounds created by air moving through narrowed air passages in the lungs. C) INCORRECT. An upper airway obstruction will not commonly result in wheezes when auscultating lung sounds. D) INCORRECT. The EMT will auscultate either bubbling or low snoring sounds when fluid is in the lungs. 13

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